Habitual dislocation of patella - surgical technique

1. Habitual Dislocation Patella
a surgical case summary
Vinod Naneria
Girish Yeotikar
Arjun Wadhwani
Choithram Hospital & Research Centre, Indore, India

2. 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
mechanism.

3. 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
patella.

4. Persistent & Obligatory
• Persistent Dislocation
• Patella is dislocated
lateral and persistent in
that location.
• Often obvious in infency
• Usually associated with
other anomalies
• Knee flexion contracture
present.
• Functional disability.
• Obligatory Dislocation
• Patella dislocates and
reduces spontaneously
with flexion and
extension of knee
• Usually present at 5 to 10
years of age
• Usually isolated anomaly
• ROM usually normal

5. optimize quadriceps alignment.
Pathology

6. Cause - Effect

7. Surgical management of congenital and habitual dislocation of
the patella.
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.

8. Typical Procedure

10. Case summary
• 10 years old Female.
• Bilateral habitual dislocations.
• No other congenital anomaly.
• Painless full range of movements.

11. Surgical procedure
• 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.

13. Anterio-medial incision

14. Exposure of lateral border of patella
medial
superior
inferior

15. Release of lateral retinaculum
Superior pole
Patellar tendon

16. VMO elevation

17. Isolation of Semitendinosus
superior
inferior

18. Isolation of semitendinosus

20. Tendon passed under the superior pole patella
Turned back medially to align patella in center as checkrein.

21. Patella
Rectus femoris tendon
Patellar tendon
Semitendinosus tendon
Semitendinosus Tenodesis
Lateral release

22. VMO advancement distally and laterally

23. Patella
Rectus femoris tendon
Patellar tendon
Semitendinosus tendon
Lateral release

24. Patella
Rectus femoris tendon
Patellar tendon
Semitendinosus tendon
Lateral release

25. VMO advancement complete

30. Summary
Lateral release - as per requirement
Medial plication
VMO advancement
Semitendinosus tenodesis
Optional :-
Patellar tendon transfer
Rectus femoris lengthening
Extent of Surgery proportional to contractures

31. DISCLAIMER
• 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.
• For any confusion please contact the sole author for clarification.
• Every body is allowed to copy or download and use the material best
suited to him.
• For any correction or suggestion please contact
naneria@yahoo.com