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Management of multifactorial causes of Patellofemoral Instability in a 19 year old girl

Volume 7 | Issue 2 | May – Aug 2019 | Page: 34-37 | Y Nishanth Shetty, George Jacob, Appu Benny Thomas, Jacob Varughese


Authors: Y Nishanth Shetty [1], George Jacob [1], Appu Benny Thomas [1], Jacob Varughese [1].

[1] 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
E-mail: ynshetty@gmail.com


Abstract

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.


References

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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.

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