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

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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 references 38

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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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              Orthopedic disorders in school children with Down's syndrome with special reference to the incidence of joint laxity.

              Thirty-nine school-age children with Down's syndrome (trisomy 21) were examined for orthopedic problems and evidence of joint laxity. Of these, 10.3% had required orthopedic surgery for feet and hip problems, and 13% had disorders not yet requiring surgery. Only two children could be regarded as showing unequivocally abnormal generalized joint laxity. Twenty-three of the children had one or more lax joints, and one had a dislocated hip without laxity of other joints. Six children had hypermobility of the patella, but this did not correlate with joint laxity. Fifteen children had no evidence of joint laxity. Laxity does not appear to be a major etiological factor in joint problems occurring in Down's syndrome.
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                Author and article information

                Journal
                Case Report Med
                CRIM
                Case Reports in Medicine
                Hindawi Publishing Corporation
                1687-9627
                1687-9635
                2012
                11 January 2012
                : 2012
                Affiliations
                1Department of Orthopaedics and Traumatology, CTO Hospital, Via Zuretti 29, 10126 Turin, Italy
                2Mount Sinai Hospital, Department of Surgery, University of Toronto, 600 University Avenue, Suite 476D, Toronto, ON, Canada M5G 1X5
                Author notes

                Academic Editor: Edward V. Craig

                Article
                10.1155/2012/182795
                3263588
                22287971
                Copyright © 2012 Alessandro Bistolfi et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Medicine

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