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Letters to the Editor

Farmington, Connecticut

Dear Editor:

I have concerns about the article "Arthroscopic Release of the Vastus Lateralis Tendon for Recurrent Patellar Dislocation" in the May 2006 issue (page 824–831). It appears to me that the authors might be releasing the vastus lateralis obliquus,¹ not the main vastus lateralis tendon (see Figure 2). This is an extremely important distinction, as the main vastus lateralis tendon provides major support of the extensor mechanism, and release of it can cause serious problems. I have seen 2 patients with quadriceps rupture after transection of the lateral quadriceps, with secondary patella baja. Whether any release along the lateral patella is a good idea in a patella dislocator is another matter. This has not been the approach that I have favored for a variety of reasons. I prefer restoration of the medial patellofemoral ligament support and correction of serious alignment pathology for long-term stability after recurrent patella dislocation. This is a generally accepted approach of the International Patellofemoral Study Group.

REFERENCE

1. Hallisey MJ, Doherty N, Bennett W, Fulkerson JP. Anatomy of the junction of the vastus lateralis tendon and the patella. J Bone Joint Surg Am. 1987;69:545–549.[Abstract/Free Full Text]

Authors’ Response

Houston, Texas

We release only the obliquely oriented fibers of the vastus lateralis, which may be construed as the vastus lateralis obliquus in Dr Fulkerson’s terminology. We do not release the fibers of the vastus lateralis that are associated with the quadriceps tendon (the "main" vastus lateralis tendon). The integrity of the quadriceps tendon at the patella is preserved, as shown in Figure 2 of our article.

In our experience, and as stated previously by Hallisey et al, the course and insertion of the vastus lateralis complex vary considerably. We find it difficult to identify consistently the vastus lateralis obliquus, per se, but relatively easy to identify a change in direction of muscle fibers from oblique to longitudinal during the release procedure.

This Article Full Text (PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fulkerson, J. P. Articles by O’Connor, D. P. Search for Related Content PubMed Articles by Fulkerson, J. P. Articles by O’Connor, D. P.