Bilateral congenital dislocation of the patella associated with synostosis of proximal tibiofibular and proximal radioulnar joints: A case report.

Congenital dislocation of the patella is a rare and difficult pathology to treat. We present a case of bilateral congenital dislocation of the patella with synostosis of proximal tibiofibular and proximal radioulnar joints without genu valgum deformity of both knees in a 30-year-old man. To our knowledge, congenital dislocation of the patella associated with synostosis of proximal tibiofibular and proximal radioulnar joints has not been reported in the literature yet.

Neglected bilateral congenital dislocation of the patella.

Congenital dislocation of the patella is a disorder that presents with dysfunction in extensor mechanism. Although congenital dislocation of the patella mostly occurs in children with genetic disorders, it may also occur in totally healthy children, despite rarely. In this article, we report a 16-year-old male patient who referred to our clinic with complaints of gait disturbance, frequent falls, and muscular weakness in lower extremity. The patient had no complaints during walking, but had difficulty in running and walking up and down the stairs. It was observed that the range of motion of the knee joint was completely painless and the quadriceps muscle strength was evaluated as 3/5. An evaluation of computed tomography and magnetic resonance imaging results showed that the patella was dislocated. It became clear with magnetic resonance imaging that extensor mechanism was continuous but patellar tendon was not attached to its anatomical position. Surgical treatment was not planned because the patient did not describe any pain complaint and there was no limitation of joint movement, he could walk without support and without device and also refused to be operated. The choice of treatment should be based on the patient's preference, and pain and functional status.

Diagnosis and Management of Traumatic Patellar Instability in the Pediatric Patient.

Instability of the patella is a common cause of knee pain and dysfunction in pediatric and adolescent patients and can be due to several factors. Although some patients will recall a specific traumatic event others may not, requiring the diagnosis to be made on the basis of physical examination and imaging. Congenital dislocation and connective tissue disorders should also be considered, even in the setting of trauma. There are radiographic parameters that may identify causes of instability such as trochlear and patellar abnormalities, and magnetic resonance imaging can identify signs of trauma such as bony edema, loose osteochondral fragments, and increased tibial tubercle-trochlear groove distance. The first line of treatment for instability is most commonly nonoperative in nature; however, there are many options for operative management in the event of severe chondral injury or recurrent dislocation. Surgical management to best restore stability of the patellofemoral joint varies depending on the skeletal maturity of the patient and the source of instability (ligamentous, osteocartilaginous, or both). A combination of soft tissue, bony, and anatomic ligamentous repair or reconstruction is used to best augment patellar tracking and optimize patient outcome. [Orthopedics. 2017; 40(5):e749-e757.].

Diagnosis and surgical correction of congenital bilateral patellar luxation in two dwarf zebu calves.

This case study presents two female dwarf zebu calves with permanent bilateral flexion of the stifle joint secondary to bilateral congenital lateral patellar luxation. The patella could be manually repositioned bilaterally in the first calf (14 days old), but re-luxated immediately with release of manual pressure (luxation grade III). In the second calf (28 days old) both patellae were permanently luxated laterally (grade IV). The right and left stifles of each calf were operated in a staged procedure with approximately 14 days between surgery of the two sides. While a lateral release and a medial imbrication were sufficient for correction in the left stifle of the younger calf, a trochlear wedge resection was required in the other three stifle joints with hypo- to aplastic trochleas in order to stabilize the patella. Postoperatively each stifle was immobilized for 10 days with a cast. The younger calf regained full function of the hind limbs during the complete gait cycle in walk and in trot one month after the procedure. The older calf regained full function in the hind limbs in walk but in trot there was some degree of lameness due to a reduced extension of approximately 20°.

Postoperative Complications and Short-Term Outcome Following Single-Session Bilateral Corrective Surgery for Medial Patellar Luxation in Dogs Weighing <15 kg: 50 Cases (2009-2014).

