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thought it was his original idea from his point
of view. But when he realized that Roux had
published it in a review, at this time inter
nationally well known, he just decided to
continue to perform this procedure and not to
publish it.
Anyway it was a very shirt series.
To summarize:
- 1882 Roux: only one case performed on a
13 years old girl followed-up for 3 months,
- Elmslie discovered perhaps later on the
publication. Few cases,
- Only known by Seddon and me,
- Wrong Christening of the operation,
- Fast dissemination due to publications and
“Journées du Genou”,
- Wrong knowledge of the origin,
- No possibility to change the Christening
name,
- No interest to add my name.
That’s all I can say
I wish you a happy new year.
A Trillat”
The technique of the Elmslie-Trillat
The technique of Elmslie-Trillat is precise and
every detail must be respected. It includes:
• Vertical paramedial approach
• Osteotomy :
- 2 cuts: the first (medial) is vertical and the
second (lateral) is horizontal,
- length of the piece of bone detached:
6-8cm,
- deep enough to include also cancellous
bone,
- the base of the osteotomy is bent (osteo
clasy).
• Fixation: 1 oblique 4.5mm AO screw
In distal transfer of the ATT, the ATT is totally
detached. The fixation is ensured by 2 horizontal
4.5mm AO screws.
After 1987
In our school, the “modern” period started with
the
“Journées Lyonnaises de Chirurgie du
Genou”
in 1987, where a strict difference was
established between patients who had had one
or several patellar dislocations, and the group of
patients who complained anterior knee pain
without morphological factors of patellar
instability. In this last group, after 1987, there is
no indication anymore for a medial transfer of
the ATT. Three theses were published at this
period by A. Mironneau, C. Levigne and G. Py.
At this period, Bernageau and Goutallier
defined the TT-TG (Tibial Tubercule –
Trochlear Groove distance) that measured the
lateral implantation of the ATT and external
femorotibial rotation of the knee. The Lyon
group validated the normal value (16mm±4mm)
of the TT-TG, knee in extension. Then a medial
transfer of the ATT was recommended in
episodic patellar dislocation patient with a TT-
TG superior to 20mm. An individualized
management of patellofemoral instabily was
proposed and the “menu à la carte” was defined.
We treated the patients according this algorythm
after 1987.
Elvire Servien reported the results of the ATT
transfert in 2003 considering a group of
130 patients (174 knees, operated between
1988 and 1999). The follow-up was 2 to
13 years. The subjective IKDC score was 77.2
(range 45.9-95.4). 94% of the patients were
very satisfied or satisfied. The post-operative
recurrent dislocation rate was 4.5%.
In this series, distalization of the ATT was
performed in patients with relatively normal
TT-TG. E. Servien found that pure distalization
of the tibial tubercle resulted also in some
medialization of the patella (4mm average).
The conclusions were that:
• Medialization and distalization was indicated
in patients with significant patella alta and
lateralized tibial tubercle (high TT-TG).
• Medialization was primarily indicated for
patients with tibial tubercle lateralization.
Someauthorsreportthatisolatedmedialization
results in patellar tendon shortening as well
(perhaps due to scar tissue formation). We
haven’t noted shortening of the patellar
tendon in our center provided post-operative
mobilization begins immediately.