2025 ISAKOS Biennial Congress ePoster
Judet’s extensive quadriceps release and “à la carte” combined procedures for patellar dislocation In flexion
Moritz Konkel, MD, Lausanne SWITZERLAND
Nicolas Cance, MD, Lyon, Rhône-Alpes FRANCE
Franck P. D. A. Chotel, MD, PhD, Prof., Lyon FRANCE
Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Lyon, Bron, Auvergne-Rhône-Alpes, FRANCE
FDA Status Not Applicable
Summary
The aims was to evaluate the Judet’s extensive quadriceps release and “à la carte” combined procedures in management of patella-femoral instability in flexion in children and adolescents (37 knees).
Abstract
Aims: To evaluate the Judet’s extensive quadriceps release and “à la carte” combined procedures in management of patella-femoral instability in flexion.
Methods
37 knees (24 females and 13 males) operated between 2011 and 2021 were included in this retrospective study. 64.9% of patients had associated syndromes. The mean age at surgery was 2.5, 12.2 and 11.7 years for respectively true congenital dislocation (TCPD)(n=7), permanent (PPD)(n=8) and habitual dislocation in flexion (HPDF)(n=22). An extensive quadriceps release was performed for 34 knees and associated to posterolateral structure release for the 7 knees with TCPD. “A la carte” surgery combined MPFL reconstruction (n=25) or VMO advancement (n=9), trochleoplasty (n=12), soft tissue (n=27) or bony (n=5) distal procedure on tibial tuberosity and femoral shortening and derotation osteotomy (4 knees with TCPD). The main outcomes measured were post-operative complications and recurrent dislocations. Functional outcomes were assessed using the Kujala score and simple knee value and also focused on quadriceps strength, active and passive range of knee motion.
Results
The mean post-operative follow-up was 6.5years. Four knees had complication (10.8%), requiring 3 revision surgeries. Three knees (8.1%) had recurrent dislocation; the recurrence occurs in flexion due to incomplete quadriceps release (n=2) or in extension (n=1). The mean post-operative full flexion was 144.7°. The mean Kujala score and simple knee value was respectively 92.7% and 87.3%. None of children operated before the age of 7 had complication or recurrence or positive Smilie test despite surgery were performed in more complex situations and mostly on syndromic patients.
Conclusion
In the treatment of patellar dislocation in flexion, Judet’s procedure in combination with “à la carte” combined procedures, gives a good function with an excellent knee range of motion and quadriceps strength and is associated to low rate of complication or recurrence.