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The Three-In-One Proximal and Distal Soft Tissue Patellar Realignment Procedure

Results, and Its Place in the Management of Patellofemoral Instability

Peter Myers, FRACS, Andrew Williams, FRCS(Orth), Richard Dodds, OBE FRCS and Jens Bülow, MD

The Brisbane Orthopaedic and Sports Medicine Centre, Brisbane, Queensland, Australia

Presented in part at the annual meeting of the Australian Orthopaedic Association, Hobart, Tasmania, September 1993.

Address correspondence and reprint requests to Andrew Williams, FRCS(Orth), The Institute of Orthopaedics, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom

The three-in-one procedure for extensor mechanism realignment of the knee combines lateral release, vastus medialis obliquus muscle advancement, and transfer of the medial one-third of the patellar tendon to the tibial collateral ligament. We observed 37 patients (42 knees) receiving this treatment at a minimum 25-month follow-up (range, 25 to 85 months; mean, 44). Thirty-two of 42 knees (76%) with recurrent patellar dislocation had good or excellent results after surgery. Redislocation occurred in four knees (9.5%). Skeletal immaturity, chondral damage, and generalized ligament laxity did not seem to affect outcome. Thirty patients (37 knees) were studied 2 years earlier as well (mean follow-up, 29 months). When comparing the results 2 years later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar stabilization. We describe the place of the three-in-one operation in our surgical protocol for patellofemoral instability, which is based on the principle that a procedure should be selected to address the underlying pathologic features in an individual case rather than always using one operation for all cases.

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