Related Experiment Video
Updated: May 5, 2026
Evaluation of Stem Cell Therapies in a Bilateral Patellar Tendon Injury Model in Rats
Published on: March 30, 2018
A Modified 4-in-1 Stanisavljevic Procedure for Treating Obligatory or Congenital Patellar Dislocations in Children: A
Roy Gigi1,2, Addy S Brandstetter1,2, Barry Danino1,2
1Department of Pediatric Orthopedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
This study presents a modified 4-in-1 surgical technique for pediatric patellar dislocations, showing improved stability and function. The procedure offers a viable solution for complex cases, enhancing patients
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Knee Joint Disorders
Background:
- Patellar instability and dislocation in children present significant clinical and surgical challenges.
- Congenital and obligatory patellar dislocations often lead to deformities and functional impairments, with conservative treatments frequently being inadequate.
Purpose of the Study:
- To describe and evaluate a modified 4-in-1 surgical technique for treating congenital or obligatory patellar dislocations in pediatric patients.
- To assess the outcomes of this technique in terms of patellar stability, range of motion, and quality of life.
Main Methods:
- A modified 4-in-1 technique involving extensive subperiosteal quadriceps realignment, distal realignment (Roux-Goldthwait or tibial tuberosity transfer), and optional medial plication was employed.
- The technique follows Stanisavljevic's principles, focusing on subperiosteal quadriceps mobilization to minimize muscle damage and complications.
Main Results:
- Twenty-four pediatric patients (35 knees) with congenital or obligatory patellar dislocations were treated between 2002 and 2021.
- A mean follow-up of 8.2 years showed satisfactory improvements in patellar stability, range of motion, and quality of life, with an average pediatric International Knee Documentation Committee (pedi-IKDC) score of 78.45.
- Nine patients were able to return to sports activities.
Conclusions:
- The modified 4-in-1 Stanisavljevic technique yields favorable outcomes for pediatric patients with congenital or obligatory patellar dislocation.
- Further research is needed to fully understand the benefits of this procedure in children with complex etiological factors for patellar dislocation.
Introduction:
Patellar instability and dislocation pose complex clinical and surgical challenges, especially in children. Congenital (fixed) and obligatory (habitual) dislocations present significant anatomical and etiological complexity, frequently leading to deformities and functional impairments, which can range from walking difficulties to sports limitations. Conservative treatment is often inadequate.
Technique:
We describe a surgical technique for treating congenital or obligatory patellar dislocations in patients with various underlying diagnoses-including Down syndrome, nail-patella syndrome, and skeletal dysplasia-that involves extensive subperiosteal quadriceps realignment, distal realignment (Roux-Goldthwait or tibial tuberosity transfer), and optional medial plication. This modified 4-in-1 technique follows the principles described in 1976 by Stanisavljevic, which involves subperiosteal quadriceps mobilization, thus minimizing muscle damage, bleeding, and postoperative muscular adherences.
Results:
In 24 patients treated at our institution between 2002 and 2021 (35 knees; age range = 5.5-16.8 years; 13 girls, 11 boys), with a mean follow-up of 8.2 years (2.4-20 years), we achieved satisfactory improvements in patellar stability, range of motion, and quality of life with a modified 4-in-1 Stanisavljevic technique. A total of 9 patients (7 with obligatory dislocations and 2 with congenital dislocations) could engage in recreational or competitive sports. The average postoperative pediatric International Knee Documentation Committee (pedi-IKDC) score was 78.45 ± 22.3 (range = 0-100); a patient with DiGeorge syndrome and 1 with multiple epiphyseal dysplasia had scores of 35 and 48, respectively.
Discussion:
We found at our institution that a modified 4-in-1 Stanisavljevic technique produced favorable outcomes in patellar stability, range of motion, and quality of life in pediatric patients with congenital or obligatory patellar dislocation. More study is warranted to determine the procedure's overall benefits for children with obligatory or congenital dislocations of complex etiology.
