Slipping or Recurrent Dislocation of the Patella; With the Report of Eleven Cases

Abstract

The above condition is seen almost entirely in girls or women, and i.s duo, in large part, to the fact that the line of pull of the quadriceps extensor muscle is not straight, this feature being increased in its effect by an unnaturally long patella tendon, knock knee or an imperfectly developed articulai-surface al the end of the femur. Eleven cases of this condition, seven operative with thirteen operations, and four nonoperative, have heen seen and treated by the writer, and the observations made in connection with the treatment of these cases represents the basis of this paper. The first feature, or the indirect muscle pull, is in part normal anatomically. The tubercle of the tibia with the attachment of the patella tendon is distinctly to the outside of the central portion of the patella when the knee is extended and the muscles arc at rest. As the action of the muscles, together with the joint motion, is studied, it-is seen that during flexion the patella, is drawn forward over the articular surface between the condyles of the femur and inclines slightly but distinctly to the outside of the me-Kia. 1 (Gray). than line. As extension lakes place the patella ascends, inclining slightly toward the inner sido until, when extension is complete, the line formed by the, origin of the reclus Icuioris, the center of the patella, and the tubercle of the tibia makes an obtuse angle (Fig. 1). As the muscle contracts tin; natural tendency is to straighten this line, with the necessary result that the patella is drawn outward, representing, as it does, the only movable point in the line. This can easily be demonstrated in any normal joint if the knee be fully extended and the quadriceps muscle be alternately contracted and relaxed. The lateral movement of the patella is distinct, the limit' outwardly being controlled in part by the ligaments, but more particularly by the outer ridge of the troohlear surface of the femur, which is distinctly higher in its upper and anterior surface than the same ridge at the inner side (Fig. 2). Against this the patella impinges, ami displacement further is impossible as long as all the parts are normal. Fig. -2 (Gray).If for any reason the line of pull becomes less direct or the articular ridge less perfectly formed; if the capsule be weakened by the distention following some acute injury; if the patella tendon be abnormally long so that the patella is drawn above the outer edge of the trochlear surface of the femur; or if the joint can be hyperextended so that, during the muscular pull the patella is lifted away from the femur in any one of these conditions the stability of the joint, so far as the patella is concerned, must be materially lessened.The displacement of the patella, which results from such a mechanical condition, may occur frequently with simple motion or muscular contraction, or may develo]) only when attended with the application of considerable force and when combined with some lateral strain, the east; or difficulty of the displacement depending, of course, upon the deg...

Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

“…The Roux-Goldthwait procedure followed the original technique [18]. The lateral half of the patellar tendon was transferred behind the medial half of the tendon, and the transferred lateral half was attached to the medial tibia to prevent lateral dislocation.…”

Restoration of patellofemoral congruity by combined lateral release and tibial tuberosity transposition as assessed by MRI analysis

“…Various operations Reprint requests to: S. K. Koskinen for proximal or distal realignment of the extensor mechanism of the knee have been advocated but none has been proven superior to others [4,5,10].…”

Dislocation of the patella in a patient with Rubinstein-Taybi syndrome – a case study.

“…It involved a liberation of the lateral vastus muscle, lenghtening of the rectus femoris muscle, plasty of the medial vastus muscle and medial trans fer of Na pod sta wie sta nu kli nicz ne go, wy ni ków ba dań ob ra zo wych i da nych z li te ra tu ry za kwa li fi ko wa no cho rą do le cze nia ope ra cyj ne go le we go sta wu rzepko wo -udo we go [15]. Wy ko na no pla sty kę apa ra tu wyprost ne go le we go sta wu ko la no we go po le ga ją cą na: uwol nie niu mię śnia ob szer ne go bocz ne go, wy dłu że -niu mię śnia pro ste go uda, pla sty ce mię śnia ob szer nego przy środ ko we go i prze nie sie niu ½ bocz nej wię zadła rzep ki na stro nę przy środ ko wą (po łą cze nie opera cji wg Gre en i Ro ux -Gold th wa it) [20,21]. Po opera cji sto so wa no dre naż ssą cy z ra ny ope ra cyj nej przez jed ną do bę.…”

“…We dług the lateral half of the patellar ligament (a com bination of the Green and Roux-Goldthwait proce dures) [20,21]. A suction drainage from the surgical wound was used for one day post-operatively.…”