Total Knee Arthroplasty Combined With Medial Patellofemoral Ligament Reconstruction for Osteoarthritic Knee With Preoperative Valgus Deformity and Chronic Patellar Dislocation

doi:10.1016/j.arth.2010.01.101

The Journal of Arthroplasty

Volume 26, Issue 3, April 2011, Pages 505.e17-505.e20

https://doi.org/10.1016/j.arth.2010.01.101 Get rights and content

Abstract

We report a challenging case of a 44-year-old woman who had osteoarthritis in the lateral compartment of her right knee with severe valgus deformity and chronic lateral patellar dislocation. Total knee arthroplasty was performed for the knee. However, persistent patellar dislocation remained during the surgery; and therefore, medial patellofemoral ligament (MPFL) reconstruction was additionally performed at the time of the surgery. Stable patellar tracking was obtained after the MFPL reconstruction; and during the 2-year follow-up, her knee functioned well, and no recurrent patellar dislocation was observed. This clinical case indicates the usefulness of MPFL reconstruction for obtaining stable patellar tracking during total knee arthroplasty when a tendency for lateral patellar dislocation remains.

Section snippets

Case Report

A 44-year-old woman complaining of right knee pain was referred to our hospital. She was able to walk unaided when she visited our clinic. Her right knee was valgus, and osteoarthritic changes were observed in the lateral compartment of the knee. She had no other abnormalities but mental retardation. Conservative treatment was initially chosen; and a long knee orthosis, which supports from just above the ankle to the middle of the thigh, was applied to the right knee to correct the valgus

Discussion

Osteoarthritis of valgus knee with chronic patellar dislocation is a rare condition; and therefore, performing TKA on such patients can be technically demanding. Particularly, it is important to make strategies for obtaining good patellar tracking. Some key surgical techniques have been described to improve patellar tracking during TKA, such as a proper amount of patella resection, correction of alignment, proper external rotation of the femoral component, and lateral soft tissue release [1].

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Cited by (14)

