Results of operative 4-in-1 patella realignment in children with recurrent patella instability

Recurrent patellar instability is a cause of knee dysfunction, limitation and pain for children. If nonoperative treatment fails to stabilise the patella, operative realignment and stabilisation have been advocated. Operative techniques in the paediatric population must preserve physeal growth while ensuring stability. We aimed to determine the outcome of children and adolescents who underwent a 4-in-1 patellar realignment (lateral release, medial reefing, Insall tube realignment and Roux-Goldthwaite patella ligament transfer).

Consecutive skeletally immature patients operated in our institution were included in the study. A total of 16 operated knees in 12 patients were recruited. All patients underwent the same procedure after attempting a minimum period of 6 months of non-operative treatment with unsatisfactory results. The main outcome measured was recurrent dislocations. Functional outcomes were assessed using the Kujala score and the Paediatric form of the International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC).

Patients were followed up for a minimum of 3 years. None of the patients sustained further patella dislocations following the operation. In 3 cases, minor patellar maltracking was noted post-operatively but all 3 remained asymptomatic. Three patients had a small area of numbness lateral to the operative incision, which coincided with hypertrophic scarring. There was one case of superficial wound infection. The mean Kujala score was 83.4 ± 11.47 and the mean Pedi-IKDC was 79.5 ± 12.56 at the latest follow-up (minimum of 36 months).

The 4-in-1 patellar realignment is a good procedure in paediatric and adolescent patients with recurrent patella instability. Satisfactory results were observed with a minimal complication and redislocation rate in our series.