Guidelines for Treatment of Lateral Patella Dislocations in Skeletally Mature Patients
The incidence of lateral patella dislocations is high, particularly in young females. Beside traumatic cases, many patients present with specific anatomical factors that predispose to lateral patella dislocations (torsional abnormalities of the femur or the tibia, trochlea dysplasia, patella alta, etc). It is of utmost importance to correct those pathologic factors during concomitant procedures as isolated reconstructions of the medial patellofemoral ligament would fail in the presence of severe anatomic risk factors. This article provides a comprehensive instruction on how to analyze the risk factors for lateral patella dislocation (anatomy, physical examination, imaging) and reports the authors’ favorite surgical techniques. Moreover, treatment algorithms are provided for primary and recurrent cases of lateral patella dislocation.
Derotational osteotomies of the femur (externally rotating) provide good outcomes in patients with LPD and associated torsional deformities,61-63 though the literature is incongruent with respect to whether rotational osteotomies of the femur should be performed at the proximal or distal aspect.64-67 In the majority of our LPD cases, we combine femoral derotation with MPFL reconstruction.
Treatment Algorithms
We suggest using different algorithms for primary LPD (Figure 22, Tables 1-2) and recurrent LPD (Figure 23).
Conclusion
In skeletally mature patients, LPD is sufficiently treated with modern versions of patellofemoral surgery. Comprehensive assessment for underlying pathology is paramount as preparation for developing an appropriate surgical plan for the patient.
Am J Orthop. 2017;46(2):E86-E96. Copyright Frontline Medical Communications Inc. 2017. All rights reserved.
