Habitual dislocation patella

Habitual dislocation of patella - surgical technique

1. Habitual Dislocation Patella a surgical case summary Vinod Naneria Girish Yeotikar Arjun Wadhwani Choithram Hospital & Research Centre, Indore, India

2. Types of Dislocations Habitual dislocation of the patella in flexion implies that dislocation occurs every time the knee is flexed. The displacement is painless. Recurrent dislocation which occurs as isolated episodes, often in response to trauma and is accompanied by pain and followed by swelling. Congenital dislocation refers to an irreducible dislocation present since birth and associated with a lateral position of the entire quadriceps mechanism.

3. The distinction between these groups is important as the surgical treatment for each is quite different. Operations for habitual dislocation of the patella always requires releases proximal to the patella. Operations for recurrent dislocation usually involve procedures distal to the patella.

4. Persistent & Obligatory Persistent Dislocation Patella is dislocated lateral and persistent in that location. Often obvious in infency Usually associated with other anomalies Knee flexion contracture present. Functional disability. Obligatory Dislocation Patella dislocates and reduces spontaneously with flexion and extension of knee Usually present at 5 to 10 years of age Usually isolated anomaly ROM usually normal

5. optimize quadriceps alignment. Pathology

6. Cause - Effect

7. Surgical management of congenital and habitual dislocation of the patella. Gao GX , Lee EH , Bose K . congenital dislocation patella (CDP) and habitual dislocation patella (HDP) followed for 2-15 years after surgical stabilization of the patella. The underlying pathology in both conditions was contracture of the quadriceps mechanism, which was more severe in CDP. Surgical stabilization included an extensive lateral release, medial plication , and transfer of the lateral half of the patella tendon. Lengthening of the rectus femoris tendon. With appropriate operative procedures, satisfactory results were achieved in 36 of the 41 knees (87.8%). J Pediatr Orthop . 1990 Mar-Apr;10(2):255-60.

8. Typical Procedure

9. Case summary 10 years old Female. Bilateral habitual dislocations. No other congenital anomaly. Painless full range of movements.

10. Surgical procedure Anterio -medial incision Dissection to lateral side of patella. Release of lateral patellar retinaculum from patellar tendon to vastus lateralis . VMO isolation, and separation. Semitendinosis tendon isolation, detachment and plication with superior pole of patella. VMO advancement and attachment with anterior and medial part of patella. Check the position of patella by flexion.

11. Anterio -medial incision

12. Exposure of lateral border of patella medial superior inferior

13. Release of lateral retinaculum Superior pole Patellar tendon

14. VMO elevation

15. Isolation of Semitendinosus superior inferior

16. Isolation of semitendinosus

17. Tendon passed under the superior pole patella Turned back medially to align patella in center as checkrein.

18. Patella Rectus femoris tendon Patellar tendon Semitendinosus tendon Semitendinosus Tenodesis Lateral release

19. VMO advancement distally and laterally

20. Patella Rectus femoris tendon Patellar tendon Semitendinosus tendon Vastus Medialis Oblicus Lateral release

21. Patella Rectus femoris tendon Patellar tendon Semitendinosus tendon Vastus Medialis Oblicus distal advancement Lateral release

22. VMO advancement complete

23. Summary Lateral release - as per requirement Medial plication VMO advancement Semitendinosus tenodesis Optional :- Patellar tendon transfer Rectus femoris lengthening Extent of Surgery proportional to contractures

24. DISCLAIMER Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 32 years. It is intended for use only by the students of orthopaedic surgery. Many GIF files are taken from Internet/Textbooks. Views and opinion expressed in this presentation are personal. Depending upon the x-rays and clinical presentations viewers can make their own opinion. For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. For any correction or suggestion please contact [email protected]