Patella re-alignment in children with a modified Grammont technique.

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Sports Medicine

Background:

• Surgical treatment for recurrent patella dislocation in skeletally immature patients is challenging due to the risk of growth disturbances from bony procedures.
• The modified Grammont technique offers a potential solution by addressing patella tendon alignment without directly impacting growth plates.

Purpose of the Study:

• To evaluate the long-term functional and radiographic outcomes of the modified Grammont procedure in skeletally immature patients with recurrent patella dislocation.
• To assess the safety and efficacy of this technique concerning growth disturbances and patient function.

Main Methods:

• A retrospective study of 65 skeletally immature knees (49 children) treated between 1999 and 2004 with the modified Grammont procedure.
• The procedure involved open lateral release and medialization of the patella tendon insertion below the tibial growth plate.
• Long-term evaluation (mean 8 years) included clinical examination, Lysholm and Tegner scores, and knee radiographs.

Main Results:

• Good functional outcomes were reported, with a mean Lysholm score of 82 postoperatively.
• No growth disturbances were observed in any of the patients.
• Eight knees experienced a single dislocation within 3 months; 3 knees with high-grade trochlear dysplasia had late re-dislocations. Mild osteoarthritis was noted in 6 knees.

Conclusions:

• The modified Grammont technique effectively restores distal patella tendon alignment in skeletally immature patients, leading to good long-term functional results without growth disturbances.
• While generally safe, patients with significant trochlear dysplasia remain at higher risk for recurrent patella dislocations.
• This technique represents a viable surgical option for pediatric recurrent patella dislocation, with careful patient selection being crucial.