The Elmslie-Trillat procedure for recurrent subluxation of the patella. One to five year follow-up.

Thirty-four patients who had undergone the Elmslie-Trillat procedure from 1985 to 1989 were examined in order to evaluate the effectiveness of this operation in the treatment of recurrent subluxation of the patella. The result of an increased Q angle accompanied by patella alta, femoral sulcus dysplasia, or vastus medialus obliquus dysplasia was also studied. Only those patients with recurrent subluxation of the patella took part in this study; cases of habitual or permanent dislocation, potential instability, traumatic dislocation, and degenerative arthritis were excluded. The patients were reviewed both clinically and radiographically, and the A.R.P.E.G.E. scoring system was used to evaluate the results. The follow-up period ranged from 1 year to 5 years and 4 months, with an average of 3 years. The overall results were excellent or good in 77% of the cases, as was the subjective knee stability rating in 87% of the cases and the pain rating in 82% of the cases. Recurrence of the subluxation was observed in only one instance. The results were not significantly different when the groups of patients with patella alta and type 1 femoral sulcus dysplasia were considered separately. The results were also excellent in the patients who underwent the Elmslie-Trillat procedure with reconstruction of the vastus medialis obliquus. In conclusion, surgical realignment of the anterior tibial tubercle confirmed its reliability in the treatment of recurrent subluxation of the patella. In cases of patella alta, the authors recommend lowering the anterior tibial tubercle only when the Insall-Burstein index is greater than 1.3. Femoral sulcus-plasty should be performed in cases of type 3 sulcus dysplasia.