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Letters to the Editor |
New York, New York
Dear Editor:
The article by Ahmad et al. ("Immediate Surgical Repair of the Medial Patellar Stabilizers for Acute Patellar Dislocation. A Review of Eight Cases," November/December 2000, pages 804–810) fits in well with the orthopaedic community’s burgeoning interest in the medial patellofemoral ligament. However, no mention is made of the other anatomic abnormalities commonly associated with patellar dislocation, such as patella alta, trochlear dysplasia, femoral/tibial torsion, stretched-out medial tissues, and a lateralized tibial tuberosity. The orthopaedic literature strongly suggests that such factors can contribute to recurrent dislocations.
The study cohort was distinctly old (average age, 32) considering that these were patients with first-time dislocations. Perhaps their abnormalities were different from the younger patients with first-time dislocations.
I am concerned that readers will be left with the impression that repair of this relatively new-found medial patellofemoral ligament is the new magic operation, replacing the many previous magic operations that have rocketed and returned to earth.
Los Angeles, California
I thank Dr. Grelsamer for his interest in and comments regarding our recent study. With regard to the age of the patients in our study (average age, 32), our small series of eight does not allow us to infer that their abnormalities are different from those of younger patients with patellar dislocation. Although the average age of our patients was older than typical, Atkin et al.1 reported a series of patients with acute first-time dislocations in which 31% were in their 30s or older.
Dr. Grelsamer also makes reference to anatomic features that are associated with patellar dislocation that are not addressed with our surgical procedure. Indeed, the goal of our technique is to restore normal anatomy that has been altered by the injury, rather than alter anatomy as is characteristic of other procedures such as tibial tuberosity transfers and proximal medial soft tissue advancements. Interestingly, Atkin et al.1 reported the characteristics of patients with acute patellar dislocation and found that "most injuries occurred during sports, and few patients had abnormal physical features" [italics added for emphasis]. We believe that, for patients who have normal anatomy and sustain a patellar dislocation, restoration of the normal anatomy acutely will decrease their natural history of recurrent dislocation, subluxation, and pain. Lastly, if a patient is found to have abnormal anatomic features that are thought to be responsible for the dislocation, such as an increased Q-angle from a lateralized tibial tubercle, we would not recommend this procedure.
REFERENCES
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