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Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient.

Li X, Nielsen NM, Zhou H, Stein BS, Shelton YA, Busconi BD - Orthop Rev (Pavia) (2013)

Bottom Line: Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability.At the one-year follow-up, our patient had improved knee range of motion and decrease in pain.Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder and Elbow Surgery, Boston University School of Medicine , Boston, MA.

ABSTRACT
Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue (predominantly, the medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation) and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semitendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

No MeSH data available.


Related in: MedlinePlus

Picture taken of the patient’s knee in clinic. Blue arrow points to the dislocated patella and deformity. The patient and parents noted this deformity since childhood.
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fig001: Picture taken of the patient’s knee in clinic. Blue arrow points to the dislocated patella and deformity. The patient and parents noted this deformity since childhood.

Mentions: A 15-year-old active male referred to our orthopedic clinic after an unsuccessful attempt at a closed reduction of a right lateral patellar dislocation in the emergency room. The patient states that he sustained a knee injury by falling off a fire hydrant. He also reports a vague history of trauma to this knee during his childhood but with no previous surgical interventions. The patient was seen by a physician in Puerto Rico over ten years ago for this injury, but both he and his parents was not sure of the diagnosis. Further questioning reveals that the patient and his parents always noticed a bump on the lateral aspect of his right knee since childhood with limitation of motion and activity. Gait is slightly antalgic and initial examination of this patient’s right knee reveals a gross deformity on the anterolateral aspect of the knee (Figure 1). There was minimal pain with palpation of the patella. Knee range of motion was limited to 15° to 120° with no pain at the extremes of motion and stable to provocative testing. Examination of the contra-lateral knee was normal. An attempt to reduce the patella in clinic was unsuccessful as there was minimal patellar movement with medially directed force. Initial radiographs of the knee (Figure 2) demonstrated a lateral dislocated patella with no fracture or patella alta and no trochlear dysplasia (no crossing sign). Magnetic resonance imaging (MRI) of the right knee confirms the lateral patella dislocation with attenuation of the MPFL, mild joint effusion, and without bone edema (Figure 3). TT-TG distance was 33 mm on computed tomography (CT) scan. Both the conservative and surgical options was discussed with the patient and his family, decision was made to proceed with surgical intervention.


Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient.

Li X, Nielsen NM, Zhou H, Stein BS, Shelton YA, Busconi BD - Orthop Rev (Pavia) (2013)

Picture taken of the patient’s knee in clinic. Blue arrow points to the dislocated patella and deformity. The patient and parents noted this deformity since childhood.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3718243&req=5

fig001: Picture taken of the patient’s knee in clinic. Blue arrow points to the dislocated patella and deformity. The patient and parents noted this deformity since childhood.
Mentions: A 15-year-old active male referred to our orthopedic clinic after an unsuccessful attempt at a closed reduction of a right lateral patellar dislocation in the emergency room. The patient states that he sustained a knee injury by falling off a fire hydrant. He also reports a vague history of trauma to this knee during his childhood but with no previous surgical interventions. The patient was seen by a physician in Puerto Rico over ten years ago for this injury, but both he and his parents was not sure of the diagnosis. Further questioning reveals that the patient and his parents always noticed a bump on the lateral aspect of his right knee since childhood with limitation of motion and activity. Gait is slightly antalgic and initial examination of this patient’s right knee reveals a gross deformity on the anterolateral aspect of the knee (Figure 1). There was minimal pain with palpation of the patella. Knee range of motion was limited to 15° to 120° with no pain at the extremes of motion and stable to provocative testing. Examination of the contra-lateral knee was normal. An attempt to reduce the patella in clinic was unsuccessful as there was minimal patellar movement with medially directed force. Initial radiographs of the knee (Figure 2) demonstrated a lateral dislocated patella with no fracture or patella alta and no trochlear dysplasia (no crossing sign). Magnetic resonance imaging (MRI) of the right knee confirms the lateral patella dislocation with attenuation of the MPFL, mild joint effusion, and without bone edema (Figure 3). TT-TG distance was 33 mm on computed tomography (CT) scan. Both the conservative and surgical options was discussed with the patient and his family, decision was made to proceed with surgical intervention.

Bottom Line: Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability.At the one-year follow-up, our patient had improved knee range of motion and decrease in pain.Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder and Elbow Surgery, Boston University School of Medicine , Boston, MA.

ABSTRACT
Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue (predominantly, the medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation) and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semitendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

No MeSH data available.


Related in: MedlinePlus