Total Knee Arthroplasty Without Reduction of the Patella for Genu Valgum With Permanent Dislocation of the Patella: A Case of Nail Patella Syndrome
2023, Arthroplasty Today
A 75-year-old woman presented with progressive bilateral knee pain and severe genu valgum. She could walk utilizing braces and T-canes, with a 20° flexion contracture and 150° of maximum flexion. During knee flexion, the patella laterally dislocated. Radiographs demonstrated severe bilateral lateral tibiofemoral osteoarthritis and patellar dislocation. She underwent posterior-stabilized total knee arthroplasty without patellar reduction. After implantation, the knee range of motion was 0°-120°. Intraoperative findings revealed that the affected patella was too small, low articular cartilage volume resulted in the diagnosis of nail patella syndrome with the tetrad of nail dysplasia, patella dysplasia, elbow dysplasia, and iliac horn. At the 5-year follow-up visit, she could walk without a brace and had a knee range of motion (10°-135°) with clinically favorable results.
Total knee arthroplasty combined with medial patellofemoral ligament augmentation using a Leeds-Keio ligament for ‘Windswept deformity’ with ipsilateral valgus deformity and permanent patellar dislocation: A case report and a literature review
2021, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Citation Excerpt :
The current case was a very severe valgus knee with permanent patellar dislocation, and not staged but simultaneous semi-constrained TKA with MPFL augmentation using artificial LK ligament without bone graft was performed due to the advanced age of the patient. Several proximal alignments, such as medialization of the tibial tuberosity,10 vastus medialis advancement11,12 and MPFL reconstruction,9,13 have been performed if the patella still dislocates after correction of alignment, proper external rotation of the femoral and tibial components, and lateral retinaculum release in TKA. In the current case, MPFL augmentation was chosen considering the patient's age, bone quality and the remaining permanent patellar dislocation after semi-constrained TKA.
We present a ‘Windswept deformity’ in patient who had osteoarthritis with a mild varus and very severe valgus with ipsilateral permanent patellar dislocation. An 83-year-old woman could not walk for the past a few years due to bilateral knee pain. The femorotibial angle was 196° in the right knee pre-operatively and 134° in the left knee with permanent patellar dislocation. She underwent a staged total knee arthroplasty (TKA) for the right knee, and a semi-constrained TKA for the left knee with medial patellofemoral ligament (MPFL) augmentation using a Leeds-Keio (LK) ligament. At the final follow-up three years after surgery, bilateral knee pain and the extension lag had disappeared and range of motion (ROM) was 0° in extension and 130° in flexion for both knees without patellar re-dislocation. This clinical case indicates that the unconstrained and semi-constrained type of TKA combined with the MPFL augmentation using an LK ligament is effective to treat a ‘Windswept deformity’.
Combined Total Knee Arthroplasty and Medial Patellofemoral Ligament Reconstruction for Chronic Patellar Dislocation and Severe Osteoarthritis
2021, Arthroplasty Today
Citation Excerpt :
In these cases, proximal, distal, or combined realignment of the extensor mechanism is necessary to achieve a satisfactory clinical outcome. Various approaches have been proposed to address fixed patellar dislocations in the setting of knee OA, and literature regarding this topic consists mainly of case reports that describe varying realignment techniques combined with TKA [1,3,11-16]. This technique article describes the utilization of a soft tissue allograft to reconstruct the medial patellofemoral ligament (MPFL) along with an extensive lateral release to achieve soft tissue balancing for a patient with a fixed patellar dislocation and knee OA.
Chronic patellar dislocation in the setting of severe knee osteoarthritis is a rare clinical problem. Surgical management often consists of total knee arthroplasty combined with realignment of the extensor mechanism. Several techniques have been described to anatomically restore the extensor apparatus, and literature regarding this topic consists mainly of case reports. We describe a technique using combined medial patellofemoral ligament reconstruction using allograft tissue and total knee arthroplasty with patellar resurfacing for the treatment of chronic patellar dislocation and severe osteoarthritis.
Total knee replacement in patients with osteoarthritis and concomitant inveterate patellar dislocation
2019, Arthroplasty Today
Citation Excerpt :
Several techniques have been described to reconstruct the dislocated extensor apparatus, including the Elmslie-Trillat procedure, proximal patellar quadricepsplasty, and medial patellofemoral ligament reconstruction [11-14]. When severe knee osteoarthritis is present, total knee arthroplasty is a treatment option, which may or may not be associated with realignment of the extensor apparatus to achieve an adequate valgus correction and obtain a correct soft tissue balance [15,16]. Available literature consists of a number of case reports that report many techniques to provide an adequate treatment for patients with inveterate patellar dislocation.
The inveterate patellar dislocation is an uncommon entity. The most frequent findings correspond to a misaligned valgus associated with lateral patellar dislocation. When severe knee osteoarthritis is present, total knee arthroplasty is an option, whether it is associated or not with realignment of the extensor apparatus. We present a review of published literature on correction of inveterate patellar dislocation associated with knee arthritis and our surgical technique with a case of inveterate patellar dislocation associated with tricompartmental knee osteoarthritis, in which a total knee arthroplasty was performed associated with proximal and distal realignment of the extensor apparatus. Total knee arthroplasty is a useful procedure in knee osteoarthritis associated with inveterate patellar dislocation, which can be associated with techniques on the extensor apparatus to achieve an adequate patellar alignment.
Total knee arthroplasty with subvastus approach in patient with chronic post‐traumatic patellar dislocation
2016, Revista Brasileira de Ortopedia
A luxação crônica da patela é uma patologia rara e o trauma sua principal causa adquirida. Quando negligenciada, leva ao geno valgo progressivo, à torção externa da tíbia e à subsequente artrose debilitante. Não existe consenso na literatura com relação ao tratamento desses pacientes, porém a artroplastia total de joelho (ATJ) tem se mostrado um procedimento eficaz em casos de gonartrose sintomática dolorosa. Poucos relatos mostraram que a via subvasto associada à liberação lateral é uma opção válida para ATJ, já que permite a correção de deformidades em valgo e da boa excursão patelar, sem interrupção do suprimento sanguíneo. Relatamos um caso de uma paciente com geno valgo e luxação crônica pós‐traumática de patela submetida a ATJ associada ao realinhamento do mecanismo extensor, com resultados satisfatórios persistentes após seguimento de dois anos.
Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post‐traumatic patellar dislocation with satisfactory results after two years of follow‐up.
Total knee arthroplasty in patients with permanent patella dislocation. Report of two cases and literature review
2018, Revista Brasileira de Ortopedia
A ocorrência de luxação permanente da patela associada a osteoartrite grave é considerada rara e de tratamento difícil. A literatura é bastante controversa sobre o assunto. O objetivo do trabalho é relatar dois raros casos de osteoartrite grave com luxação permanente da patela que foram submetidos a artroplastia total do joelho, além da técnica cirúrgica relacionada e de uma revisão da literatura. A artroplastia total do joelho com o acesso parapatelar medial associado a uma liberação lateral foi uma boa opção cirúrgica em pacientes com luxação permanente da patela associada a osteoartrite avançada.
The occurrence of permanent patellar dislocation associated with severe osteoarthritis is considered rare and difficult to treat. Literature The literature is quite controversial on the subject. The objective of the study is to report two rare cases of severe osteoarthritis with permanent dislocation of the patella that underwent total knee arthroplasty, in addition to a review of the literature on the subject and related surgical technique. Total knee arthroplasty with using the medial parapatellar approach associated with lateral release was a good surgical option in patients with permanent patellar dislocation associated with advanced osteoarthritis.

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Case ReportTotal Knee Arthroplasty Combined With Medial Patellofemoral Ligament Reconstruction for Osteoarthritic Knee With Preoperative Valgus Deformity and Chronic Patellar Dislocation

Abstract

Section snippets

Case Report

Discussion

Patellar tracking in primary total knee arthroplasty

Instr Course Lect

Elmslie-Trillat procedure for the treatment of recurrent patellar instability

Arthroscopy

Tibial tubercle osteotomy in primary total knee arthroplasty: a safe procedure or not?

Knee

Total knee arthroplasty in an adult with congenital dislocation of the patella

J Arthroplasty

Total knee replacement for osteoarthritis of the knee with congenital dislocation of the patella

J Bone Joint Surg Br

Medium-term results of the operative treatment of recurrent patellar dislocation by Insall proximal realignment

Knee Surg Sports Traumatol Arthrosc

A modified Hauser procedure for recurrent dislocation of the patella. A long-term follow-up study with special reference to osteoarthritis

Arch Orthop Trauma Surg

Indications in the treatment of patellar instability

J Knee Surg

Case Report
Total Knee Arthroplasty Combined With Medial Patellofemoral Ligament Reconstruction for Osteoarthritic Knee With Preoperative Valgus Deformity and Chronic Patellar Dislocation