Superficial Quad Technique, an answer to recurrent dislocation of knee cap

Monday, December 23, 2013

by Vidhi Rathee

Ahmedabad: Dr Deepak Goyal, a consultant knee joint surgeon at Saumya Orthocare: Centre for Advanced Surgeries of the Knee Joint, Ahmedabad has developed a surgical approach to patellar insufficiency, a condition in which the knee cap keeps dislocating.

Dr Deepak Goyal

Dr Deepak Goyal

Dr Goyal has designed the Superficial Quad Technique used as the graft to replace the ruptured medial patellofemoral ligament (MPFL). MPFL is the stabilizing ligament that helps keep the patella (knee cap) tracking up and down over the knee. When the patella is dislocated, this ligament is almost always ruptured. And once a ligament is torn, it does not repair or heal itself.

The study is published in The American Journal of Sports Medicine.

Generally, in order to regain patellar stability and prevent repeated dislocations, surgical reconstruction is needed. Though, there are many different ways to reconstruct the damaged ligament, most techniques involve a tendon graft to replace the ligament. Attaching the graft in place creates problems of its own. This is where the new technique holds promise as a better way to accomplish the reconstruction procedure.

Dr Deepak Goyal told India Medical Times about his discovery, “The surgery is a technique to prevent recurrent dislocation of patella. Recurrent dislocation of the patella is a condition, when patella dislocates repeatedly on the lateral aspect. Out of multiple local, regional and general causes of recurrent dislocation of patella, the tear of Medial Patellofemoral Ligament (MPFL) is a very common cause. The Superficial Quad Technique is the procedure to reconstruct the MPFL. In short, we can say that a new surgical technique to treat recurrent dislocation of the patella is devised. The technique reconstructs the torn MPFL, a major reason for recurrence.”

Generally, older surgical techniques used for patella dislocation gave results of around 60-70 per cent and the older technique was very high surgically demanding and caused many complications. In contrast, the new technique developed by Dr Goyal is reportedly easy to perform, has so far zero complication and has almost 100 per cent success rate.

Explaining the whole objective behind the discovery Dr Goyal said, “The objective of this study was to devise a technique that is easy, doesn’t require too much of surgical expertise, can be reproduced even at mid-size centres and gives consistent good results.”

Dr Goyal has published his data of upto 68 months of follow-up where patients’ knee score improved from mean 49 per cent to mean 91 per cent after surgery and on final follow-up.

According to Dr Goyal, the study included 32 patients (10 male, 22 female; mean age, 25 years) who underwent MPFL reconstruction using the Superficial Quad Technique and who were followed for a mean duration of 38 months (range 12-68 months). Objective assessment was performed and Kujala scores were obtained preoperatively and at the time of final follow-up. “There were no patellar complications, including redislocation, in the present study. The mean Kujala score improved to 91.25 (range, 73-100) from a preoperative score of 49.31 (range, 23-62),” he said.

Describing the treatment response as “fantastic”, Dr Goyal said, “We have received messages from France, Belgium, Germany, UK, Romania, Italy, Philippines, Pakistan, Iran, Chile, UAE etc applauding the technique. Even surgeons have tried this surgery in India and they wrote a congratulating email to the editors of the journal where it has been published.”

Amidst the huge success the new technique is anticipated to make, the only drawback of the technique is that it involves an anterior incision of around 7 cm.

However, Dr Goyal is developing new instruments to decrease the size of anterior incision, purely for cosmetic reasons.

by Vidhi Rathee

Categories: Orthopaedics, RESEARCH

Tags: , , ,

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