Effects of surgical intervention on trochlear remodeling in pediatric patients with recurrent patella dislocation cases


Patella instability is often encountered among physically active pediatric athletes, and surgical intervention is useful in cases with recurrent patella dislocations, chronic instability, and abnormal alignment. Several surgical procedures have been used for patella-realignment and stabilization, but the effects of surgical intervention on bony trochlear remodeling in skeletally immature patients have not been well studied. We thus present two cases of pediatric recurrent patella dislocations that showed trochlear remodeling following patella-realignment surgery. The first case describes an 11-year-old female treated with a Roux–Golthwait procedure and the second case highlights a 12-year-old male treated with lateral release and medial capsular reefing. The Merchant technique, a radiographic criterion that was designed to evaluate patella alignment in relation to the femoral trochlea groove, including sulcus and congruence angles was used to measure postoperative bony development. Both pediatric patients showed successful outcomes following surgical interventions for chronic patella instability. Using the Merchant technique, both patients showed improved congruence and sulcus angles postoperatively. Patella realignment in skeletally immature patients may be beneficial for promoting trochlear remodeling and deepening of the trochlear groove, which may help protect against future dislocation or subluxation events. Level of Evidence: Level IV, case report. 


Autor / Fonte:Dai Sugimoto, Melissa A Christino, Lyle J Micheli Journal of Pediatric Orthopedics. Part B 2016, 25 (4): 349-53
Link: http://journals.lww.com/jpo-b/Abstract/2016/07000/Effects_of_surgical_intervention_on_trochlear.11.aspx