Soft tissues surgery in recurrent patellar dislocation

Recurrent dislocations and subluxations of the patella are common disorders which cause pain and disabilities. Lateral dislocations are the great majority. Several risk factors have been identified, like patella alta, trochlear dysplasia, excessive Q angle or previous traumatic injuries. Many conservative and surgical techniques are used for treatment. This article analyses soft tissue surgery techniques and results. Major surgery involving osteotomy has not been considered. Soft tissue surgery involves different structures like Vastus Medial Obliquus Muscle (VMO), medial patello femoral ligament (MPFL), medial retinaculum (MR) and lateral retinaculum (LR). Different techniques are used like medial reefing, medial repair, medial reconstruction and lateral retinaculum release, alone or associated. No widely accepted and clear indications for intervention are explained. Classification methods for patients' outcome, physical and radiological evaluation are not homogeneous and have no statistical evidence. All different techniques analysed provides a success rate from 50% to 97%, but they have been performed on small samples of selected patients. Currently there is no evidence about soft-tissue surgery effectiveness, although good results seem to be encouraging on some classes of patients. The next step will be to validate all procedures to evaluate patients pre and post-operatively for better surgical indications and statistically prove the effectiveness of each surgical technique.