This document describes the case of a 35-year-old male construction worker who presented with recurrent patellar dislocations. An MRI revealed a medial patellofemoral ligament (MPFL) tear. The diagnosis was chronic patellar instability due to an MPFL tear. The treatment plan was for an arthroscopically assisted MPFL reconstruction using an autograft hamstring tendon. Post-operative rehabilitation started with the knee immobilized in extension to avoid flexion and allow early walking.

1. ORTHOPEDIC
SURGERY UNIT 1
DR.M IMRAN ASHRAF
PGR ORTHOPEDIC SURGERY

2. 35 YRS OLD MALE
RESIDENT OF KANGAN PUR,
MARRIED,
CONSTRUCTION WORKER BY PROFESSION
PRESENTED WITH COMPLAINTS OF
RECURRENT PATELLAR DISLOCATIONS 5-6
EPISODES

3. PAST SURGICAL HISTORY –VE
PAST MEDICAL HISTORY –VE
FAMILY HISTORY NOT SIGNIFICANT
DRUGS HISTORY:NOT SIGNIFICANT
Personal history: lives in his own house with family on ground
floor with good sunlight and ventilation .belongs to lower
socioeconomic status

4.  G.P.E WAS UNREMARAKBLE
 SYSTEMIC EXAMINATION WAS UNREMARKABLE
 BEIGHTON SCORE WAS NORMAL

5. QUADRICEPS ATROPHY
APPREHENSION TEST +VE
J SIGN -VE
GAIT WAS ANTALGIC WITH SHORT
STANCE PHASE WITH NO SWAYING OF
UPPER TRUNK

6. ON AP VIEW :
NORMAL ANATOMICAL
ALIGNMENT OF FEMUR
AND TIBIA
NO VARUS AND VALGUS
DEFORMITY
CORTICAL BREACH OF
PATTELLA (ARROW)

7. on Lateral view
Trochlear dysplasia -ve
cross over sign -ve
no supratrochlear spur -ve
Normal patellar height
INSALL SALVATI RATIO WAS 1
(NORMAL VALUE IS 0.8- 1.2)
PATELLAR
HEIGHT
PATTELAR TENDON
LENGTH

9. SUNSET VIEW RADIOGRAPH
SULCUS ANGLE IS 130 DEGREE
NO FEMORAL CONDYLE HYPOPLASIA
BARPATITE PATELLA
LATERAL PATELLA FEMORAL ANGLE IS
NORMAL I.E. >11 DEGREE
BIPARTITE
PATTELA

12. AXIAL VIEW MRI
 POSITIVE FINDINGS WERE
 BIPARTITE PATTELA
 MPFL TEAR
 NORMAL SULCUS DEPTH 3mm
BIPARTITE
PATELLA
DEPTH OF
SULCUS >3mm
MPFL TEAR

13. CORONAL VIEW OF MRI
MPFL
TEAR

14. DIAGNOSIS IS ?

15. CHRONIC PATTELAR INSTABILITY DUE
TO MEDIAL PATTELO FEMORAL
LIGAMENT TEAR
 SUGGESTED BY
 RECURRENT PATTELAR DISLOCATION
 MPFL TEAR ON MRI
 NORMAL SULCUS DEPTH

17. PATELLA
 The patella (derived from Latin means
'small plate') is a flat, inverted
triangular bone, situated on the front
of the knee-joint. It is the largest
sesamoid bone, developed in the
tendon of the Quadriceps femoris

18. Passive stability:
MPFL first 20-30 degrees
of knee flexion.
trochlear groove
morphology
patella height
patellar tracking
Dynamic stability:
vastus medialis (vmo)

19. TREATMENT OPTIONS
 OPEN RECONSTRUCTION
 ARTHROSCOPIC ASSISSTED RECONTRUCTION

21. PLAN
 ARTHROSCOPICALLY ASSISTED MPFL
RECONSTRUCTION WITH AUTOLOGOUS
HAMSTRING GRAFT.

23. POST OPERATIVE XRAY

24. IMMEDIATE POST OPERATIVE
REHABILITATION PROTOCOL WAS
STARTED WITH KNEE
IMMOBILZER IN PLACE IN
EXTENSION TO AVOID FLEXION
AND PATIENT CAN START
WALKING WITH THE HELP OF
WALKER

25. TAKE HOME MESSAGE
 CONVENTIONAL METHOD
 OPEN TECHNIQUE
 LARGE INCINSION
 DELAYED WEIGHT
BEARING
 BIG SCAR OVER KNEE
 MORE WOUND RELATED
COMPLICATIONS
VS
• LATEST TECHNIQUE
• ARTHROSCOPIC
ASSISSTED
• SMALL INCISION
• EARLY WEIGHT
BEARING
• LESS WOUND
COMPLICATION