Visualization of osteochondral fragments in the cavity of the knee joint in case of patellar dislocation in children

The objective was to assess the capabilities of MRI and CT in visualizing free bone and cartilage fragments in the knee cavity after lateral dislocation of the patella. Materials and methods. CT and MRI were performed in 220 patients, including 127 girls and 93 boys aged 12 to 18 years (mean age 14.5 years), with acute lateral patellar dislocation. Results. Lateral dislocation of the patella in 25% of cases led to the appearance of osteochondral fragments. CT scan revealed and confirmed osteochondral fragments surgery in 55 people (100%), MRI scan - in 50 people (90%). The sites of the detachment of the osteochondral fragments were: a medial facet of the patella in 22 (38.8%), the outer edge of femur lateral condyle in 33 (58.2%), t patella and lateral condyle of the femur in 2 patients (3%). Free cartilage fragments not detected by CT were detected by MRI in 2 patients. Conclusion. Patellar dislocation is an injury that is likely to require surgery. The volume of osteochondral and soft tissue lesions can be established with the maximum degree of probability by MRI while detecting small osteochondral fragments is most reliable with CT. Combining these two observation methods provides the complete possible information about the extent of damage, which allows timely resolution of treatment tactics.

Congenital Dislocation of the Patella – Surgical Treatment Rationale and Literature Review

Introduction: Congenital dislocation of the patella (CDP) is a rare condition and its treatment is not well defined. In CDP, patella is dislocated on the lateral aspect of the distal femur, laterally from the trochlear groove, it cannot be reduced manually and it is almost always associated with genu valgum, lateral torsion of the proximal tibia, and flexion contracture of the knee. This condition is present at birth, but the clinical findings can be subtle at birth due to the size and character of the structures being examined; early diagnosis is essential, but it may be delayed to late childhood or adulthood. If CDP is not promptly treated, the disability increases during growth, so surgical correction should be planned as soon as the diagnosis is confirmed. Case Report: We report a case of bilateral CDP associated with bilateral proximal radioulnar joint stiffness; the patient at the age of diagnosis was 11 years old and underwent a bilateral delayed surgical procedure; the 4-year follow-up results are satisfactory. Surgical treatment rationale and literature are reviewed. Conclusion: Surgical correction for CDP is generally recommended, but there is no agreement in literature on the ideal treatment and in some cases, with mild impairment of the knee function, observation alone has been suggested. The decision about a surgical treatment can be difficult and depends on the degree of disability of the patient. Keywords: Congenital dislocation of the patella, bilateral congenital dislocation, patella, Z-plasty quadriceps muscle, lateral retinaculum release, lack of active knee extension.

Review of Trillat, Dejour and Couette on ‘Diagnosis and treatment of recurrent dislocations of the patella’

‘Numerous operations have been described for correction of recurrent dislocation of the patella. The number in itself predicates that the problem has not been solved’.This classic discusses the original publication ‘Diagnosis and treatment of recurrent dislocations of the patella’ from Trillat A, Dejour H, Couette A. Published in 1964 at the Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur, where the authors described a surgical procedure modifying Elmslie’s original surgery for patients with objective patellar dislocations and also for patients with anterior knee pain who had the sign of the ‘baïonnette’. Medialisation of the anterior tibial tubercle (ATT) has been known worldwide as the Elmslie-Trillat procedure, but the history of procedure has its roots going back to 1888. The history of the publications of the Elmslie-Trillat technique is really something special. César Roux published in 1888 the original technique that is similar to Elmislie’s procedure. In 1944 in London, Trillat met Selddon and became aware about Elmslie’s procedure for the ATT medialisation. Back to France, Trillat published and named it as the Elmslie’s technique. Later, after the ‘Journées du Genou’, the technique was disseminated as ‘The Elmslie-Trillat’ procedure. Nowadays, isolated ATT medialisation, the ‘true’ Elmslie-Trillat operation, is still occasionally performed. Too few surgeons use these elegant operations largely because the details of the techniques are not taught routinely. This classic section has the objective to encourage young surgeons to learn tibial tubercle transfer operations and the benefits they bring to patients when performed for proper indications.

Congenital Deformity of the Knee Joint: A Boy With Congenital Patella Alta

ntroduction: Patella alta is an extremely rare condition, refers to an abnormally high position of the patella. Surgical treatment of habitual dislocation of the patella aims at a step-by-step correction of the abnormality. Case Presentation: A 4-year-old boy presented with a rare superior dislocation of the patella. Clinical examination and radiographs confirmed the dislocation of the patella. The patella was reduced with proper reduction technique under sedation, resulting in the improvement of active range of motion. onclusion: Congenital patella alta is a rare deformity in children. Treatment and diagnosis in the early stages are of our priority in the treatment. Our non-surgical treatment is our preferred treatment in this patient. The surgical treatment approach is performed in patients that have no response to non-surgical treatments.

Intra-articular horizontal dislocation of the patella: a rare injury and review of the literature

Acute traumatic intra-articular dislocation of the patella is not a common presentation in orthopaedic practice; less frequently observed than extra-articular dislocation of the patella. In some of these cases, closed reduction is not possible and an open reduction in the operating theatre must be performed. In this case report, we present an elderly patient with an intra-articular horizontal dislocation of the patella without any other bony or ligamentous lesions seen in a postreduction MRI. We conducted a literature review looking at intra-articular patella dislocations, identifying 64 published studies (articles, case reports and papers). The following sources of data were searched until December 2017: PubMed, OVID, Google Scholar, Scopus, using the search strategy of (intra-articular dislocation of patella, horizontal patellar dislocation) with no limitation on the year or language of publication. The patient presented in this case report was managed with a closed reduction under general anaesthesia, without the need of any surgical intervention. As proposed in the literature, the hypothesis of an intra-articular entrapment of the patella due to the trapped osteophytes of the superior pole of the patella into the intercondylar notch was thought to be the cause of intra-articular dislocation in this elderly patient.