MR imaging of patellar dislocation and relocation

Patellar dislocation and relocation (PDR) typically occurs suddenly after trauma or torsional stress on the extensor mechanism. Clinical evaluation after patellar dislocation/relocation usually reveals a swollen knee that is difficult to examine. Radiographs may show hemathroses and a minority of patients will have a chip fracture of the patella. Magnetic resonance (MR) imaging features seen with PDR include disruption or sprain of the medial retinaculum, lateral patellar tilt or subluxation, lateral femoral condylar and medical patellar osseous contusions, osteochondral injury, damage to Hoffa's fat pad, and joint effusion. Up to one third of patients will also show concomitant injury to the major ligaments of the knee or menisci. Without repair of the primary injury, redislocation occurs in greater than one half of patients. Consequently, surgical correction is often advocated. This article reviews the factors predisposing to PDR, the activities associated with PDR, the clinical, radiographic, and MR imaging features of PDR, and (briefly) therapy for this injury.