Reconstructing stability: Surgical management of habitual patellar dislocation in children using a noval modified 4-in-1 technique.

Abstract

To study clinical outcomes of the "4-in-1" surgical technique in pediatric cases of atraumatic habitual patellar dislocation. A prospective case series including seven patients with atraumatic habitual patellar dislocation were studied at a tertiary care center. After formal Orthopaedic examination and imaging, all patients underwent a "4-in-1" surgical procedure. Postoperatively, an AK POP slab with the knee in 30° of flexion was applied until suture removal at two weeks. Rehabilitation was started after the slab removal, and swimming was encouraged after eight weeks. Seven patients (aged 4-9 years) with patellar instability were analyzed in this study. Four had right knee involvement, and three had left knee involvement. The study revealed that the patients' mean Kujala score improved from 55.86 to 92.87 following the surgery, indicating good positive outcomes. The patients reported a satisfactory functional recovery at six months post-op and could return to playing activities at 12 months post-op. No complications were reported in any of the cases, except for one case of wound dehiscence after the surgery, which was treated with local wound care and secondary suturing. Our study has demonstrated that using this noval 4-in-1 surgical technique for habitual patellar dislocation in children with open physis avoids bony procedures and combines soft-tissue procedures, and is effective in preventing further patellar dislocation in patients with habitual patellar dislocation. It is simple, cheap, and does not require any image guidance. However, careful surgical and post-surgical rehabilitation techniques have to be followed to prevent post-op complications.