Make a midline incision from the distal aspect of the femur to the tib

Make a midline incision from the distal aspect of the femur to the tibial tuberosity. Perform a full-thickness skin n dissection over the patella to expose the medial and lateral aspects of the knee joint and the quadratus femoris muscle. n Release the vastus lateralis from its most proximal muscle origin in the quadratus femoris to the level of the joint. This may require release of the iliotibial band laterally to the intermuscular septum. n Because a midline surgical incision over the patella tends to heal with more proliferative scarring in children than in adults, Eilert suggested making the surgical incision over the anterolateral knee so that the scar is not under direct pressure against the patella. The incision must be long enough to expose a sufficient portion of the quadriceps muscle so that it can be realigned, and in an infant with congenital patellar dislocation, the incision may extend halfway up the thigh. n n Occasionally, the rectus femoris must be dissected and lengthened by a Z-plasty. Incise the vastus medialis obliquus from its origin proximally and distally from the patella, the medial capsule, and the patellar tendon. n Reduce the patella into the femoral groove. n Reattach laterally and distally the vastus medialis obliquus to the patellar tendon and medial retinaculum to secure the patella in the femoral groove. n When the initial suture has been placed distally, move the knee through a gentle range of motion to assess reduction and tracking of the patella in the femoral groove. If the tension is too tight on the vastus medialis obliquus, remove the suture and transfer the muscle slightly proximally. If the tension is too lax, attach the vastus medialis obliquus farther distally and laterally. n Occasionally, the patella is so unstable that the gracilis or semitendinosus tendon must be divided at the musculotendinous junction and transferred into the patella as a checkrein for added stability. The vastus medialis obliquus is sutured to the remaining retinaculum of the patella and the quadratus femoris. Continue the repair of the vastus medialis obliquus proximally and distally. Move the knee again through a range of motion to ensure reduction of the patella in the femoral groove and normal tracking during flexion and extension. n Deflate the tourniquet and obtain hemostasis with electrocautery. Insert a drain deep into the wound and close the subcutaneous tissue and skin. n Apply a long leg cast with the knee in 30 degrees of flexion.

Reading File

Finding Sources

Reading File

I now have all the information I need. Let me compose a thorough, well-structured response.

The text you have pasted is Technique 31.26 (Beaty; modified from Gao et al. and Langenskiöld): Lateral Release and Medial Plication for congenital/habitual (obligatory) patellar dislocation in children - taken verbatim from Campbell's Operative Orthopaedics, 15th Edition (2026), Chapter 31, pp. 1337-1338.

Here is a step-by-step annotated breakdown of the procedure with clinical commentary:

Surgical Context

Indication: Congenital dislocation of the patella - a persistent, irreducible lateral displacement of the patella caused by contracture of the quadriceps mechanism. The vastus lateralis may be absent or contracted, the patella may adhere to the iliotibial band, and secondary deformities (genu valgum, external tibial rotation) develop if untreated. Early surgery - as soon as the diagnosis is confirmed - is recommended to prevent progressive knee deformity.

Primary objectives:

Release contracted lateral structures (lateral capsule, iliotibial band, lateral quadriceps)
Medial plication of the lax capsule to stabilize the reduced patella
Advance/reattach the vastus medialis obliquus (VMO) to maintain reduction

Step-by-Step Technique

Step 1 - Incision and Exposure

Make a midline incision from the distal femur to the tibial tuberosity. Full-thickness skin dissection over the patella to expose medial and lateral aspects of the knee joint and the quadriceps femoris muscle.

A midline incision gives excellent access to both medial and lateral structures. "Full-thickness" skin dissection means the flaps are raised as a single layer (skin + subcutaneous tissue) to preserve the blood supply and minimize wound complications. The quadratus femoris referenced in the original text is a transcription quirk - the intended muscle is the quadriceps femoris (specifically the VMO and vastus lateralis components).

Step 2 - Lateral Release

Release the vastus lateralis from its most proximal muscle origin in the quadriceps femoris to the level of the joint. This may require release of the iliotibial band laterally to the intermuscular septum.

