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

Xinning Li, Natalie M. Nielsen, Hanbing Zhou, Beth Shubin Stein, Yvonne A. Shelton, Brian D. Busconi

Authors information
  • Xinning Li
    Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder and Elbow Surgery, Boston University School of Medicine, Boston, MA, United States. xinning.li@gmail.com
  • Natalie M. Nielsen
    Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States.
  • Hanbing Zhou
    Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States.
  • Beth Shubin Stein
    Department of Orthopedic Surgery, Division of Sports Medicine, Hospital for Special Surgery, New York, NY, United States.
  • Yvonne A. Shelton
    Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States.
  • Brian D. Busconi
    Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States.

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 semi-tendinosis 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.

Keywords


pediatric orthopedics, patella dislocation, Faulkerson procedure, MPFL reconstruction

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Submitted: 2013-03-10 23:15:41
Published: 2013-06-10 12:19:49
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