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Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon.

ABSTRACT: Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity.

SUBMITTER: Filho RB

PROVIDER: S-EPMC5765918 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position. Technique Video Video 1 Modified endoscopic lateral soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation of the left foot. The patient is in the supine position with the legs spread. The plantar portal is the viewing portal, and the toe web portal is the working portal. The adductor hallucis and lateral capsuloligamentous complex are released. Endoscopic bunionectomy is performed with the proximal bunion portal used as the viewing portal and the distal bunion portal used as the working portal. Two meniscal repair needles are inserted via the dorsal incision to the lateral side of the medial sesamoid. These bring back two PDS suture loops. The suture loops serve as suture retrievers and bring the minitape to the lateral side of the medial sesamoid. The minitape is passed through a bone tunnel at the first metatarsal neck, wrapped around the second metatarsal neck, and returned to the proximal bunion portal. The intermetatarsal space is closed up and transfixed by a basal intermetatarsal screw. The minitape is tensioned and fixed to the bone tunnel by a SwiveLock anchor.

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Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon.

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