[Autofixation of the transposed tibial tuberosity in habitual patellar dislocation]

Habitual luxation of the patella is as a rule considered an indication for a stabilizing operation. As regards approaches to the surgical solution of this problem we can differentiate between operations of the proximal part of the extension apparatus, i.e. operations of the soft tissues and operations on the distal part of the extension apparatus, above all plastic operations and transposition of the insertion of the lig. patellae on the tuberositas tibiae. In the present paper the authors submit their own modification of transposition of the tuberositas tibiae, suitable in severe affections after closure of the epiphyseal space. The described technique makes it possible to anchor the transposed tuberosity by an autofixation mechanism without using osteosynthetic material. The basis of the method is removal of a small block of bone with the insertion of the lig. patellae, size 2 x 4 cm, and its insertion beneath the corticalis at a site selected in advance into an opening 2 x 2 cm with subsequent covering and stitching of the periosteum. The extent of medialization depends on testing during flexion and extension. To prevent the development of the syndrome of patellar hyperpression it is important to avoid excessive distalization of the insertion of the ligament. During the preoperative period it is recommended to apply a plaster splint for two weeks, followed by functional rehabilitation and gradual burdening; complete burdening should be attained by the third month after operation. The surgical technique was tested in a group of 16 patients at the First Orthopaedic Clinic and with regard to its simplicity and reliability the method can be recommended.