Medial Patellar Retinaculum Cable Transfer With Anchoring Suture Reinforcement and Medial Tightening to Correct Patellar Dislocation in Skeletally Immature Patients.

Abstract

Surgical treatment of patellar dislocation poses a challenge in skeletally immature patients. The traditional approach of lateral release and medial imbrication carries a high probability of recurrence. Medial patellofemoral ligament reconstruction recently has become a popular procedure for patellofemoral instability, but its broad application in immature skeletal systems is limited by the risk of injury to epiphyseal plate. Herein, we describe an alternative surgical strategy whereby medial patellar retinaculum cable transfer is done in conjunction with anchoring suture reinforcement and medial tightening. We first harvest the longitudinal retinaculum cable situated along medial patella, dissecting the distal end and leaving the proximal attachment to quadriceps tendon insertion intact. The free end of medial patellar retinaculum cable is then transferred to medial femoral condyle (distal to growth plate) through a soft-tissue tunnel (superficial to capsule) and fixed by absorbable suture anchor. The latter allows suture reinforcement of medial patella via bone tunnels. Finally, the vastus medialis oblique muscle and remaining medial patellar retinaculum are fastened through bone tunnels onto patella. This technique is simple and reproducible, avoiding the risk of growth plate injury.