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4in1 Procedure in Treating Congenital Dislocation of Patella in Children
Meng-Jie Chen1, Yi-Chen Wang1, Qi-Chao Ma1
1Department of Orthopedics, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
The 4in1 procedure effectively treats congenital dislocation of the patella (CDP), significantly improving knee function and patellar stability. This surgical approach offers a promising solution for this rare lower limb disorder.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- Congenital dislocation of the patella (CDP) is a rare condition requiring surgical intervention.
- The 4in1 procedure combines lateral release, quadriceps correction, Roux-Goldthwait procedure, and MPFL reconstruction.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the 4in1 procedure for treating congenital dislocation of the patella.
- Assess the impact of the 4in1 procedure on patellar stability and knee function in CDP patients.
Main Methods:
- Retrospective collection of 10 CDP patients (14 patellae) from two centers (2013-2024).
- Preoperative and postoperative bilateral X-ray, CT, and MRI evaluation.
- Assessment of knee motion and quadriceps exercises post-surgery.
- Kujala Score used for functional outcome measurement before and after operation.
Main Results:
- The 4in1 procedure was performed on 10 patients (14 patellae) with a mean age of 8.36 years.
- Postoperative Kujala Scores significantly improved from 39.9 to 82.9 (p < 0.001).
- All patellae were successfully centered in the groove postoperatively with no recurrence after at least 1 year of follow-up.
Conclusions:
- Early diagnosis and the 4in1 procedure are crucial for optimizing patellar stability and knee function in CDP.
- The 4in1 procedure demonstrates excellent efficacy in treating congenital dislocation of the patella, preventing long-term complications.
Objectives:
Congenital dislocation of patella (CDP) is a rare condition and surgery is needed to treat CDP once a diagnosis is made. The 4in1 procedure includes lateral release, correction of quadriceps, Roux-Goldthwait procedure, and medial patello-femoral ligament (MPFL) reconstruction. This study was aimed at evaluating the efficacy and outcome of the 4in1 procedure in the operative treatment of CDP.
Methods:
CDP patients were retrospectively collected from two operative centers from January 2013 to December 2024. For all patients, patellae on both sides were examined by x-ray, CT, and MR bilaterally. Ten patients (14 patellae) underwent 4in1 procedure. Gradual passive and active exercises of knee motion and quadriceps were begun as tolerated. Kujala Score was collected before and after the operation.
Results:
This cohort included 10 patients (4 males, 6 females), with 4 cases of bilateral involvement and 6 unilateral cases (total 14 limbs). The mean age at surgery was 8.36 years (4-14 years), with an average surgical duration of 157.7 min and intraoperative blood loss of 35.6 mL. Kujala scores improved from 39.9 preoperatively to 82.9 postoperatively (p < 0.001). All patients were followed up for at least 1 year. All patellae were centerized on the groove postoperatively with no recurrence.
Conclusion:
CDP is a rare lower limb skeletal disorder requiring thorough evaluation. Early diagnosis and 4in1 procedure optimize patellar stability and knee function, preventing long-term complications.
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