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Combined Proximal and Distal Realignment for Recurrent Patellofemoral Instability

This case appears in the HSS publication Grand Rounds from HSS - Management of Complex Cases, Winter 2014 - Volume 4, Issue 3, Case 1

Case 1, presented by Beth E. Shubin Stein, MD, Sabrina M. Strickland, MD and Jacqueline Munch, MD describes A 15-year-old female who began dislocating both patellae at the age of five. Her problem worsened when she began to play sports. On examination, the patient had valgus knee alignment with hypermobile patellae bilaterally. Her lateral retinaculae were not felt to be excessively tight. She had obvious bilateral patella alta (abnormally high patellae in relation to their femoral trochlear grooves), and her patellae were not captured in the trochlear groove until 65 degrees of knee flexion. She had bilateral positive patellar apprehension tests and significant J signs (patellar subluxation laterally in active terminal extension). Otherwise, her ligamentous and physical examinations were within normal limits. Taking into account these and other findings, both proximal and distal patellar realignment were recommended. Postoperatively, her osteotomy sites healed well, and she maintained patellar stability. Two and half years after both knee surgeries, she was very satisfied with the outcome, having returned to all her normal activities with no further instability events.

Read full case details in Volume 4, Issue 3 of Grand Rounds - Complex Cases.

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Questions or Comments?

For any questions or comments regarding GRMCC, email complexcases@hss.edu.