Skip to main content


Log in

High failure rate 10.8 years after vastus medialis transfer and lateral release (Green’s quadricepsplasty) for recurrent dislocation of the patella

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



In adolescent patients with recurrent patellar dislocation, the Green’s quadricepsplasty stabilizes the patella in a combination of a lateral release, a transfer of the medial head of the quadriceps onto the lateral part of the patella and an imbrication of the medial patellar retinaculum and joint capsule. This study aimed to evaluate the long-term performance, considering re-dislocations and functional outcomes. We hypothesized a high failure rate in the long term.


In this single surgeon and single center study 26 knees in 23 patients (mean age 14.2 years; 4–22 years, 18 females) with recurrent patellofemoral dislocation underwent a vastus medialis transfer, medial reefing and lateral release as it was described by Green in 1965 with a mean follow-up 10.8 years (6–24 years). Clinical assessment was carried out with an IKDC-score (international knee documentation committee) and a self-assessment for each knee separately. The radiologic evaluation included measurement of the patella height, the grade of trochlear dysplasia and the sulcus angle.


In 12 of 26 cases (46.2%) the patella did not re-dislocate after vastus medialis transfer and lateral release. In 11 of 26 cases (42.3%), the patients described the function of their knees as normal or nearly normal according to IKDC after the surgical treatment without any re-dislocation. In 14 of 26 cases (53.8%), the patella re-dislocated. 7 of these 14 cases underwent a revision operation. Re-dislocations occurred after a mean interval of 21 months after the index procedure. In only 2 of 26 cases (7.7%) the patients returned to sports.


Green’s procedure to stabilize patellofemoral instabilities results in a high failure rate on the long-term and low subjective assessments. We do not recommend performing vastus medialis transfer, medial imbrication and lateral release as a standalone technique.

Level of evidence


This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Blanke F, Watermann K, Haenle M, Feitenhansl A, Camathias C, Vogt S (2019) Isolated medial patellofemoral ligament reconstruction can be an effective procedure in patellofemoral instability with risk factors. J Knee Surg.

    Article  PubMed  Google Scholar 

  2. Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66

    Article  Google Scholar 

  3. Camathias C, Rutz E, Gotze M, Brunner R, Vavken P, Gaston MS (2014) Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability. Arch Orthop Trauma Surg 134:473–478

    Article  Google Scholar 

  4. Camathias C, Speth BM, Rutz E, Schlemmer T, Papp K, Vavken P et al (2018) Solitary trochleoplasty for treatment of recurrent patellar dislocation. JBJS Essent Surg Tech 8:e11

    Article  Google Scholar 

  5. Camathias C, Studer K, Kiapour A, Rutz E, Vavken P (2016) Trochleoplasty as a solitary treatment for recurrent patellar dislocation results in good clinical outcome in adolescents. Am J Sports Med 44:2855–2863

    Article  Google Scholar 

  6. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325

    CAS  PubMed  Google Scholar 

  7. Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA (2006) Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc 14:273–277

    Article  CAS  Google Scholar 

  8. Colvin AC, West RV (2008) Patellar instability. J Bone Jt Surg Am 90:2751–2762

    Article  Google Scholar 

  9. Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76:45–54

    CAS  PubMed  Google Scholar 

  10. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  Google Scholar 

  11. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65

    Article  CAS  Google Scholar 

  12. Dickschas J, Ferner F, Lutter C, Gelse K, Harrer J, Strecker W (2018) Patellofemoral dysbalance and genua valga: outcome after femoral varisation osteotomies. Arch Orthop Trauma Surg 138:19–25

    Article  Google Scholar 

  13. Dickschas J, Tassika A, Lutter C, Harrer J, Strecker W (2017) Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg 137:179–185

    Article  Google Scholar 

  14. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  Google Scholar 

  15. Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ (2016) Computational analysis of factors contributing to patellar dislocation. J Orthop Res 34:444–453

