Patellar Dislocation

Epidemiology
Patellar dislocations primarily affect adolescents and young adults. Up to 44% may experience recurrent dislocations (Stefancin et al Clin Orthop Relat Res, 2007).


Anatomy
Stability of the patella is dependent on the bony configuration of itself sitting within the trochlear groove and on the surrounding soft tissue structures. There are multiple soft tissue layers surrounding the patellafemoral joint. Medially, there are three layers. Superficially is the fascia overlying the sartorius muscle, intermediately is the medial patellofemoral ligament (MPFL) and the retinaculum, and the third layer consists of the medial collateral ligament and joint capsule. The lateral retinaculum is comprised of fascial connections from the ITB, lateral hamstrings, LCL, and lateral quadriceps.


Risk Factors
Potential risk factors may include: tight lateral structures, femoral anteversion, patella alta, increased Q-angle, increased sulcus angle, lateralization of the tibial tubercle, excessive foot pronation, and a vertical vastus medialis oblique insertion.


Non-operative Management
Conservative management is usually preferred after first-time subluxation/dislocation. This consists of bracing, taping, and physical therapy.


Operative Management
There are many different procedures to correct patellar instability. Proximal realignment procedures include lateral release, medial reefing, advancement of the VMO, and Galleazzi's procedure. Distal realignment is where the tibial tubercle and patellar tendon are transferred medially.

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