OBJECTIVE: To assess complication rates and short-term outcome in small dogs with bilateral medial patellar luxation (MPL) undergoing single-session bilateral corrective surgery. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs weighing <15 kg with congenital bilateral MPL that underwent single-session bilateral corrective surgery (n = 50). METHODS: Surgical procedures for MPL correction included trochlear wedge recession (TWR), crest transposition, lateral imbrication, and medial fascial release. Complication rates were correlated with number of surgical procedures, weight, whether or not a bandage was applied postoperatively, and surgeon experience (ACVS Diplomate vs resident). Results were compared with the most recent study evaluating single-session bilateral corrective surgery for MPL. RESULTS: Overall complication rate was 22% (11 of 50 dogs). Implant failure occurred in 2 dogs (3 stifles) requiring revision. Grade 1 patella reluxation was the most common minor complication at 10% (5/50). Overall complication and reluxation rates were similar to previous studies. There were no intraoperative complications after performing TWR in small dogs. CONCLUSION: Single-session bilateral corrective surgery for MPL is well tolerated in small dogs with complication rates historically similar to dogs undergoing unilateral or staged bilateral surgery. With individual case assessment, single-session surgery could be offered to owners, allowing one anesthetic episode and potentially lowering the chance for morbidity. Further studies, ideally prospective studies, are needed to assess long-term outcome following single-session bilateral corrective surgery for MPL.

Congenital dislocation of the patella - clinical case / Luxação congênita da patela - Caso clínico

Congenital patellar dislocation is a rare condition in which the patella is permanently dislocated and cannot be reduced manually. The patella develops normally as a sesamoid bone of the femur. This congenital dislocation results from failure of the internal rotation of the myotome that forms the femur, quadriceps muscle and extensor apparatus. It usually manifests immediately after birth, although in some rare cases, the diagnosis may be delayed until adolescence or adulthood. Early diagnosis is important, thereby allowing surgical correction and avoiding late sequelae, including early degenerative changes in the knee. A case of permanent dislocation of the patella is presented here, in a female child aged seven years.

A luxação congênita da patela é uma patologia rara, em que a patela se encontra permanentemente luxada e manualmente irredutível. A patela desenvolve-se normalmente como um osso sesamoide do fêmur. A luxação congênita da patela resulta da falência da rotação interna do miótomo que forma o fêmur, músculo quadricípite e o aparelho extensor. Usualmente manifesta-se imediatamente após o nascimento, embora em alguns casos raros o diagnóstico possa ser adiado até a adolescência/idade adulta. O diagnóstico precoce é importante, permite a correção cirúrgica, evita as sequelas tardias, notadamente alterações degenerativas precoces do joelho. É apresentado um caso de luxação permanente da patela, numa criança de sexo feminino, com sete anos.

Surgical treatment of congenital patellar dislocation in skeletally mature patients: surgical technique and case series.

BACKGROUND: Congenital patellar dislocation is a rarely encountered condition and is readily treated in childhood to prevent lasting disability, knee pain, decreased range of motion and ambulation problems. This condition is very rarely seen in skeletally mature patients, and the treatment of the condition represents a challenge to the orthopedic surgeon. SURGICAL TECHNIQUE AND METHODS: Patients were treated with soft tissue reconstruction and tibial tubercle transfer with or without a prior medial close-wedge distal femoral osteotomy, depending on the degree of valgus deformity. We, then, searched the database of our orthopedics center for cases of congenital patellar dislocation in skeletally mature patients who were surgically treated. We collected a total of five knees and analyzed the cases according to the type of surgery performed and difference between pre- and postoperative functions. RESULTS: Five knees with congenital patellar dislocation were treated. The mean age of the patients was 29.6 years, and mean follow-up time was 4.3 years. Mean preoperative range of motion was 65°, and it increased to a mean of 105.5° after surgical treatment. The mean preoperative Kujala score was 29.2 and increased to 67.2 after surgical treatment. DISCUSSION: Congenital patellar dislocations that are allowed to proceed to adulthood are difficult to treat, and surgical treatment depends on the degree of deformity of the patella and of the knee joint. This study shows that surgical treatment is able to correct the deformity and provide better knee function.

Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability.

INTRODUCTION: Congenital dislocation of the patella and recurrent symptomatic dislocation in adolescents are difficult pathologies to treat. Stanisavljevic described an extensive release procedure essentially involving medializing the entire lateral quadriceps and medial soft tissue stabilization. There are no significant series reporting the success of this method. This procedure has been performed in our institution over several years and we report our results. METHOD: Retrospective case series. Between 1990 and 2007, 20 knees in 13 children and adolescents (mean age 12.8 years; 4-17, 7 female) with recurrent or congenital dislocation of the patella (8 knees) underwent this procedure after failed conservative treatment (mean follow-up 7.5 years; 4-16). All were immobilized in a long leg cast for 6 weeks. RESULTS: Five knees in five patients (20 %, 1 congenital dislocation) reported their knees as improved without further dislocations. Out of the 15 knees with failures (80 %) 12 in six patients (60 %) were revised due to redislocation. Three knees in two patients (15 %) still had dislocations or subluxations, but any revision was refused. Three knees in three patients caused pain and discomfort during daily activity. Redislocation first developed after a mean of 21.3 months (4-72) postoperatively. Only one patient had returned to sport at the 12-month follow-up. DISCUSSION: The Stanisavljevic procedure produces a mediocre success rate with our long-term follow-up series showing a failure rate up to 80 %. We therefore recommend more specific procedures dealing with the anatomical deformity such as trochleaplasty to produce superior success rates.

Congenital medial dislocation of the patella with multiple congenital anomalies: case report and method of treatment.

Lateral dislocation of the patella is reported frequently in orthopaedics references but congenital medial patellar dislocation is reported rarely. An 8-year-old girl was referred to our department for knee surgery. She had genuvarum, knee flexion contracture and tibial internal rotation. She had multiple congenital anomalies at birth. The patella was palpated in the medial side of knee and its reduction to the midline was impossible. We performed an operative procedure for her medial dislocation of the patella. At the 1-year follow-up, the patella was in midline and there was no medial subluxation on range of motion of the knee. In infants with genuvarum, knee flexion contracture and tibial internal rotation, the possibility of medial patellar instability should be considered. For correction of patellar tracking and prevention of bone deformities, surgical management should be performed.

Medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome.

The objective of this study was to explore the clinical effect of medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome. Twelve patients with congenital patellar dislocation due to small patella syndrome treated at the authors' hospital between January 2005 and February 2010 were enrolled in the study. The study group comprised 4 men (4 knees) and 8 women (8 knees) with an average age of 10.58±6.91 years. All patients underwent medial and lateral retinaculum plasty. Clinical evaluation included the number of patellar redislocations, patellar apprehension sign, Kujala score, subjective questionnaire score, and patella lateral shift and patellar tilt angle measured using a cross-sectional computed tomography scan. All patients were followed up, and the shortest follow-up time was 2 years. Kujala scores improved from 49.20±6.20 preoperatively to 80.10±5.80 postoperatively. Subjective questionnaire scores indicated that the excellent and good rate was 75%. In addition, a significant difference existed in the patellar tilt angle and patella lateral shift between pre- and postoperative results (P<.05). Medial and lateral retinaculum plasty for patients with congenital patellar dislocation due to small patella syndrome can be effective to correct the tracking of the patellofemoral joint and improve knee function.

Patellar dislocation with genu valgum treated by DFO.