This is the central lateral release. The vastus lateralis - which is often the primary deforming force in congenital patellar dislocation - is released from its proximal origin down to the joint line. The iliotibial band (ITB) may be tethering the patella anterolaterally; if so, it is released to the level of the intermuscular septum. This step converts the irreducible dislocation into a reducible one.

Step 3 - Incision Placement Consideration (Eilert's Modification)

Because a midline incision over the patella tends to heal with more proliferative scarring in children than in adults, Eilert suggested an anterolateral incision...

This is an important pediatric-specific point. Children form more hypertrophic scars over the patella (a point of direct pressure and motion), which can cause pain, limited flexion, and cosmetic problems. Eilert's anterolateral incision shifts the scar off the patellar apex. In infants, the incision may need to extend halfway up the thigh to allow adequate proximal exposure of the quadriceps for realignment.

Step 4 - Rectus Femoris Z-plasty (if needed)

Occasionally, the rectus femoris must be dissected and lengthened by a Z-plasty.

In severe contractures, the rectus femoris itself (not just the vastus lateralis) is tight. A Z-plasty lengthens the tendon while preserving continuity, adding to the overall quadriceps lengthening and allowing knee flexion without re-dislocating the patella.

Step 5 - Medial Capsule and VMO Release/Mobilization

Incise the vastus medialis obliquus from its origin proximally and distally from the patella, the medial capsule, and the patellar tendon.

The VMO and medial retinaculum are incised - not destroyed - to free the VMO as a mobile unit that can then be repositioned. This is the preparatory step for the subsequent medial advancement.

Step 6 - Patellar Reduction

Reduce the patella into the femoral groove.

With the lateral structures released and the VMO mobilized, the patella can now be manually seated into the trochlear groove.

Step 7 - VMO Reattachment (Medial Advancement)

Reattach laterally and distally the vastus medialis obliquus to the patellar tendon and medial retinaculum to secure the patella in the femoral groove.

The VMO is advanced distally and laterally relative to its original detached position - this tightens the medial vector on the patella and is the key stabilizing step. Note that "laterally and distally" here means relative to where the VMO was cut free, not that it is being moved toward the lateral side.

Step 8 - Intraoperative Tracking Assessment

Move the knee through a gentle range of motion. Adjust VMO tension as needed - proximally if too tight, distally/laterally if too lax.

This is a critical intraoperative check. Overtightening the VMO causes a medial patellar tilt or restricted flexion; undertightening allows re-dislocation. The adjustment is done before completing the suture line.

Step 9 - Checkrein Tendon Transfer (if needed)

If the patella is so unstable that additional stability is needed, the gracilis or semitendinosus tendon is divided at the musculotendinous junction and transferred into the patella as a checkrein.

This augmentation (a form of medial patellofemoral ligament reconstruction analog using hamstring tendons) is reserved for cases of severe instability where VMO advancement alone is insufficient. The tendon acts as a passive restraint to lateral translation.

Step 10 - Complete the VMO Repair

Continue the repair of the vastus medialis obliquus proximally and distally.

The entire VMO advancement is completed after confirming the correct tension in step 8.

Step 11 - Final Tracking Check

Move the knee through range of motion again to ensure reduction and normal patellar tracking during flexion and extension.

A second dynamic assessment confirms the final repair maintains patellar congruence through the full arc of motion.

Step 12 - Closure and Casting

Deflate tourniquet, hemostasis, drain placement, layered closure. Apply long leg cast with knee in 30 degrees of flexion.

The knee is cast at 30 degrees of flexion - enough to seat the patella in the trochlear groove (which deepens with flexion) and reduce tension on the repair, while avoiding a position that would cause significant stiffness or risk of contracture.

