Baksi procedure for habitual dislocation of patella in children - Revisiting the key surgical steps - PubMed (original) (raw)

Review

Baksi procedure for habitual dislocation of patella in children - Revisiting the key surgical steps

Anil Agarwal et al. J Clin Orthop Trauma. 2022.

Abstract

The pes anserinus transfer procedure for habitual dislocation of patella described by Baksi is a biomechanically sound technique with predictable long term results. The dynamic pes anserinus sling counteracts the lateral quadriceps contracture and keeps patella relocated till the vastus medialis activity is restored and takes over. The procedure is especially suitable for children with open physeal growth plates. Moreover, the surgery runs a low complication rate. In the present review, we recapitulated the steps of the procedure to illustrate its surgical basics. We also describe our experience and long term follow up results of 4 cases operated with same technique. The indigenous Baksi's procedure remains a viable option for managing habitual patellar dislocations in pediatric age group with immature skeleton.

Keywords: Children; Dislocations; Habitual; Patella; Pes anserinus.

© 2022 Delhi Orthopedic Association. All rights reserved.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1

Fig. 1

The surgical steps of Baksi's pes anserinus transfer for habitual dislocation of patella: A. Skin markings for incisions B. Identification of vastus lateralis C. Mobilization of vastus lateralis from proximal patella, rectus femoris and iliotibial tract D. Plane between rectus femoris and vastus intermedius identified E. After lateral capsular and vastus lateralis release, if patella is still unstable in trochlear groove, rectus femoris is resected F. If still unsuccessful, vastus intermedius is sectioned too G. Following this, patella always reduces in the trochlear groove H. Vastus lateralis is sutured to distal cut ends of rectus femoris and vastus intermedius I. Completed quadriceps repair and alignment J. Pes anserinus harvest is planned along with 1 cm distal sleeve of periosteum K. Attachment of pes anserinus to anteromedial aspect of patella and adjoining patellar tendon L. The completed repair.

Fig. 2

Fig. 2

Patient 1: A,B. Habitual dislocation of left patella in a 10 year old child C,D. Follow up 60 months. Matching quadriceps strength in left lower limb E,F. Full knee range of motion. No recurrence and patella stable in knee flexed position.

Fig. 3

Fig. 3

Patient 2: A,B. Eight year child having right sided habitual dislocation of patella C,D. Follow up 138 months. Active straight leg raising and quadriceps strength demonstrated for both limbs E,F. No restriction in knee movements. No patellar instability.

Fig. 4

Fig. 4

Patient 3: Left sided habitual dislocation in a 10 year girl C,D. Follow up 40 months. This child recovered quadriceps power by 4 months. Figure illustrating no extensor lag at follow up and comparable straight leg raising in both limbs E,F. Patella stable in knee flexed position and full knee range of motion at above follow up.

Fig. 5

Fig. 5

Patient 4: A,B. Habitual dislocation of left patella in a 9 year old child. The dislocation occurred each time when knee was flexed 30° C,D,E,F. Knee function and strength post Baksi's procedure 60 months. There were no recurrences.

References

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