The traumatic factor plays a prominent rôle in this condition. Two types of cases are noted: (1) the. Academic Surgeons. Upstate Orthopedics, LLP – Upstate Medical University Department of Orthopedic Surgery in Syracuse, NY is seeking a BC/BE Surgeons in. Habitual dislocation of patella. 1. Case Presentation Habitual Dislocation of Patella Dr Sushil Sharma First Year MS Orthopaedic Resident; 2.

Author: Mazil Darg
Country: Martinique
Language: English (Spanish)
Genre: Software
Published (Last): 16 May 2007
Pages: 209
PDF File Size: 9.78 Mb
ePub File Size: 10.32 Mb
ISBN: 898-5-76740-218-4
Downloads: 55777
Price: Free* [*Free Regsitration Required]
Uploader: Brar

First lateral retinacular release of the patella was performed. Long term follow up results. Contracture of the deltoid muscle in the adult after intramuscular injections. A discussion on the etiology and relationship to recurrent dislocation of the patella.

Treatment of habitual dislocation of patella in an adult arthritic knee

They recommended that distal procedures alone are certain to fail, and if the procedure involves distal advancement of the tibial tendon the condition will actually be made worse. In case of no retraction of the knee extensor apparatus or predisposing bone factors, isolated MPFL reconstruction seems effective in treating confirmed patellar instability. Pes anserinus transposition for patellar dislocation. Bone factors probably had only a small role in the dynamic stability of the patella.

In our patient, radiographic results have shown that instability was not caused by bone anomalies. Other abnormalities including a shallow femoral groove, hypoplastic lateral femoral condyle, and lateral insertion of the patella tendon were also noted. Imaging of the soft tissues might have provided more specific information. We adjusted the length of the graft by taking into account engagement of the patella and by obtaining full range of motion in the patrlla. Various pathological factors have been described in the pathogenesis of pqtella dislocation of patella.

In later childhood didlocation present with habitual dislocation of the patella.


At the final month clinical follow-up, the operated knee was stable and there was no pain. Journal List Oatella J Orthop v. The surgery included lateral release, advancement of medial retinaculum, and the anteromedial tibial tubercle transfer. The rest of the clinical examination, in particular the neurological, muscular, and tendon results were normal. The lateral tether is released by dividing the fibrous adhesions, which extended along the lateral intermuscular septum.

Quadriceps tendon was lengthened using V Y plasty at aponeurotic junction. Criteria which allowed him to return to work were no pain, stability of the patella, no swelling, and full range of motion.

Because the injury was anatomical, conservative treatment with rehabilitation was not proposed. There was no recurrent dislocation or apprehension. The most important factor is contracture of soft tissues lateral to patella. When the vastus lateralis and the iliotibial tract are involved there is great tendency for habitual dislocation of the patella to occur on flexion of the knee. Treatment A number of reconstructive procedures have been described in the literature for the management of patellar instability.

View at Google Scholar J. Please review our privacy policy. The failed TKA was revised by using constrained-type prosthesis. There were no scars on the knee. Depending on the pathology; medial plication, advancement of vastus medialis across the anterior surface of the patella, patellar tendon transfer or transfer of sartorius to the patella was added. Williams reported clinical presentations and pathophysiology in patients with quadriceps contractures.

During surgery the tight lateral bands were released from the patella and the incision was continued proximally, lateral to the rectus femoris tendon, thus fully releasing the vastus lateralis. She was carrying out her daily activities without much pain or symptoms, but she was never symptom free during this period.

This is not the same for adult patellar dislocation with arthritis, where no specific treatment protocols are established. The distinction between these groups is important as the surgical treatment for each group is quite different.


They found that vastus medialis was so deficient that muscle advancement was not possible. Redislocation was seen in a few cases and was due to either rectus lengthening not being performed at initial surgery or failure to realign distally when ppatella lateral patellar tendon insertion was detectable clinically, or reformation of contractures.

Open in a separate window.

Though the initial plan was to subject the patient for total knee replacement after soft tissue surgery, the procedure was deferred as there was significant improvement in function kujala score after the soft tissue surgery and the patient herself denied the second procedure. This is followed by complete dissection of vastus lateralis from its attachment to the patella and the lateral side of rectus femoris.

The main difficulty which could have been encountered during surgery was identifying a flexion deficit after performing reconstruction because of the secondary retraction of the habitusl. Influence of soft tissue structures on patellar three dimensional tracking.

Quadriceps strength was rated 4 MRC grade.

Treatment of habitual dislocation of patella in an adult arthritic knee

Habtiual diagnostic relevance of Q angle as an indication for distal realignment was not established in our case and we recommend tibial tuberosity-trochlear groove distance TTTG as measured by CT scan as a better tool. Therefore, there was no indication for recentering the patella or lowering the tibial tubercle by osteotomy. National Center for Biotechnology InformationU.