ORTHOPAEDICS

1. PATELLAPATELLA
RECURRENTRECURRENT
DISLOCATIONDISLOCATION
DR. PAWAN K. YADAV
D.ORTHO.,DNB(ORTHO)
BIRRD HOSPITAL, TIRUPATHI

2. RECURRENT DISLOCATION
• When the patella shifts laterally with minimal stress on flexion of
knee,..

3. ANATOMY - Q ANGLE

4. PREDISPOSING CAUSES
• Increased Q angle
• Weakness and laxity of medial quads.
• Tight lateral structures.
• Abnormal insertion of lig. Patella. ( lateral)
• Defective development of lat. Femoral condyle
and flattening of intercondylar groove.
• Maldevelopment of patella.(alta/baja)
• Valgus deformity of knee.

5. CLINICAL FEATURES
• Girls > boys
• Bilateral
• Acute pain & knee stuck in flexion, falls to ground.
• Tenderness medial side of knee.
• Swollen joints- later
• Aspiration- haemarthrosis

6. • Apprehension test(provocative): positive
• A positive J sign—slight lateral subluxation of
the patella as the knee approaches full
extension
• X ray- AP/Lat/ Skyline
• Blumensaat line
• Sulcus angle
• Q angle
• Insall’ s index

7. APPREHENSION TEST(PROVOCATIVE):

8. X RAY - SKYLINE VIEW

9. BLUMENSAAT LINE

10. SULCUS ANGLE
& CONGRUENCE ANGLE
• Angle MSL is the sulcus angle
• Angle PSO is the congruence
angle

11. INSALL’ S INDEX

12. TREATMENT.
• Conservative:
Once reduced, immobilize for 3
weeks, start quads & vmo

13. Surgical Mx:
Release tight structures
Tighten loose structures
Realignment of extensor mechanism.

14. SURGICAL-CONTD………
1. Suprapatellar realignment (campbell’s).
2. Infrapatellar realignment (Gold-twait).
3. Infrapatellar bony realignment ( Hauser).
4. Patellectomy (Soto-hall).

15. SUPRAPATELLAR
REALIGNMENT (CAMPBELL’SCAMPBELL’S).

16. INFRAPATELLAR REALIGNMENT
(GOLD-TWAIT).

17. INFRAPATELLAR BONY REALIGNMENT
(HAUSER)

18. PATELLECTOMY (SOTO-HALL).

19. COMPLICATIONS
• Instabilty of knee.
• Loose bodies due to osteochondral #
• Osteoarthritis- secondary
• Postsurgical
1. Infection
2. stiffness

20. OTHER TYPES
• Congenital dislocation: from birth due to
tight lateral structures. Very rare. Poor
results.
• Habitual dislocation: patella dislocates
every time there is flexion and reduces on
extension.

21. paoneortho@gmail.com