Chapter 9:Patellar Subluxation


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Figure 9.1. This patient demonstrates bilateral subluxation and tilt. Although there is no sign of arthrosis here, this combination usually leads to patellar articular cartilage degeneration.

Figure 9.2. This patient had long‑standing permanent patellar subluxation and tilt after medial arthrotomy. This led eventually to lateral facet arthrosis. Anteromedial tibial tubercle transfer gave excellent relief to the patient by transferring most articular contact load onto the intact medial facet.

Figure 9.3. Despite substantial patellar subluxation throughout knee flexion and extension, some patients have remarkably little pain or evidence of arthrosis.

Figure 9.4. Anteroposterior view of the knee in a 58year‑old obese woman with genu valgum, severe lateral compartment arthrosis, and permanent lateral patella subluxation.

Figure 9.5. A and B, Patient with bilateral subluxation.

Figure 9.6. Patellar subluxation may occur without any evidence of articular cartilage damage in some patients.

Figure 9.7. Chronic lateral patellar subluxation will lead to dysplastic changes, which usually include elongation and deterioration of the lateral facet, distal medial and central cartilage degeneration, lateral subchondral sclerosis, and flattening of the lateral trochlea.

Figure 9.8. Alpine hunter's cap dysplasia associated with a very shallow trochlear sulcus in a patient with recurrent dislocation of the patella.

Figure 9.9. A, The 30‑degree axial view shows mild subluxation. B, Further flexion leads to perfect centering.

Figure 9.10. A, Axial views of a patient complaining only of right knee instability show marked subluxation on 30‑degree view only of both patellae. Perfect recentering is evident on the 60‑ and 90‑degree flexion views, which underscores the need for obtaining radiograms or computerized tomography with knee flexion of 20 to 30 degrees. B, Computerized tomographic view of subluxation without tilt.

Figure 9.11. Mild tilt and subluxation at 20 de­grees of knee flexion. Often, subluxation improves with further flexion, but tilt may either improve or worsen.

Figure 9.12. At 30 degrees of knee flexion (A), the patella is lateral, but on further flexion (B and C), the patella centralizes.

Figure 9.13. Medial retinacular calcification in a patient who, by history, has never had a dislocation. The history, however, was compatible with recurrent subluxation.

Figure 9.14. Several popular methods of extensor mechanism equilibration. Reprinted with permission from Ficat P. Pathologie Femoro‑Patellaire. Paris: Masson et Cie; 1970.

Figure 9.15. The Galliazzi semitendinosus tenodesis provides medial support for major or permanent patellar subluxation in the skeletally immature patient. Reprinted with permission from Baker RH, Carroll N, Dewar P Hall JE. Semitendinosus tenodesis for recurrent dislocation of the patella. J Bone Joint Surg 1972;548:103‑109.

Figure 9.16. Procedures that transfer the tibial tubercle in a medial direction down the medial slope of the tibia are rarely, if ever, indicated. Reprinted with permission from Cox JS. Evaluation of the Roux‑Elmslie‑Trillat procedure for knee extensor realignment. Am J Sports Med 1982;10:303.

Figure 9.17. A, Transection through the tibia at the level of the tibial tubercle, with the tibial plateau superimposed for orientation. O = axis of knee flexion; R = extensor lever arm. B, Lateral view of extensor mechanism and the knee. M1, M2 = quadriceps vectors (see Chapter 2). C, Transected view of proximal tibia showing detrimental effect of tibial tubercle medialization using such methods.

Figure 9.18. Method of medial tibial tubercle transfer fashioned after the method of Elmslie and modified by Goutallier and Debeyre (41). This minimizes diminution of the extensor lever arm.

Figure 9.19. Creating an oblique osteotomy deep to the tibial tubercle will permit anterior as well as medial tibial tubercle displacement. One must beware of the anterior tibial artery and the deep peroneal nerve at the posterolateral corner of the osteotomy.


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