Congenital habitual patellar dislocation is a rare condition of the knee where the patella dislocates during flexion and relocates during extension. The congenital form is permanent, irreducible, and presents at birth. It is characterized by a short quadriceps and a major patellofemoral dysplasia and short height. This article presents a rare case of a 27-year-old woman with recurring bilateral habitual dislocation of the patella after a failed previous proximal and distal realignment procedure. Clinical examinations of both knees revealed genu valgus knees and lateral joint pain that recurred after several previous operations. Radiographs of both knees showed patellar dislocation and genu valgum associated with patellofemoral dysplasia and osteoarthritis of the lateral compartment. Long-leg standing radiographs showed an anatomic tibiofemoral angle of right 13° and left 6° valgus and a mechanical tibiofemoral angle of right 8° and left 2° valgus and weight-bearing line of 65% on the right and 48% on the left. The authors performed a distal femoral closing wedging osteotomy to correct the valgus deformity, and then percutaneous lateral release and medial reefing were performed to stabilize the patellas of both knees simultaneously.

Dislocation of the patella in a patient with Rubinstein-Taybi syndrome--a case study.

The Rubinstein-Taybi syndrome is a rare syndrome of congenital disorders whose etiology is still unknown. Most RTS patients have musculoskeletal abnormalities which, if untreated, may significantly affect independent mobility. This paper presents the results of a surgical treatment of a 13-year-old patient with RTS and instability of the patellofemoral joint. The patient was followed up for 3 years. Surgery resulted in complete pain relief, increased knee range of motion and marked improvement in the patient's gait. An extensive plasty of the extensor apparatus of the knee joint increases the likelihood of a good and lasting treatment result in patients with RTS and instability of the patellofemoral joint.

Grossly apparent cartilage erosion of the patellar articular surface in dogs with congenital medial patellar luxation.

One hundred and forty-five stifles of client-owned dogs that underwent corrective surgery for congenital medial patellar luxation were inspected for cartilage erosion on the articular surface of the patella. The lesions were mapped in surface percentage ranges of 20% and by location. Two-thirds of the patellae had cartilage erosion. Cartilage erosion varied between 0 and 100% of the total patellar articular surface and was localised mainly on the medial and distal side of the patella. Dogs with Grade IV patellar luxations and heavier dogs were more affected. The majority of dogs in our study with congenital medial patellar luxation had grossly apparent cartilage erosion on the articular surface of the patella, which may help to explain why certain patients do not function well clinically after technically successful corrective surgery.

Congenital patella dislocation in a child with Rubinstein-Taybi syndrome.

A child with Rubinstein-Taybi syndrome was diagnosed at birth with contraction of the left knee in flexion. A sonography of both knees, performed at 4 months of age, resulted in diagnosing a laterally displaced, hypoplastic left patella. Surgery was performed at 8 months of age as described by Stanisavljevic, which resulted in correct alignment of the patella. Follow-up examination at 2.5 years of age showed a contracture in flexion of 10 degrees , passively redressible with application of gentle force and clinically correct alignment of the patella. Sonography showed the left patella to be similar in size, shape, and position to the right patella. The child still did not walk because of mental retardation, but stood upright unsupported. Stanisavljevic procedure in this case gave good results. Sonography gives excellent view of the unossified patella, as well as other nearby soft tissues, and is sufficient for a correct diagnosis.

Tratamiento quirurgico de la luxacion congenita de rotula con tecnica de Stanisavljevic / Surgical treatment of the congenital patellar dislocation with Stanisavljevic technique

