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Habitual Dislocation Patellaa surgical case summary
Vinod NaneriaGirish Yeotikar
Arjun WadhwaniChoithram Hospital & Research Centre, Indore, India
Types of Dislocations
• Habitual dislocation of the patella in flexion implies that dislocation occurs every time the knee is flexed. The displacement is painless.
• Recurrent dislocation which occurs as isolated episodes, often in response to trauma and is accompanied by pain and followed by swelling.
• Congenital dislocation refers to an irreducible dislocation present since birth and associated with a lateral position of the entire quadriceps mechanism.
The distinction between these groups is important as the surgical treatment for each is quite different.Operations for habitual dislocation of the patella always requires releases proximal to the patella.Operations for recurrent dislocation usually involve procedures distal to the patella.
Persistent & Obligatory
• Persistent Dislocation
• Patella is dislocated lateral and persistent in that location.
• Often obvious in infency• Usually associated with
other anomalies• Knee flexion contracture
present.• Functional disability.
• Obligatory Dislocation
• Patella dislocates and reduces spontaneously with flexion and extension of knee
• Usually present at 5 to 10 years of age
• Usually isolated anomaly• ROM usually normal
optimize quadriceps alignment.
Pathology
Cause - Effect
Surgical management of congenital and habitual dislocation of the patella.Gao GX, Lee EH, Bose K.congenital dislocation patella (CDP) and habitual dislocation patella (HDP) followed for 2-15 years after surgical stabilization of the patella.
The underlying pathology in both conditions was contracture of the quadriceps mechanism, which was more severe in CDP. Surgical stabilization included an extensive lateral release, medial plication, and transfer of the lateral half of the patella tendon. Lengthening of the rectus femoris tendon. With appropriate operative procedures, satisfactory results were achieved in 36 of the 41 knees (87.8%).
J Pediatr Orthop. 1990 Mar-Apr;10(2):255-60.
Typical Procedure
Case summary
• 10 years old Female.• Bilateral habitual dislocations.• No other congenital anomaly.• Painless full range of movements.
Surgical procedure
• Anterio-medial incision• Dissection to lateral side of patella.• Release of lateral patellar retinaculum from patellar
tendon to vastus lateralis.• VMO isolation, and separation.• Semitendinosis tendon isolation, detachment and
plication with superior pole of patella.• VMO advancement and attachment with anterior and
medial part of patella.• Check the position of patella by flexion.
Anterio-medial incision
Exposure of lateral border of patella
medial
superior
inferior
Release of lateral retinaculum
Superior polePatellar tendon
VMO elevation
Isolation of Semitendinosus
superior
inferior
Isolation of semitendinosus
Tendon passed under the superior pole patellaTurned back medially to align patella in center as checkrein.
PatellaRectus femoris tendon
Patellar tendon
Semitendinosus tendon
Semitendinosus TenodesisLateral release
VMO advancement distally and laterally
PatellaRectus femoris tendon
Patellar tendon
Semitendinosus tendon
Vastus Medialis Oblicus
Lateral release
PatellaRectus femoris tendon
Patellar tendon
Semitendinosus tendon
Vastus Medialis Oblicus distal
advancement
Lateral release
VMO advancement complete
Summary
Lateral release - as per requirementMedial plication
VMO advancementSemitendinosus tenodesis
Optional :-Patellar tendon transfer
Rectus femoris lengthening
Extent of Surgery proportional to contractures
DISCLAIMER• Information contained and transmitted by this presentation is based
on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 32 years.
• It is intended for use only by the students of orthopaedic surgery. Many GIF files are taken from Internet/Textbooks.
• Views and opinion expressed in this presentation are personal.• Depending upon the x-rays and clinical presentations viewers can
make their own opinion.• For any confusion please contact the sole author for clarification. • Every body is allowed to copy or download and use the material best
suited to him. • For any correction or suggestion please contact [email protected]