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Use of a Modified Elmslie-Trillat Procedure to Improve Abnormal Patellar Congruence Angle

Methodist Sports Medicine Center, Indianapolis, Indiana

David A. Porter, MD, PhD

Methodist Sports Medicine Center, Indianapolis, Indiana

William Rozzi, MD

Methodist Sports Medicine Center, Indianapolis, Indiana

Forty patients underwent 45 modified Elmslie-Trillat re alignment procedures (mean followup, 2 years) for re fractory patellar instability (34 knees) or painful patel lofemoral syndrome with malalignment (11 knees). The postoperative congruence angle (mean, +3.4°) was significantly improved compared with the preoperative value (mean, +21.5°). We considered the "normal" con gruence angle average as -8° (range, -20° to +4°). Overtime postoperatively, we detected no statistical dif ference in the congruence angle (5 months, 3.4°; 24 months, 6.3°). There were no patellar dislocations post operatively. Nine knees (20%) had some postoperative subluxation. Ninety-four percent of the patients without subluxation had congruence angles less than 15°, whereas 54% of patients with postoperative subluxation had postoperative congruence angles greater than 15°.

The evidence in this study population indicates that the modified Elmslie-Trillat procedure can predictably improve the patellar congruence angle. Adequate cor rection may eliminate patellar dislocation. Correction of the congruence angle to less than +15° will result in a decreased incidence of postoperative patellar instabil ity. Early full activity postoperatively did not affect the modified Elmslie-Trillat correction of the congruence angle being maintained over time.

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