Habitual Dislocation Patella
a surgical case summary
Choithram Hospital & Research Centre, Indore, India
Types of Dislocations
• Habitual dislocation of the patella in flexion
implies that dislocation occurs every time the
knee is flexed. The displacement is painless.
• Recurrent dislocation which occurs as isolated
episodes, often in response to trauma and is
accompanied by pain and followed by swelling.
• Congenital dislocation refers to an irreducible
dislocation present since birth and associated with
a lateral position of the entire quadriceps
The distinction between these groups is
important as the surgical treatment for
each is quite different.
Operations for habitual dislocation of the
patella always requires releases proximal
to the patella.
Operations for recurrent dislocation
usually involve procedures distal to the
Persistent & Obligatory
• Persistent Dislocation
• Patella is dislocated
lateral and persistent in
• Often obvious in infency
• Usually associated with
• Knee flexion contracture
• Functional disability.
• Obligatory Dislocation
• Patella dislocates and
with flexion and
extension of knee
• Usually present at 5 to 10
years of age
• Usually isolated anomaly
• ROM usually normal
Surgical management of congenital and habitual dislocation of
Gao GX, Lee EH, Bose K.
congenital dislocation patella (CDP) and habitual dislocation
patella (HDP) followed for 2-15 years after surgical stabilization
of the patella.
The underlying pathology in both conditions was contracture of
the quadriceps mechanism, which was more severe in CDP.
Surgical stabilization included an extensive lateral release,
medial plication, and transfer of the lateral half of the patella
tendon. Lengthening of the rectus femoris tendon.
With appropriate operative procedures, satisfactory results
were achieved in 36 of the 41 knees (87.8%).
J Pediatr Orthop. 1990 Mar-Apr;10(2):255-60.
• 10 years old Female.
• Bilateral habitual dislocations.
• No other congenital anomaly.
• Painless full range of movements.
• Anterio-medial incision
• Dissection to lateral side of patella.
• Release of lateral patellar retinaculum from
patellar tendon to vastus lateralis.
• VMO isolation, and separation.
• Semitendinosis tendon isolation, detachment and
plication with superior pole of patella.
• VMO advancement and attachment with anterior
and medial part of patella.
• Check the position of patella by flexion.
Lateral release - as per requirement
Patellar tendon transfer
Rectus femoris lengthening
Extent of Surgery proportional to contractures
• Information contained and transmitted by this presentation is based
on personal experience and collection of cases at Choithram Hospital
& Research centre, Indore, India, during last 32 years.
• It is intended for use only by the students of orthopaedic surgery.
Many GIF files are taken from Internet/Textbooks.
• Views and opinion expressed in this presentation are personal.
• Depending upon the x-rays and clinical presentations viewers can
make their own opinion.
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