Open Medial Plication and VS Trillat

[fawn2388]

First of all, WHAT in the world is an open medial plication and VS Trillat?

Second of all - anthesia risk when your on your 3rd surgery, is it relatively low? For some strange reason I have a high anixety about anethisa and death. Even though, I've been through three surgeries.
Thanks - Fawn

[Natalie.D]

Hi,

Medial plication is where they tighten up the structures on the medial (inside) part of the knee by either stitching or folding and stapling (I think) the tissue, usually done in conjunction with a lateral release but not always, this is usually done to help move the patella into a more centralised position.  Not sure what the VS is but the Trillat is the Elmslie Trillat which is a form of TTT (tibial tubercle transfer), there is loads of info on TTTs in the patello femoral section of the board.

I've had over 10 anasthetics and have been fine through all of them, try not to worry too much.

Natalie.

[shade]

Fawn,

Hi there....  maybe you mean VMO advancement.

Found this article......

Medial Plication

The medial retinaculum and medial patellofemoral ligament provide a passive medial restraint to lateral displacement of the patella and the vastus medialis obliquus (VMO) is the major dynamic stabilizer of the patella. It is natural to try to increase the pull on the inner (medial) aspect of the kneecap.

The simplest procedure in this category is the medial plication as popularized in the United States by Hughston. The medial retinaculum is divided as it inserts into the patella. It is then re-attached more medially onto the patella itself in a "pants-over-vest " fashion.

In addition to plicating the medial retinaculum, the VMO can be dissected free by dissecting along its insertion and then dissecting along its inferior border. The muscle can then be pulled in the direction of its fibers as far as one wishes onto the supero medial portion of the patella. The inferior fibers can also be sutured more distally to "horizontalize" the VMO. Dissection of the VMO changes the rehabilitation considerably since vigorous contraction of the muscle could conceivably pull the VMO out of its new position.

*Note: A lateral release is carried out in conjunction with either of the above medial procedures.

Indications: Moderate or severe patellar tilt, lateral translation of the patella, subluxation (sensation of giving way).

Tibial tuberosity transfer (Elmslie-Trillat)

The concept of displacing the tibial tuberosity to affect patellar tracking goes back to the 19th century.  The Swiss Roux described displacing the patellar tendon in 1888.  He was also one of the first to publish the observation that patellar dislocation is a problem that occurs near extension (slight flexion).  People do not dislocate their patella going up and down stairs, but they readily dislocate with social dancing.

Elmslie popularized the procedure in Great Britain and it was further popularized in the Western world by Albert Trillat from Lyon, France, and by Cox in the USA. By transferring the tibial tuberosity medially, one decreases the quadriceps (Q) angle. Accordingly one decreases the bowstring effect of the quadriceps mechanism, and, most significantly the tendency of the patella to move laterally when the quadriceps contracts.

Indications: The presence of an increased quadriceps (Q) angle is the prime indication for the procedure since the main effect of the operation is to decrease the Q angle.

Take care.  ~shade

[Natalie.D]

Hi Shade,

Great info but I have to point out that I don't agree with one section which states that "People do not dislocate their patella going up and down stairs, but they readily dislocate with social dancing."  I have unfortunately dislocated numerous times on coming down stairs (never up) - as well as with social dancing 

Natalie.

[fawn2388]

Still haven't had... but I'm two days before hand...

Still confused, had it explained that open medial plication is when they basically stitch up your knee and trillat is the moving of the top of the tiba. Actually, my knee dislocates whenever it feels that it will be the most problematic for me... along with up/down stairs. The NP explained I may have one or the other or both.

One odd thought thou, with the TTT - can a doctor use a tubercule from an Osgood Schlatters knee? Yes, I had that also along with two failed attempts to take it out, but resolved the problem, but now its to the point that when walking down the stairs I can feel my tendon being pulled out along with sliding to the outside, which orginally caused the need for the surgery... after a failed attempt on mesicus repair and tubercule removal the follow up being the same along with a lateral release....

And yes, I am only 18.

[akasuki]

Hi 

Does anyone know if surgeons drill holes in the patella to tightened the medial ligaments in the "open medial plication" surgery?

Thanks