Volume 7 | Issue 2 | May – Aug 2019 | Page: 34-37 | Y Nishanth Shetty, George Jacob, Appu Benny Thomas, Jacob Varughese
Authors: Y Nishanth Shetty , George Jacob , Appu Benny Thomas , Jacob Varughese .
 Department of Orthopaedics, VPS Lakeshore hospital, NH-66 Bypass Near Police Station, Nettoor, Maradu, Ernakulam, Kerala 682040
Address of Correspondence
Dr. Y Nishanth Shetty,
M.S. (Ortho), VPS Lakeshore hospital, NH-66 Bypass Near Police Station, Nettoor, Maradu, Ernakulam, Kerala 682040
Background: Patellofemoral instability is a common cause of recurrent patellar dislocation in adolescent females and athletes. The various risk factors for this condition include generalised ligamentous laxity, abnormal lower limb alignment. abnormal patella and trochlear morphology. We report a case where we encountered multiple factors causing recurrent patellar instability and addressed each problem in a step by step surgical approach.
Case Report: A 19 year old female presented with 5 episodes of recurrent patella dislocation a year. On examination, she had a beighton score of 8/11,a positive J sign and apprehension test. Radiographic evaluation showed a laterally subluxed patella with trochlear dysplasia and patella alta. CT scan and MRI confirmed a dejour type 2 trochlear dysplasia with increased tibial tuberosity –trochlear Groove distance and a deficient medial patellofemoral ligament(MPFL). She underwent an MPFL reconstruction with deepening trochleoplasty and medialization of the tibial tubercle.
Conclusion: This case highlights the complex presentation of patellar instability and the need for careful clinical and radiographic evaluation, along with a step by step surgical correction f each problem. This is to prevent overdoing any one procedure while addressing a multi factorial pathology by a surgeon resulting in increased patellofemoral pressures but instead use multiple procedures to ensure efficient correction and good clinical result.
Keywords: Recurrent patellar dislocation, Patella instability, trochlear dysplasia, TT-TG distance, MPFL reconstruction, patellofemoral arthritis, trochleoplasty.
1. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clinics in Sports Medicine. 2002;21(3):499–519.
2. Petri M, Falck CV, Broese M, Liodakis E, Balcarek P, Niemeyer P, et al. Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2012Sep;21(3):683–9.
3. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. The Journal of bone and joint surgery. British volume. 2005 Apr;87(4):577-82.
4. Colvin AC, West RV. Patellar instability .The Journal of bone and joint surgery. 2008 Dec 1;90(12):2751-62.
5. Guilbert S, Chassaing V, Radier C, Hulet C, Rémy F, Chouteau J, et al. Axial MRI index of patellar engagement: A new method to assess patellar instability. Orthopaedics & Traumatology: Surgery & Research. 2013;99(8).
6. Dejour D, Ferrua P, Ntagiopoulos P, Radier C, Hulet C, Rémy F, et al. The introduction of a new MRI index to evaluate sagittal patellofemoral engagement. Orthopaedics & Traumatology: Surgery & Research. 2013;99(8).
7. Diduch D, Laidlaw M. Current concepts in the management of patellar instability. Indian Journal of Orthopaedics. 2017;51(5):493
8. Beck P, Brown NA, Greis PE, Burks RT. Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. The American journal of sports medicine. 2007 Sep;35(9):1557-63.
9. Camp CL, Stuart MJ, Krych AJ, Levy BA, Bond JR, Collins MS, et al. CT and MRI Measurements of Tibial Tubercle–Trochlear Groove Distances Are Not Equivalent in Patients With Patellar Instability. The American Journal of Sports Medicine. 2013;41(8):1835–40.
10. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surgery, Sports Traumatology, Arthroscopy. 2005Nov;13(7):529–33.
11. Reddy K, Reddy N. Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Indian Journal of Orthopaedics. 2012;46(2):242.
12. Dean CS, Chahla J, Cruz RS, Cram TR, Laprade RF. Patellofemoral Joint Reconstruction for Patellar Instability: Medial Patellofemoral Ligament Reconstruction, Trochleoplasty, and Tibial Tubercle Osteotomy. Arthroscopy Techniques. 2016;5(1).
|How to Cite this article: Shetty Y N, Jacob G, Thomas A B, Varughese J. Management of multifactorial causes of Patellofemoral Instability in a 19 year old girl. Journal of Karnataka Orthopaedic Association May – Aug 2019; 7(2): 34-37.|