Goldthwait technique for patellar instability: surgery of the past or here to stay procedure? A systematic review of the literature.

Patellar instability is the pathologic condition where the patella is prone to recurrent lateral dislocation. The clinical results on large series of patients and long-term outcome of Goldthwait techniques have not been described in the literature. The aim of this systematic review is: (1) to analyze and summarize the available literature focused on Goldthwait procedure in the treatment of recurrent patellar dislocation and (2) to evaluate the clinical and functional outcomes of patients treated with this surgical procedure. A systematic review of the literature was performed to investigate the results of Goldthwait procedure according to the PRISMA 2009 guidelines. A total of 7 articles published were systematically reviewed. A total of 197 knees (182 patients: 86 males and 96 females) have been treated with Goldthwait procedure. The mean reported follow-up was 6.8 years. The mean age at surgery was 18 years old. The Goldthwait procedure was associated with open lateral retinacular release in 127 (64.5%) knees to arthroscopic lateral retinacular release in 20 (10.1%) knees, and with retinacular plasty and a vastus medialis advancement in 33 (16.7%) knees. Only in 17 (8.6%) knees the Goldthwait procedure was performed as an isolated procedure. Poor standardization of methodological assessment has been observed. Despite the limitations of the available literature, the Goldthwait technique provides satisfying results for the treatment of patellar instability even in pediatric population. More high-quality studies are necessary to evaluate the long-term complications and the real incidence of long-term PF osteoarthritis.