Chronic Patellofemoral instability can be a disabling condition. Female adolescents are the most common first time dislocators. The younger a patient is at the time of first dislocation and the more severe the dislocation, the greater is the risk of subsequent dislocation.
Common causes of Recurrent patellar dislocation are :
1. Increased Q angle
2. Trochlear dysplasia
3. Lax or deficient medial Patellofemoral ligament
4. High riding patella, or small patella
5. Increased knee valgus
6. Hyperextension of the knee
The vastus medialis obliquus and the medial patellofemoral ligament act together as a combined dynamic complex preventing lateral dislocation of patella.
Non-operative measures must be exhausted before offering a surgical option.
Physiotherapy is directed towards closed chain exercises and VMO strengthening, in close supervision of an Orthopedic surgeon.
Surgical options include the soft tissue procedures and bony procedures, depending upon the underlying pathology.
Skeletally immature patients are particularly demanding, as bony procedures should be avoided until maturity.
Soft tissue procedures include the MPFL reconstruction, Medial imbrication, Lateral retinacular release. Bony procedures include Trocheoplasty and Tibial tubercle osteotomy and re-alignment.
Key Points :
1. Outcome with MPFL reconstruction alone in patients with trochlea dysplasia may not be good.
2. There is no evidence that surgical stabilization of the patellofemoral joint decreases long term degenerative changes, despite improving short term stability.
Common causes of Recurrent patellar dislocation are :
1. Increased Q angle
2. Trochlear dysplasia
3. Lax or deficient medial Patellofemoral ligament
4. High riding patella, or small patella
5. Increased knee valgus
6. Hyperextension of the knee
The vastus medialis obliquus and the medial patellofemoral ligament act together as a combined dynamic complex preventing lateral dislocation of patella.
Non-operative measures must be exhausted before offering a surgical option.
Physiotherapy is directed towards closed chain exercises and VMO strengthening, in close supervision of an Orthopedic surgeon.
Surgical options include the soft tissue procedures and bony procedures, depending upon the underlying pathology.
Skeletally immature patients are particularly demanding, as bony procedures should be avoided until maturity.
Soft tissue procedures include the MPFL reconstruction, Medial imbrication, Lateral retinacular release. Bony procedures include Trocheoplasty and Tibial tubercle osteotomy and re-alignment.
Key Points :
1. Outcome with MPFL reconstruction alone in patients with trochlea dysplasia may not be good.
2. There is no evidence that surgical stabilization of the patellofemoral joint decreases long term degenerative changes, despite improving short term stability.
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