Good outcomes of modified Grammont and Langenskiöld technique in children with habitual patellar dislocation

Abstract

Purpose In this study, the functional mid-term outcomes of the modified Grammont and Langenskiöld technique was assessed in skeletally immature patients with habitual patellar dislocation, with emphasis on knee function, pain, and other possible post-surgical complications. This is the first study concerning the application of the modified Grammont and Langenskiöld technique in habitual patellar dislocations. Methods This retrospective cohort study considered 10 patients (15 knees), ranging from 7 to 11 years old, who underwent the modified Grammont and Langenskiold procedure between 2015 and 2018. History of dislocation, patellar stability and range of motion (ROM) were analysed. To assess functional improvement and knee pain, the Kujala Anterior Knee Pain Scale and KOOS-Child Knee Survey were used before and after surgical treatment. Results No history of dislocation was noted after surgical treatment. All 15 knees showed full ROM. There were no signs of genu recurvatum and no length discrepancies were found. The subjective assessment revealed significant improvement in the scores of the KOOS-Child questionnaire in all five sections (p < 0.001), as well as in The Kujala Anterior Knee Pain Scale (p = 0.001). Conclusion The modified Grammont and Langenskiöld technique yields remarkable results in terms of knee stability and knee function, while decreasing recurrence risk and intensity of pain in patients with challenging cases of patellofemoral joint dislocation. This surgical technique is most effective in cases where the patella remains dislocated continuously; however, it may also be used in immature patients with recurrent instability. Level of evidence IV.

A preliminary study of proximal realignment combination surgery in the treatment of adolescent habitual patellar dislocation

“…In recent years, many scholars have advocated the combined application of multiple surgical methods. Musielak [ 16 ] held that to obtain permanent repositioning and good knee function in habitual patellar dislocation, a combination of proximal (patellar) and distal (tibial) reconstruction was needed and used a modifed Grammont and Langenskiöld technique to restore the correct anatomical conditions. Although the causes of habitual patellar dislocation include femoral trochlear dysplasia and a high patella, Mittal did not find this in his research [ 17 ], he performed a multiple incomplete transverse incision along the vastus lateralis under the surface of the rectus femoris, iliotibial band and thick antrelateral part of the femur periosteum instead of reconstruction of the medial patellofemoral ligament.…”

Tibial Tubercle Osteotomy in the Adolescent Patient

“…In skeletally immature patients, soft tissue distal realignment procedures such as the Roux-Goldwaithe and Modified Grammont have been described. [25][26][27][28] While these procedures appear to obviate the risk of physeal injury, making TTOs considered a contraindication in skeletally immature patients, other disadvantages may exist. First, these procedures have largely been described in skeletally immature patients, and therefore, their efficacy in older adolescents nearing or at skeletal maturity is uncertain, especially considering the less robust periosteum in an older patient population.…”

Management of the first episode of traumatic patellar dislocation: an international survey

“…Although it may result from traumatic events, patellar dislocation for the first time is most commonly associated with the presence of a pathoanatomical condition that predisposes patients to dislocation [20, 26, 29]. The most common predisposing factors that predispose patients to instability are trochlear dysplasia, patella alta, increased femoral antetorsion, increased external tibial rotation, patellar lateral tilt, oblique vastus medialis hypoplasia, varus‐valgus deformities, and increased ligamentous laxity [12, 14, 28]. Most patients present two or more pathoanatomical predisposing factors, which synergistically predispose to dislocation [20].…”