Postoperative Care (Campbell's)

If anterior skin is under excessive tension, the cast can be changed at 2 weeks under outpatient anesthesia
Cast removed at 4-6 weeks, followed by active and passive exercises
In older patients, continuous passive motion (CPM) may be used for the first 3-6 weeks
A long leg brace is worn for 6-12 months to prevent knee hyperextension

Key Anatomical Principles

Structure	Role in Deformity	Surgical Action
Vastus lateralis	Primary deforming/lateral vector	Released proximally to joint
Iliotibial band	Lateral tether of patella	Released to intermuscular septum
Rectus femoris	Tight in severe cases	Z-plasty lengthening if needed
Vastus medialis obliquus	Lax/ineffective medial vector	Mobilized and advanced distally/laterally
Medial retinaculum	Stretched lax capsule	Plicated/tightened via VMO reattachment
Gracilis/semitendinosus	Augmentation option	Checkrein tendon transfer if needed

Source: Campbell's Operative Orthopaedics, 15th Ed (2026), Technique 31.26, pp. 1337-1338 - Lateral Release and Medial Plication (Beaty; modified from Gao et al. and Langenskiöld)

Make video of the same

I'm not able to create videos — that's outside my current capabilities. I can only generate static images, not animated or video content.

Here are some alternatives I can help with:

Illustrated poster/diagram - A visual step-by-step surgical diagram of the lateral release and medial plication technique, showing key anatomical structures and steps
PowerPoint presentation - A multi-slide deck walking through each surgical step with labeled anatomy
Illustrated PDF guide - A formatted document with surgical steps and anatomical diagrams

For an actual surgical video, you could look for:

The Campbell's Operative Orthopaedics companion videos (Video 31.8 is referenced directly in the textbook for this exact technique)
Orthobullets or AO Surgery Reference for surgical technique videos
JBJS Essential Surgical Techniques which often has narrated video walkthroughs

Which of the alternatives above would be most useful to you?

Make an illustrated step-by-step surgical poster of this procedure

Generating Image

A detailed medical surgical poster titled "Lateral Release & Medial Plication for Congenital Patellar Dislocation" showing 12 numbered illustrated steps in a clean grid layout. Medical illustration style, clean white background, anatomical accuracy. Each step has a small labeled diagram and short caption: Step 1: Midline incision from distal femur to tibial tuberosity, skin flaps raised, patella and knee joint exposed - diagram shows anterior knee with incision line marked Step 2: Vastus lateralis released from proximal origin down to joint level; iliotibial band released to intermuscular septum - diagram shows lateral structures being cut Step 3: Anterolateral incision option (Eilert modification) shown - scar placement away from patella for pediatric patients Step 4: Rectus femoris Z-plasty lengthening shown if contracted - diagram shows Z-shaped tendon cut and lengthening Step 5: VMO (vastus medialis obliquus) incised from patella, medial capsule and patellar tendon mobilized Step 6: Patella manually reduced into femoral trochlear groove - diagram shows patella being seated centrally Step 7: VMO reattached distally and laterally to patellar tendon and medial retinaculum - sutures shown Step 8: Knee moved through range of motion - patella tracking assessed, VMO tension adjusted Step 9: Optional gracilis or semitendinosus tendon transfer as checkrein into patella for severe instability Step 10: VMO repair completed proximally and distally along full length Step 11: Second range of motion check - patella confirmed tracking in femoral groove Step 12: Drain inserted, wound closed, long leg cast applied with knee at 30 degrees flexion Bottom of poster: anatomical legend showing patella, VMO, vastus lateralis, iliotibial band, patellar tendon, medial retinaculum. Color coded: lateral structures in red, medial structures in blue, bone in beige. Professional medical education poster style.

Lateral Release & Medial Plication Surgical Poster

Here is your illustrated surgical poster covering all 12 steps of the Lateral Release and Medial Plication procedure (Technique 31.26, Campbell's Operative Orthopaedics 15th Ed).

The poster includes:

All 12 operative steps with labeled anatomical diagrams
Color coding: lateral structures (red), medial structures (blue), bone (beige)
An anatomical legend at the bottom (patella, VMO, vastus lateralis, ITB, patellar tendon, medial retinaculum)
The Eilert modification note for pediatric incision placement
Optional steps (Z-plasty, gracilis/semitendinosus checkrein transfer)
Final casting position (30° knee flexion)

Let me know if you'd like a version focused on any specific portion (e.g., just the VMO advancement steps, or the anatomy legend in more detail), or if you'd like this exported as a downloadable PDF or PowerPoint slide.

This is a shared conversation. Sign in to Orris to start your own chat.