NOTES - Surgical Procedures :
VMO tightening? - - Posted by smelton5 (smelton5), 22 September 2004
Hi all! I went a new Dr. yesterday. One who finally didn't recommend a LR (because I have no patellar tilt 
) I told him that even though I have been in PT for several months now my L knee is still dislocating on a weekly basis. He looked me over and told me that my joints a really loose and my grooves are really shallow. So he said a lateral release would only make things looser and wouldn't correct anything. So, he said that because my patella has dislocated so much it has probably stretched my VMO out and no matter how much I try to strengthen it, it won't tighten up anymore. So he told me he could go in a tighten my VMO up which would hopefully allow me to strengthen it and pull my knee cap back where it belongs. My question is to anyone who has heard of this being done or has had it done. Is this anything like a VMO advancement? I really don't want to jump into anything that won't help my patellas stop dislocating. So i was just looking for info. about this procedure. Thanks! 
Posted by hmaxwell (Heather M.), 23 September 2004
I think it's a VMO advancement, where the attachment of the VMO is cut, pulled tight, and resutured. So that kind of shortens things, if that makes sense, because some is cut out.
Here's a much better explanation than I could make:
Quote: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).
Contra-Indications: The presence of arthritis on the medial half of the patella.
Complications: Since the origin of the VMO is posterior to the plane of the patella, concerns have been voiced with respect to creating a posterior vector on the patella. If we pull or push the medial portion of the patella posteriorly are we not going to increase pressure on the patella and increase pain? The answer to this is unknown. In defense of the procedure, the patella is "pulled down" only as much as is needed to bring it back to a normal position.
Numbness: Sensation about the knee comes to a large extent from branches of the saphenous nerve. This nerve sweeps around the medial aspect of the knee and fans around anteriorly. The skin incision interrupts some of these branches and numbness lateral to the incision ensues. This numbness can resolve in time and usually does not interfere with every day function. Patients undergoing patellar re-alignment should be willing to trade some pain for an element of numbness which is not to say that - all things being equal- the surgeon shouldn’t try to minimize it. In my experience, patellar patients rate pain relief and cosmesis above sensation.
Posted by cat (cat), 24 September 2004
Sounds like a VMO advancement to me. I had one along with a medial reefing, Z-release, and TTT.
Here's another site with some info-
http://users.rcn.com/dcornelius/big_red_knee/
cat
Posted by smelton5 (smelton5), 25 September 2004
Thanks Heather and Cat! It always helps to know in laymans terms what kind of surgery my Dr. is suggesting! Thanks for the great info!
Stacy
Updated Sat Nov 21 2009
