Related Experiment Videos
Congenital dislocation of the patella. Part II: orthopaedic management
I Ghanem1, L Wattincourt, R Seringe
1Saint Joseph University, Hôtel-Dieu de France Hospital, Beirut, Lebanon. ghanem.i@dm.net.lb
Insights
Congenital patellar dislocation in children, often with foot deformities, can be effectively treated with surgical intervention. This approach successfully centers the patella and improves knee function and mobility.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- Congenital dislocation of the patella is a rare condition often associated with knee flexion contractures and rotational deformities.
- Associated foot deformities are common in patients with congenital patellar dislocation.
- The quadriceps muscle is typically active, though its function may be impaired by the dislocation.
Observation:
- Five patients (eight knees) diagnosed with congenital patellar dislocation were reviewed, with ages at diagnosis ranging from 4 days to 6 years.
- All patients presented with knee flexion contractures and varying degrees of femorotibial rotatory dislocation.
- Foot deformities such as clubfoot, calcaneovalgus, or congenital vertical talus were present in all cases.
Findings:
- Surgical treatment for patellar dislocation involved quadriceps release or V-Y lengthening, lateral soft tissue division, and medial retinaculum/capsule reefing.
- Gradual correction of knee flexion contracture using serial casting was attempted in five cases, achieving near-complete extension in two.
- At an average follow-up of 6.9 years, all patients could walk, with the patella centered in the trochlea and improved knee mobility, rotatory dislocation, and daily function in seven cases.
Implications:
- Surgical management of congenital patellar dislocation can lead to successful patellar tracking and functional improvement.
- Early diagnosis and intervention are crucial for managing associated knee and foot deformities.
- This study highlights the effectiveness of a comprehensive surgical approach for congenital patellar dislocation, improving patient ambulation and quality of life.
Abstract:
Five patients (eight knees) with diagnosed congenital dislocation of the patella and well-documented charts were reviewed. Age at diagnosis ranged from 4 days to 6 years. A flexion contracture of the knee and femorotibial rotatory dislocation of varying degrees were present in all the cases. The quadriceps was active in all the cases, producing knee flexion in four cases. Foot deformity was associated in all the cases (clubfoot, calcaneovalgus, or congenital vertical talus). Gradual correction of knee flexion contracture with serial casting was attempted in five cases leading to an almost complete extension in two cases. Treatment of patellar dislocation was surgical in all the cases, consisting in extensive quadriceps release (seven knees) or V-Y lengthening (one knee), division of lateral soft tissues, and reefing of the medial retinaculum and capsule. Intraoperative anomalies were recorded. At an average follow-up of 6.9 years, all the patients are able to walk on their operated limb, and the patella is centered in the trochlea in all the cases. Knee mobility, rotatory dislocation, and daily function were improved in seven cases.