Complex Surgical Management of Permanent Patellar Dislocation in an Adolescent: An Eight-Year Follow-Up Case Report

Introduction: This case report presents the multifactorial surgical management and long-term outcome of a permanent patellar dislocation in a 16-year-old female patient. Case presentation: A 16-year-old female with permanent patellar dislocation of the left knee complained of progressive pain and functional limitations. Physical examination revealed a 20-degree passive flexion contracture, significant muscle weakness in knee extension, and a permanently laterally dislocated patella that could not be manually repositioned. Imaging studies revealed a complex knee deformity characterised by femoral valgus, tibial varus, posterior tibial slope, and trochlear dysplasia. The patient underwent a comprehensive surgical approach addressing all deformities, including femoral and tibial osteotomies, trochleoplasty, medial patellofemoral ligament (MPFL) plasty, and quadriceps muscle balancing. Results: At the eight-year follow-up, the patient demonstrated a full range of motion and adequate stability, and experienced mild pain only rarely. Outcomes improved significantly: the International Knee Documentation Committee (IKDC) score increased from 10.3% to 75.9%, the Lysholm score rose from 24 to 72, the Kujala score improved from 22 to 67, and the BPII score increased from 14.9 to 55.4. Conclusions: Comprehensive surgical correction of all predisposing factors achieved sustained functional improvement over eight years, demonstrating that systematic treatment of anatomical and functional abnormalities is essential for the successful management of permanent patellar dislocation. Level of evidence: V.