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      Adult Congenital Permanent Bilateral Dislocation of the Patella with Full Knee Function: Case Report and Literature Review

      Case Reports in Medicine
      Hindawi Limited

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          Abstract

          Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because of inability of active extension in the knee and impaired ability during walking. This report presents an unusual case of a 51-year-old man with bilateral congenital permanent dislocation of the patella. The pathology had never been treated because there were few symptoms. The patient presented with right knee pain caused by a fall on the knee during his work. The right knee was painful on the lateral side and the clinical signs were positive for pathology of the lateral meniscus, confirmed by MRI. The clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore we performed a knee arthroscopy, whose intra-operative findings confirmed the MRI findings. During the surgery we performed just a selective arthroscopic meniscectomy, without correcting patella dislocation, because the condition was unusually asymptomatic before the trauma.

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          Most cited references38

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          Management of the chronic irreducible patellar dislocation in total knee arthroplasty.

          Neglected dislocation of the patella with gonarthrosis, genu valgum, flexion, and external rotation deformity is rarely encountered. Experience with five total knee arthroplasties in three patients with chronic patellar dislocation and gonarthrosis is reported. All knees had a modified proximal patellar realignment and arthroplasty with a constrained prosthesis. Preoperative Hospital for Special Surgery knee scores averaged 55. Average follow-up period was 40 months. At latest follow-up examination, the average Hospital for Special Surgery knee score was 83, the Knee Society knee score was 95, and the functional score averaged 50. There was one complication: a full-thickness lateral skin necrosis requiring flap coverage. The patellar score was zero in all knees. Four knees had mild quadriceps weakness. Three knees rated as excellent and two as good on both The Hospital for Special Surgery and Knee Society rating systems. Radiographic analysis revealed no radiolucent lines or osteolysis. The patellas were centralized in the trochlear groove in all patients. Patellar height averaged 14 mm (range, 12-17 mm). In conclusion, satisfactory results were obtained by restoring axial alignment with a constrained implant and realigning the patella with an extensive proximal realignment.
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            Total knee arthroplasty in an adult with congenital dislocation of the patella.

            This article reports the use of total knee arthroplasty with release of the lateral retinaculum, proximal extensor mechanism realignment, and patellar resurfacing as a valid treatment option for adult patients with congenital dislocation of the patella who have absence of the femoral sulcus and associated osteoarthritis. The patient presented in this case report had improvement of his Knee Society knee score and function score from preoperative levels of 8 and 45 to 77 and 80 postoperatively.
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              Congenital, irreducible, permanent lateral dislocation of the patella.

              This is a report of 6 cases (one bilateral) of congenital irreducible, permanent lateral dislocation of the patella, ages 5 to 14; 2 patients were normal and 4 were mongoloid. The dislocation was reduced by means of a newly-devised surgical reconstruction of anterior attachments of nearly all of the para-articular bone and ligamentous structures. The 2-year follow-up results are satisfactory.
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                Author and article information

                Journal
                10.1155/2012/182795
                http://creativecommons.org/licenses/by/3.0/

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