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Roentgenograms of bilateral knees in AP, showing laterally displaced patellae with initial degenerative tibiofemoral arthritis.
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Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because...
Citations
... Permanent Dislocation of the Patella is a atraumatic and isolated condition in which patella is located lateral to the trochlea and is asymptomatic during the first and second decades of life [5]. Treatment approach is affected by the anatomical and clinical differences of the periodical patellar instability and permanent dislocations of the patella. ...
... MPFL may have lost its tension. Genu valgum may accompany [5,10,11]. ...
... Some authors claimed that a conservative approach should be taken in permanent patella dislocation cases due to its clinically asymptomatic nature in early decades despite of its extraordinary morphology [5,12]. One of the supporters of this idea, Bistolfi et al. reported severe articular cartilage degeneration in the arthroscopic results of a 51-year-old asymptomatic bilateral permanent patella dislocation patient [5]. ...
Four knees of 3 patients were treated with medial patellofemoral ligament (MPFL) reconstruction and Fulkerson osteotomy for the dislocation of the permanent patella. Perioperative flexion limitation was treated with tibial tubercle elevation. In this study, we evaluated newly applied patella height and range of motion (ROM). Four knees of 3 patients (2 females and 1 male) underwent surgery. The mean age was 24.6 years (between 17 and 30 years). The mean follow-up period was 35 months (between 30 and 40 months). Mean preoperative ROM, mean perioperative ROM before tubercle elevation and mean postoperative ROM after tubercle elevation were 126 degrees (between 125 and 130 degrees), 71 degrees (between 60 and 80 degrees), and 131 degrees (between 130 and 135 degrees), respectively. Mean Lysholm score increased from 66 to 100. Tibial tubercle transfer/osteotomy and medial patellofemoral reconstruction are good treatment options for the dislocation of the permanent patella. In addition, during the recentering of the patella located in the outer part of the trochlea or rarely of the lateral condyle, the flexion can be restricted depending on the shortness of the extensor mechanisms. In our study, we elevated the tibial tubercle, and patella height remained within physiological limits. We believe tubercle elevation is a convenient solution for the flexion limitation that occurs during the reconstruction of the dislocation of the patella.
... In the presence of CDP, genetic disorders such as arthrogryposis, lateral femoral condyle aplasia, nail patella syndrome, genitopatellar syndrome, Meier-Gorlin syndrome, Down syndrome, or others should be excluded [1,2]. CDP is a permanent and irreducible dislocation of the patella, resting adjacent to the lateral femoral condyle with empty trochlear groove, knee flexion contracture, or inability to achieve a full active extension; it is associated with varying degrees of genu valgum and proximal tibial torsion [3,4]. The most accepted etiological hypothesis is failure of the rotation of the myotome containing the quadriceps and patella which normally occurs in the first trimester of intrauterine life; if this fails to occur the extensor apparatus remains in the lateral position with permanent patellar dislocation: In this position, the extensor apparatus works as a knee flexor and external rotator [1,5]. ...
... Most patients in previous review had a flexion knee contracture with difficult walking. It is reported that when the ability to extend the knee is preserved, CDP does not lead to functional failure and it is likely that the pathology comes at the attention of the physician during the adulthood [3,11,16,17,18]. ...
... Bistolfi et al. described the case of a 51-year-old patient suffering from bilateral CDP who complained of knee pain after a meniscal injury; no treatment of the patella dislocation had been proposed. The authors reported other cases of CDP diagnosed and treated in adulthood with varying results [3]. ...
Introduction:
Congenital dislocation of the patella (CDP) is a rare condition and its treatment is not well defined. In CDP, patella is dislocated on the lateral aspect of the distal femur, laterally from the trochlear groove, it cannot be reduced manually and it is almost always associated with genu valgum, lateral torsion of the proximal tibia, and flexion contracture of the knee. This condition is present at birth, but the clinical findings can be subtle at birth due to the size and character of the structures being examined; early diagnosis is essential, but it may be delayed to late childhood or adulthood. If CDP is not promptly treated, the disability increases during growth, so surgical correction should be planned as soon as the diagnosis is confirmed.
