Document Title: Ahmad-AJSM-Nov00

Article Title: Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation: A review of eight cases

Author: Christopher S. Ahmad, Beth E. Shubin Stein, David Matuz, Jack H. Henry.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: November-December 2000.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 28

Issue: 6

Pages: 804-810

Key Words: Knee, patellar, dislocation.

 

Ahmad et al. discuss a series of very successful surgical repairs of the injured medial patellar stabilizers (vastus medialis oblique muscle and medial patellofemoral ligament). (Note that "patellar dislocation" is very distinct from "knee dislocation". The latter entails catastrophic disruption of essentially all four major ligaments of the knee, and usually only results from high-kinetic-energy injuries such as from motor-vehicle accidents. Patellar dislocation, while painful, tends to occur independently of tibiofemoral-compartment major-ligament -- that is, ACL, PCL, MCL, LCL -- problems.)

 

ABSTRACT

 

An open surgical repair of the injured medial patellar stabilizers, including the vastus medialis oblique muscle and the medial patellofemoral ligament, after acute patellar dislocation was studied in eight patients. At initial examination, all patients had tenderness over the adductor tubercle and a positive patellar apprehension sign. Four of eight patients had obvious ecchymosis over the adductor tubercle. Magnetic resonance imaging, diagnostic arthroscopy, and open surgical exploration documented injury to both the medial patellofemoral ligament and the origin of the vastus medialis oblique muscle. In all patients, the torn muscle was retracted in an anterior and superior direction and an arthroscopic lateral release was performed followed by open primary repair of the medial patellofemoral ligament to the adductor tubercle and repair of the vastus medialis oblique muscle to the adductor magnus tendon. Patients were evaluated postoperatively with the Kujala scoring questionnaire. The average follow-up was 3.0 years, with a minimum of 1.5 years. No patients experienced a recurrent dislocation. The average Kujala score was 91.9. Patients rated their return to athletic activity at an average 86% of their pre-injury level. The average subjective satisfaction was 96%. In appropriate cases of acute patellar dislocation, we recommend primary repair of the medial patellofemoral ligament and the vastus medialis oblique muscle to avoid recurrent dislocation, chronic subluxation, pain, and disability.

 

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