Visualization of osteochondral fragments in the cavity of the knee joint in case of patellar dislocation in children

The objective was to assess the capabilities of MRI and CT in visualizing free bone and cartilage fragments in the knee cavity after lateral dislocation of the patella. Materials and methods. CT and MRI were performed in 220 patients, including 127 girls and 93 boys aged 12 to 18 years (mean age 14.5 years), with acute lateral patellar dislocation. Results. Lateral dislocation of the patella in 25% of cases led to the appearance of osteochondral fragments. CT scan revealed and confirmed osteochondral fragments surgery in 55 people (100%), MRI scan - in 50 people (90%). The sites of the detachment of the osteochondral fragments were: a medial facet of the patella in 22 (38.8%), the outer edge of femur lateral condyle in 33 (58.2%), t patella and lateral condyle of the femur in 2 patients (3%). Free cartilage fragments not detected by CT were detected by MRI in 2 patients. Conclusion. Patellar dislocation is an injury that is likely to require surgery. The volume of osteochondral and soft tissue lesions can be established with the maximum degree of probability by MRI while detecting small osteochondral fragments is most reliable with CT. Combining these two observation methods provides the complete possible information about the extent of damage, which allows timely resolution of treatment tactics.

Download Full-text

Extensive Lateral Release and Medial Patellofemoral Ligament Reconstruction in 25 Years of Chronic Fixed Lateral Patellar Dislocation: A 5-Year Follow-Up Case Report

Case Reports in Orthopedics ◽

10.1155/2019/9542398 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Andri M. T. Lubis ◽

Petrus Aprianto ◽

Yudistira P. Siregar

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Daily Activities ◽

Lateral Release ◽

Medial Patellofemoral Ligament Reconstruction ◽

Lateral Dislocation ◽

Lateral Patellar Dislocation ◽

The Right

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.

Download Full-text

Extensive Lateral Release and Medial Patello-femoral Ligament Reconstruction in 25 years of Chronic Fixed Lateral Patellar Dislocation: A 5 year follow up Case Report

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00481 ◽

2019 ◽

Vol 7 (11_suppl6) ◽

pp. 2325967119S0048

Author(s):

Andri Lubis ◽

Petrus Aprianto ◽

Yudistira P. Siregar

Keyword(s):

Case Report ◽

Patellar Dislocation ◽

Femoral Tunnel ◽

Mpfl Reconstruction ◽

Lateral Release ◽

Modified Technique ◽

Lateral Dislocation ◽

Cortical Screw ◽

Lateral Patellar Dislocation

Objectives: Chronically fixed lateral patellar dislocation is uncommon and mostly associated with disruption of the medial patellofemoral ligament (MPFL) which is a major risk factor for this condition, as it functions as the main patella medial stabilizer. This paper focuses on the reconstruction of the MPFL after an extensive lateral release in a fixed lateral patellar dislocation. We aim to explain the technique that was used to reduce and maintain the position of the patella and prevent it from re-dislocation. Extensive lateral release and modified MPFL reconstruction for a chronically fixed patellar lateral dislocation provide a satisfactory result. We aim to explain a modified technique to treat a chronically fixed patellar lateral dislocation Case presentation: We present a case report of a 49-year-old Caucasian male with a history of falling on his right knee 25 years before. He complained of pain on his knee for 8 months before. Physical examination showed chronically fixed lateral patellar dislocation with a normal range of motion. The diagnosis of patellar dislocation was confirmed with a conventional radiograph. The patient underwent extensive lateral release of the knee followed by a modified technique for MPFL reconstruction. Semitendinosus tendon was used as the graft because of the chronic nature of this condition. The graft was inserted into the patellar tunnel and fixed using endobutton®. The graft was inserted into the femoral tunnel that was made at Schottle point from the medial through the lateral side. After that, the cortical screw with the washer was inserted on the lateral femoral side just above the femoral tunnel as an anchor to make sure the tendon is secured. We follow-up the patient for 5 years. Results and Conclusion: On a 5 year follow-up, there was no complaint of recurrent patellar dislocation. The result of this extensive lateral release followed by modified MPFL reconstruction for a chronically fixed lateral patellar dislocation is satisfactory. The extensive release was needed to reduce the fixed dislocated patella and this modified technique of MPFL reconstruction by using screw and washer as an anchor on lateral sides of the femur could be an alternative to prevent re-dislocation.

Download Full-text

Two Patients with Osteochondral Injury of the Weight-Bearing Portion of the Lateral Femoral Condyle Associated with Lateral Dislocation of the Patella

Case Reports in Orthopedics ◽

10.1155/2014/876410 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Shuji Nakagawa ◽

Yuji Arai ◽

Hiroaki Inoue ◽

Satoru Atsumi ◽

Shohei Ichimaru ◽

...

Keyword(s):

Patellar Dislocation ◽

Femoral Condyle ◽

Weight Bearing ◽

Lateral Femoral Condyle ◽

Bearing Surface ◽

Lateral Dislocation ◽

Osteochondral Injury ◽

Osteochondral Fragment ◽

Femoral Groove ◽

Dislocation Of The Patella

Complications of patellar dislocation include osteochondral injury of the lateral femoral condyle and patella. Most cases of osteochondral injury occur in the anterior region, which is the non-weight-bearing portion of the lateral femoral condyle. We describe two patients with osteochondral injury of the weight-bearing surface of the lateral femoral condyle associated with lateral dislocation of the patella. The patients were 18- and 11-year-old females. Osteochondral injury occurred on the weight-bearing surface distal to the lateral femoral condyle. The presence of a free osteochondral fragment and osteochondral injury of the lateral femoral condyle was confirmed on MRI and reconstruction CT scan. Treatment consisted of osteochondral fragment fixation or microfracture, as well as patellar stabilization. Osteochondral injury was present in the weight-bearing portion of the lateral femoral condyle in both patients, suggesting that the injury was caused by friction between the patella and lateral femoral condyle when the patella was dislocated or reduced at about 90° flexion of the knee joint. These findings indicate that patellar dislocation may occur and osteochondral injury may extend to the weight-bearing portion of the femur even in deep flexion, when the patella is stabilized on the bones of the femoral groove.

Download Full-text

Lateral Dislocation of the Patella Following Marmor and Guepar Arthroplasty of the Knee

Acta Orthopaedica Scandinavica ◽

10.3109/17453677809005767 ◽

1978 ◽

Vol 49 (3) ◽

pp. 291-294 ◽

Cited By ~ 13

Author(s):

Otto Sneppen ◽

Nis Fredensborg ◽

Agnete Karle ◽

Ulrik Klaumann

Keyword(s):

Lateral Dislocation ◽

Dislocation Of The Patella

Download Full-text

The management of lateral patellar dislocation: state of the art

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2015-000011 ◽

2017 ◽

Vol 2 (4) ◽

pp. 205-212 ◽

Cited By ~ 5

Author(s):

Elizabeth A Arendt ◽

Simon T Donell ◽

Petri J Sillanpää ◽

Julian A Feller

Keyword(s):

Patellar Dislocation ◽

State Of The Art ◽

Lateral Patellar Dislocation

Download Full-text

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

The American Journal of Sports Medicine ◽

10.1177/0363546516680604 ◽

2016 ◽

Vol 45 (5) ◽

pp. 1012-1017 ◽

Cited By ~ 41

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.

Download Full-text