Elmslie-Trillat procedure for the treatment of recurrent patellar instability.

PURPOSE: The purpose of this study was to evaluate the mid-term results of the Elmslie-Trillat procedure for the treatment of patella instability. Patella instability can be addressed by proximal, distal, and combined approaches. The Elmslie-Trillat procedure is a combined bony distal realignment with medial soft tissue technique offering a more rapid recovery than more extensive distal realignments.

METHODS: A consecutive series of patients with recurrent patellar instability treated with a modified Elmslie-Trillat procedure were assessed subjectively by visual analog scale, Tegner scale, and both pre-and postoperatively by physical examination, International Knee Documentation Committee activity, Lysholm, and Fulkerson knee scores. Inclusion criteria were patients with recurrent lateral dislocations or increasingly frequent subluxations who failed nonoperative therapy. Exclusion criteria were open growth plates, patellofemoral arthritis, and concurrent cruciate ligament or meniscal injuries. The primary endpoint was evidence of recurrent instability. The secondary endpoint was the functional scoring status.

RESULTS: Thirty-five knees were evaluated for an average of 98 months (range, 25 to 209) postsurgery. The average age was 27.7 years. Twelve had failed a previous surgery to correct the patellar instability. The mean Lysholm and Fulkerson scores improved from 44.5 and 42.4 to 83.4 and 84.3, respectively. Follow-up Tegner score was 3.8, and the average visual analog scale score was 7.9 out of 10. Two patients had recurrent dislocations and 1 had a single subluxation 6 weeks after surgery.

CONCLUSIONS: The Elmslie-Trillat procedure successfully eliminated recurrent patellar instability in 91.4%. Functionally, all patients were improved at an average of 98 months after surgery.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.