The semitendinosus tenodesis for recurrent dislocation of the patella in adolescents

Summary

Objectives

Correction of recurrent dislocation of the patella in children using a semitendinosus tenodesis and a double breasting of the medial retinaculum.

Indications

Recurrent lateral patellar sub- or dislocation in skeletally immature patient.

Patella alta with recurrent subluxation of the patella.

Patella dislocation in the presence of generalized ligamentous laxity.

Contraindications

Degenerative changes of the patellofemoral joint.

Congenital dislocation of the patella.

Surgical Technique

First incision at the posterior aspect of the thigh: division of the semitendinosus at its musculotendinous junction. Its muscle belly is sutured to the semimembranosus. Second incision over the pes anserinus: the tendon is delivered through this wound. Third incision over middle of the patella: division of the lateral patellar retinaculum. Passing of the semitendinosus tendon through a drill hole in the patella from mediodistal to proximolateral and fixation at the proximal pole of the patella. Double breasting of the medial patellar retinaculum.

Results

Between 1990 and 1997, 29 children (5 boys, 24 girls) were operated for a recurrent patellar dislocation. Average age at surgery: 14 years and 3 months (7 years and 8 months to 17 years and 10 months). Preoperatively, pain was present in 19 out of 34 knees, ligamentous laxity in 13, a positive apprehension sign in 12, and a patellar hypermobility in 11. Average length of follow-up: 3 years and 2 months (1 year to 7 years and 2 months). 27 out of 34 knees were asymptomatic and the children returned to normal activities. Patellofemoral pain persisted in 7 children. A medial patellar subluxation occurred in one child. A medial release led to a good result.