Case report:
We report a case of bilateral CDP associated with bilateral proximal radioulnar joint stiffness; the patient at the age of diagnosis was 11 years old and underwent a bilateral delayed surgical procedure; the 4-year follow-up results are satisfactory. Surgical treatment rationale and literature are reviewed.
Conclusion:
Surgical correction for CDP is generally recommended, but there is no agreement in literature on the ideal treatment and in some cases, with mild impairment of the knee function, observation alone has been suggested. The decision about a surgical treatment can be difficult and depends on the degree of disability of the patient.
... 13 It has been reported that it is possible for patients with this condition to be pain-free and have no limitations in daily life, which can lead to delayed diagnosis during adulthood. 18,19 Different types of foot pathology can be seen with this condition and include calcaneovalgus foot deformity, congenital vertical talus, and talipes equinovarus. 13 Regarding the laterality of this condition, numerous authors have reported that it can present either unilaterally or bilaterally. ...
... Definitive treatment of fixed dislocation of the patella requires surgical intervention in order to improve function and to prevent subsequent degenerative changes to the knee. 13,14,19,31 The strategies described below are used for congenital dislocations and habitual dislocators that are fixed. This approach is also used for the obligate dislocator that is not fixed. ...
... 13,20,[32][33][34][35] The same approach to the lateral quadrant has been documented by other surgeons with only minor modifications. 11,36 For example, Sever et al. described splitting the fascia lata rather than excising it as described in the original procedure, and Gordon et al. noted that the lateral dissection did not need to be extended as proximally as described by Stanisavljevic et al. 11,19,36 Other surgeons may also take slightly modified approaches for their lateral release. Ghanem et al. noted Copyright @ 2020 JPOSNA www.jposna.org ...
Congenital dislocation of the patella is a rare disorder present at birth which manifests as a permanent and irreducible patella fixed on the lateral aspect of the femoral condyle. Congenital dislocation of the patella is frequently found in syndromic patients with a flexion contracture at the knee, genu valgum, foot deformity and external tibial torsion. Other syndromic patients with habitual or obligate dislocation may also develop a fixed position laterally with time. Surgical correction for fixed patella dislocation is the only definitive treatment for this condition and typically includes lateral release, medial stabilization, distal patellar tendon realignment, and proximal extensor lengthening if needed. Outcomes following surgical correction are generally satisfactory, with an improvement in function, range of motion, and quality of life for patients. The aim of this paper is to review the current understanding of fixed dislocation of the patella and provide an updated overview of the diagnosis and to outline a surgical strategy according to the different quadrants of knee pathology.
... Lateral vastus and medial vastus muscle tightness was found intraoperatively. These findings were also reported by Bistolfi et al. as conspicuous muscle wasting of each thigh on the medial side with depression on the medial vastus [16]. The muscle anatomical changes in this patient required that the initial lateral release of the tightened and fibrotic muscle must be done extensively so that the patella could be freed and reduced into its anatomical position. ...
Lateral dislocation of the patella is not uncommon and may impede daily activities as this causes compressive dysfunction and instabilities. Most cases of patellar lateral dislocation are due to damage to the medial patellofemoral ligament (MPFL), either rupture of detachment of the patella or femoral attachment. MPFL reconstruction alone was considered adequate for the treatment of this condition. We present a case of a 49-year-old male with chronic posttraumatic lateral patellar dislocation of the right knee of 25 years, which we treated with extensive lateral release and right medial patellofemoral ligament reconstruction with 5-year follow-up data.
... There have been only a few reports of operative treatment for PDP with knee osteoarthritis [6,7]. Total knee arthroplasty through the medial parapatellar approach together with realignment procedures have been selected in most cases. ...
... Knees with PDP generally have several other anatomical abnormalities other than valgus coronal alignment such as rotational malalignment of the lower limb, femoral trochlear dysplasia, or lateralization of the tibial tuberosity [7,8]. These can affect rotational alignment between the tibia and femur, therefore we have used a mobile bearing TKA that allows rotational adjustment after implantation even for a minor rotational error in component placement [9]. ...
Introduction:
Permanent dislocation of the patella (PDP) is a rare condition. In cases of PDP with tibiofemoral arthritis, total knee arthroplasty may be performed through a medial parapatellar approach with patellar realignment. In this article we present two cases of PDP with tibiofemoral osteoarthritis successfully treated via lateral approach TKA without any additional realignment procedure. We performed two total knee arthroplasties for PDP with lateral tibiofemoral arthritis through a lateral approach without any realignment procedure. Mobile bearing inserts were used to adjust rotational alignment. The patients showed improved functional outcomes (Japanese Orthopaedic Association Knee score and Oxford Knee Score), and improved range of motion. Three years postoperatively, the patellae remain stable without dislocation nor maltracking, maintaining a high functional score.
Conclusion:
To treat permanent dislocation of the patella with lateral knee osteoarthritis, TKA through a lateral approach have potential to be a new treatment option to achieve both a good outcome and repositioning of the patella.
... The higher age in our series may be due to local geographical and health care issues leading to most of our patients presenting later for treatment. However, others have reported similar late presentation 1 and Bistolfi 18 published the case of a 51-year-old male with CDP, stating that the condition dated since child hood and that in the presence of a fixed-flexion knee contracture, if arthrogryposis is excluded, the condition is CPD. ...
... Although Koplewitzet al 10 stated that CDP causes severe impairment in joint function, Bistolfi et.al. 18 reported a 51-yearold patient who presented with pain following trauma, which they attributed to a lateral meniscus tear which they treated arthroscopically and left the patella dislocated. Marmor 21 reported a 63year-old patient with CDP, whom he treated with TKR for osteoarthritis and Torisu 22 reported a 50- ...
ABSTRACT
Background: Congenital dislocation of the patella (CPD) is a rare anomaly which produces a marked contracture of the quadriceps mechanism and deformity of the knee. Conservative treatment is unlikely to succeed.
Objective: To study the outcome of management of (CPD) at the Department of Paediatric Orthopaedics
Soba University Hospital.
Materials and Methods: A retrospective review of the records of six patients (five females, one male) with a mean age of 9.5 years (range 5 to 15). Three cases were bilateral. All underwent operative reconstruction. The assessment of the outcome as excellent, good, fair or poor was based on the Ferris classification which included, range of movement, stability and absence of pain.
Results: The outcome was good in all cases, and there were no significant complications.
Conclusion: These results are similar to reports elsewhere and we advise reconstruction of the deformity as soon as reasonably possible after diagnosis.
Key word: Congenital dislocation of the patella, Ferris classification, Soba, Sudan.
Congenital dislocation of the patella is a rare condition characterized by lateral dislocation of the patella that is irreducible without surgical correction. Although there is no clear inheritance pattern, it is associated with several congenital syndromes. Patients often demonstrate flexion contracture, loss of active knee extension, increased tibial external rotation, and absent patella in the trochlea. Treatment requires surgical management and is comprised of lateral release, medial stabilization, quadriceps lengthening, and distal realignment. Results are generally favorable after treatment; persistent flexion contracture and redislocation are the most common complications. Further study is needed to define the optimal timing and treatment strategy for this uncommon condition.
In diesem Kapitel steht die Rotation des Kniegelenks im Fokus der Betrachtung. Hierbei werden Physiologie und Pathophysiologie der freien und aktiven Rotation ebenso beleuchtet wie Besonderheiten der patello-femoralen Anatomie und ihrer Auswirkung auf die Rotation. Ein weiterer Abschnitt befasst sich mit der Varus-Flexion-IR und Valgus-Flexion-AR. Neben den physiologischen Aspekten werden auch die Verletzungen des aktiven Rotationssystems näher betrachtet. Ein weiteres Thema stellt die passive Rotationsstabilisierung (u. a. durch die trianguläre Struktur, die Fabella etc.) dar.