Introducción: La luxación congénita de la rótula (LCR) es una entidad infrecuente que produce diversos grados de discapacidad de rodilla en los niños. Existe cierta controversia con respecto a su tratamiento; mientras algunos autores apoyan la realineación quirúrgica del aparato extensor, otros recomiendan sólo la observación afirmando que los resultados quirúrgicos suelen ser malos. Materiales y métodos: Se analizaron 8 pacientes consecutivos (8 rodillas) con luxación congénita permanente irreducible de rótula tratados en el período 1993-2006. El promedio de edad fue de 7,8 años. El seguimiento promedio fue de 67 meses (r, 7-173 meses). Cinco casos presentaron asociaciones sindrómicas. Los resultados funcionales subjetivos fueron evaluados con la Tegner-Lysholm Knee Scoring Scale y el score de Kujala. Resultados: Todos los pacientes poseen un buen centrado de la rótula, mejoraron la amplitud de movimiento y la capacidad para la deambulación. Seis de los 8 pacientes recuperaron la extensión completa. Siete pacientes presentaron resultados funcionales entre buenos y excelentes y uno, regular. No se observaron infecciones de la herida ni lesiones neurovasculares en el posoperatorio. Ninguno de los pacientes presentó recidiva de la luxación ni requirió cirugías adicionales en la rodilla tratada. Conclusiones: En nuestra serie la técnica de Stanisavljevic permitió una marcada mejoría de la amplitud de movimiento y de la capacidad para la deambulación. En los casos de deformidad moderada podría ser suficiente un procedimiento más limitado. El tratamiento quirúrgico debe realizarse de manera precoz para obtener los mejores resultados.

Congenital dislocation of patella with ipsilateral hip flexion-abduction deformity: a case report.

Iliotibial band tightness and its abnormal insertion on patella is one of the contributing factors in congenital dislocation of patella. Although hip flexion-abduction deformity is caused by a tight iliotibial band, as frequently seen in postpolio residual paralysis, an association of hip flexion-abduction deformity with congenital dislocation of patella has never been reported previously. Such a case was presented to us, and surgical repositioning of the patella was carried out by means of release of the tight iliotibial band from the patella besides other tight lateral structures along with medial augmentation and distal realignment of the quadriceps mechanism. The hip deformity was corrected spontaneously after release of the tight iliotibial band from the knee without need for additional surgery at the hip.

[Permanent, habitual dislocation and recurrent dislocation of the patella in children: surgical management by patellar ligamentous transfer in 50 knees]. / Traitement chirurgical des luxations et instabilités patellaires chez l'enfant et l'adolescent par transfert ligamento-périosté

PURPOSE OF THE STUDY: Appropriate treatment of patellar dislocation in children and adolescents remains a subject of debate. Ligamentous transfer or "soft rod" is a technique for realigning the extensor mechanism that can be adapted to children. We analyzed results obtained in our patients. MATERIAL AND METHODS: Between 1979 and 2000, 35 children (50 knees) underwent realignment which was combined in all cases with lateral retinacular release and medial reefing using the Insall procedure. Complementary procedures were needed in certain cases (quadriceps lengthening, femoral sulcus plasty, quadriceps release). Mean age at surgery was 11 years, range 5-15 years. All patients were reviewed at skeletal maturity with a mean follow-up of 7.5 years. The last review included a functional assessment using the IKDC form and standard x-rays (anteroposterior and lateral standing view and tangential view at 30 degrees flexion). A computed tomography scan and/or magnetic resonance imaging series were done preoperatively and at last follow-up. DISCUSSION: We distinguished two groups of patients, those with major (permanent or habitual) dislocation of the patella and those with recurrent dislocation. Functional outcome was good in 76% and 86% of knees respectively. There were eight cases of recurrent dislocation: five knees underwent revision surgery with good outcome. The femoral sulcus angle was improved in both groups, but especially in the congenital dislocation group. There was on case of reversed tibial slope (-2 degrees) ant to slopes at 0 degrees. Functional outcome was equivalent to results from earlier series (Grammont, Bensahel, Langeskiold), but comparison was hampered due to the heterogeneous nature of the different series. Femoral sulcus remodeling can enable good patellar stability if the surgery is performed early enough (before age 10 years). In teenagers with major instability, femoral sulcus plasty must be associated with the realignment procedure. We noted a small amplitude reduction of the tibial slope in eleven knees. The procedure appears to have an "epiphysiodesis effect" but with no functional consequence. CONCLUSION: Ligamentous transfer combined with different procedures is a method of choice for stabilizing the extensor system, enabling a normal femoral sulcus angle if the child is operated early. Remodeling of the tibial tuberosity could be related to a transient vascular disorder.