Delayed proximal repair and distal realignment after patellar dislocation

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Chronic patellar instability is a common sequela of traumatic patellar dislocation in athletes.
• Distal malalignment and medial patellofemoral ligament (MPFL) attenuation contribute to persistent instability.
• Conservative management often fails in cases of post-physial closure traumatic patellar dislocation.

Purpose of the Study:

• To evaluate the efficacy of a combined surgical technique for treating chronic patellar instability in athletes with distal malalignment.
• To assess functional outcomes, recurrent instability, and radiographic changes following MPFL repair and Q angle normalization.

Main Methods:

• Surgical repair of MPFL tears at the site of disruption and advancement of the medial patellomeniscal ligament.
• Tibial tubercle osteotomy to normalize the Q angle to 10 degrees and distal lateral retinacular release.
• Evaluation of outcomes using the Turba criteria and International Knee Documentation Committee guidelines.

Main Results:

• 90% of patients achieved good or excellent results with no recurrent instability at a minimum 24-month follow-up.
• Mean patellofemoral congruence angle improved significantly from 20 to 0 degrees postoperatively.
• Two patients reported fair subjective results with mild impairment during vigorous activity.

Conclusions:

• Combined surgical treatment of MPFL disruption, medial patellomeniscal ligament advancement, and Q angle correction is effective for chronic patellar instability.
• This approach restores stability and improves patellofemoral congruence in athletes after failed conservative management.
• Successful outcomes support this surgical strategy for athletes with traumatic patellar dislocation and distal malalignment.