    Article  Google Scholar 

  16. Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497

    Article  Google Scholar 

  17. Frosch S, Balcarek P, Walde TA, Schuttrumpf JP, Wachowski MM, Ferleman KG et al (2011) The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 149:630–645

    Article  CAS  Google Scholar 

  18. Green WT (1965) Recurrent dislocation of the patella: its surgical correction in the growing child. J Bone Jt Surg Am 47:1670–1675

    Google Scholar 

  19. Hefti F (2014) Kinderorthopädie in der Praxis, 3rd edn. Springer, Berlin

    Book  Google Scholar 

  20. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  CAS  Google Scholar 

  21. Herring JA (2013) Tachdjian's pediatric orthopaedics e-book: from the Texas Scottish Rite hospital for children, 5th edn. Elsevier Health Sciences, Amsterdam

    Google Scholar 

  22. Hohne S, Gerlach K, Irlenbusch L, Schulz M, Kunze C, Finke R (2017) Patella dislocation in children and adolescents. Z Orthop Unfall 155:169–176

    Article  Google Scholar 

  23. Kocon H, Kabacyj M, Zgoda M (2012) The results of the operative treatment of patellar instability in children with Down's syndrome. J Pediatr Orthop B 21:407–410

    Article  Google Scholar 

  24. Kohlitz T, Scheffler S, Jung T, Hoburg A, Vollnberg B, Wiener E et al (2013) Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 23:1067–1074

    Article  Google Scholar 

  25. Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M (2014) Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 42:1661–1668

    Article  Google Scholar 

  26. Madigan R, Wissinger HA, Donaldson WF (1975) Preliminary experience with a method of quadricepsplasty in recurrent subluxation of the patella. J Bone Jt Surg Am 57:600–607

    Article  CAS  Google Scholar 

  27. Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Jt Surg Am 56:1391–1396

    Article  CAS  Google Scholar 

  28. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Jt Surg Am 90:463–470

    Article  Google Scholar 

  29. Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12

    Article  Google Scholar 

  30. Panni AS, Cerciello S, Vasso M (2013) Patellofemoral instability: surgical treatment of soft tissues. Joints 1:34–39

    PubMed  PubMed Central  Google Scholar 

  31. Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36:2447–2456

    Article  Google Scholar 

  32. Rouanet T, Gougeon F, Fayard JM, Remy F, Migaud H, Pasquier G (2015) Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res 101:443–447

    Article  CAS  Google Scholar 

  33. Sanders TL, Pareek A, Hewett TE, Stuart MJ, Dahm DL, Krych AJ (2017) High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc.

    Article  PubMed  Google Scholar 

  34. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923

    Article  Google Scholar 

  35. Smith TO, Song F, Donell ST, Hing CB (2011) Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:988–998

    Article  Google Scholar 

  36. Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101

    Article  Google Scholar 

  37. Tachdjian MO (1972) Pediatric orthopaedics, vol 1. W.B.Saunders, Philadelphia

    Google Scholar 

  38. Vavken P, Wimmer MD, Camathias C, Quidde J, Valderrabano V, Pagenstert G (2013) Treating patella instability in skeletally immature patients. Arthroscopy 29:1410–1422

    Article  Google Scholar 

  39. von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Jt Surg Br 88:1331–1335

    Article  Google Scholar 

  40. Weeks KD 3rd, Fabricant PD, Ladenhauf HN, Green DW (2012) Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc 20:194–202

    PubMed  Google Scholar 

  41. Zhao J, Huangfu X, He Y, Liu W (2012) Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med 40:123–132

    Article  Google Scholar 

Download references


This manuscript serves as doctoral thesis for the first author.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Alexander Vacariu.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vacariu, A., Studer, K., Rutz, E. et al. High failure rate 10.8 years after vastus medialis transfer and lateral release (Green’s quadricepsplasty) for recurrent dislocation of the patella. Arch Orthop Trauma Surg 140, 1349–1357 (2020).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: