Permanent patellar dislocation after a nonoperative treatment of recurrent dislocation of the patella because of trochlear dysplasia

2013 ◽  
Vol 22 (4) ◽  
pp. 325-328 ◽  
Author(s):  
Sabine Lippacher ◽  
Heiko Reichel ◽  
Manfred Nelitz
Keyword(s):  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Nonoperative Treatment ◽  
Dislocation Of The Patella

scholarly journals Recurrent Dislocation of the Patella in Kabuki Make-Up Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Lucie Rouffiange ◽  
Jean-Paul Dusabe ◽  
Pierre-Louis Docquier
Keyword(s):  
Postoperative Complication ◽  
Patellar Dislocation ◽  
Recurrent Dislocation ◽  
Tibia Fracture ◽  
Tibial Tuberosity ◽  
Vastus Medialis ◽  
Kabuki Syndrome ◽  
Surgical Results ◽  
Ligamentous Laxity ◽  
Dislocation Of The Patella

Two patients with Kabuki make-up syndrome with bilateral recurrent dislocation of the patella are presented. They had generalized ligamentous laxity and patellofemoral dysplasia. Both developed patellar dislocation in adolescence and required surgery, with medial transfer of the tibial tuberosity associated with vastus medialis plasty (Insall technique). One postoperative complication occurred in one case: a nondisplaced tibia fracture at the sixth postoperative week that healed with conservative means. Final results were good in both cases. Good surgical results can be achieved in patellar dislocation in patients with Kabuki syndrome.

scholarly journals Tratamiento quirúrgico de la luxación recidivante de rótula en el niño asociada a displasia patello-femoral./ Surgical treatment of recurrent patellar dislocation in children associated with patello-femoral dysplasia

2014 ◽  
Vol 14 (1) ◽  
pp. 117-128
Author(s):  
Enrique Vergara- amador ◽  
Ricardo Castro
Keyword(s):  
Down Syndrome ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Recurrent Patellar Dislocation ◽  
Femoral Trochlea ◽  
Small Series ◽  
Q Angle ◽  
Proximal Realignment

Objetivo:El objetivo del presente trabajo es mostrar los resultados en una serie cortade pacientes con inestabilidad patelo-femoral o luxación recurrente de rótula en niñosoperados con la técnica de realineamiento proximal. La inestabilidad patelo-femoralse define como una enfermedad en la cual no hay suficiente acople de la rótula con latróclea femoral durante el rango de movimiento de la rodilla. En niños esta inestabilidadpuede deberse a diversos factores anatómicos conduciendo a luxación recurrente dela rótula. Hay cirugías sobre la parte proximal o distal de la rótula.Materiales y mé-todos:tratamos una serie de 10 rodillas en 7 niños, con un realineamiento proximalde la rótula según la técnica de Insall.Resultados:se obtuvieron buenos resultadosen 8 rodillas, sin dolor, sin luxación ni inestabilidad residual, presentando buenaestabilidad y seguridad durante la marcha. Un paciente presento reluxación y otrocon Síndrome de Down, presento con el tiempo una subluxación.Conclusiones:Elrealineamiento proximal en esta serie muestra buenos resultados en pacientes quetenían poca displasia troclear y sin mucha alteración del ángulo Q. Es una técnicano muy usada, que tiene indicación en casos escogidos. Hoy en día con el conceptode la reconstrucción del ligamento patelo- femoral medial, este puede ser usado encombinación con las técnicas de realineamiento proximal. Hay que estar alerta conlos pacientes con síndromes que se acompañan de hiperlaxitud como el S. de Down. Objective: The aim of this paper is to show the results in a small series of patients withpatellofemoral instability or recurrent patellar dislocation in children operated with theproximal realignment technique. Materials and methods: It is a series of 10 knees in7 children, with proximal patela realignment patela using the Insall technique. The mostimportant role of the patela is to increase the quadriceps efficiency. The patelo -femoralinstability is defined as a condition in which there is insufficient coupling of the patelawith the femoral trochlea during the knee range of motion. In children this instabilitymay be due to various anatomical factors leading to recurrent dislocation of the patela.There are surgeries proximal o distal to the patela level. Results: Good results wereobtained on 8 knees, without pain, neither dislocation nor residual instability and havinggood stability and safety during the gait. One patient showed redislocation and anotherpatient with Down syndrome had a subluxation. Conclusions: proximal realignment inthis series shows good results in patients who had little trochlear dysplasia with mildalteration of the Q angle. It is a technique not widely used but has indicated in selectedcases. Today, the patelo - femoral medial ligament reconstruction, can be used incombination with proximal realignment techniques. Patients with collagen problemslike Marfan and Down syndrome usually have redislocation and require some otherprocedures for patelar stabilization.

scholarly journals Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110111
Author(s):  
Anthony J. Ignozzi ◽  
Zane Hyde ◽  
Scott E. Dart ◽  
David R. Diduch
Keyword(s):  
Patient Satisfaction ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Trochlear Groove ◽  
Thick Shell ◽  
Absorbable Sutures ◽  
Postoperative Dislocation ◽  
A Prospective Study ◽  
Patellar Stability

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis

2016 ◽  
Vol 45 (5) ◽  
pp. 1012-1017 ◽  
Author(s):  
Thomas L. Sanders ◽  
Ayoosh Pareek ◽  
Nicholas R. Johnson ◽  
Michael J. Stuart ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Cumulative Incidence ◽  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patellofemoral Arthritis ◽  
Level Of Evidence ◽  
Lateral Patellar Dislocation ◽  
Osteochondral Injury

Background: The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Study Design: Cohort study; Level of evidence, 3. Methods: In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. Results: At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P < .001) than individuals without a patellar dislocation. However, the risk of knee arthroplasty was similar between groups (HR, 2.8; 95% CI, 0.6-19.7; P = .2). Recurrent patellar dislocations (HR, 4.5; 95% CI, 1.6-12.6), osteochondral injury (HR, 11.3; 95% CI, 5.0-26.6), and trochlear dysplasia (HR, 3.6; 95% CI, 1.3-10.0) were associated with arthritis after patellar dislocation. Conclusion: Patellar dislocation is a significant risk factor for patellofemoral arthritis, as nearly half of patients have symptoms and radiographic changes consistent with arthritis at 25 years after lateral patellar dislocation. Osteochondral injury, recurrent patellar instability, and trochlear dysplasia are associated with the development of arthritis.

scholarly journals Personalized preoperative planning in children with recurrent patellar dislocation severe

2019 ◽  
Vol 26 (3) ◽  
pp. 31-36
Author(s):  
G. P Kotel’nikov ◽  
Yu. V Lartsev ◽  
A. K Povelihin ◽  
P. V Ryzhov ◽  
D. S Kudashev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Postoperative Period ◽  
Patellar Dislocation ◽  
Preoperative Planning ◽  
Recurrent Dislocation ◽  
Knee Joints ◽  
Lateral Projection ◽  
Results Of Treatment ◽  
Personalized Approach ◽  
Severe Degree

The aim of the study: was to improve the results of treatment in children with recurrent severe patellar dislocation, through the development of a differentiated approach to preoperative planning. Material and Methods. In SLLP Clinics Samara state medical University from 2014 to 2018 was observed 54 patients with this disease. In 37 patients recurrent severe dislocation. The average age of patients is 14.2 years. The patients underwent postural radiography of the lower extremities, radiography of the knee joint in the lateral projection, computed tomography of the knee joints, computed tomography of the hip joints. Research patients measured parameters, confirming mnohopocetny dysplastic changes of the joint angle Q, the index Insall-Salvati, the congruence angle on Merchant and anticarsia of the femoral head. Because of the severe degree of the disease, bone plastic surgery is indicated. Patients underwent corrective supracondylar derotation-dialysisa osteotomy of the femur in combination with medialization and distalization of the tibial tuberosity. During this operation, it is possible to perform a correction in all three planes. Results. In the postoperative period, 32 patients have no complications, 1 patient has relapse, 4 patients have contracture. In the long-term postoperative period 86.5% of positive results and 13.5% of unsatisfactory results, which is much lower than 36.1% - the percentage of complications according to the medical literature. Conclusion. The proposed personalized approach in preoperative planning for recurrent dislocation of the patella of severe degree, allows you to choose the best option for surgery.

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