ABSTRACT
Introduction: Patellar dislocation encompasses the 2-3% of the knee joint injuries, and lateral patellar luxation is by far more common than the medial one. Medial patellar dislocation is described only by few reports and generally as a consequence of previous surgeries. The purpose of this case report is to describe the surgical management of a rare case of traumatic bilateral medial patellar dislocation in a 15-year-old girl with no previous patellofemoral surgeries. Case Report: The patient underwent a traumatic medial patellar dislocation on the left knee, and 18 months later also on the right one. In both cases, the first proposed treatment was a conservative therapy, encompassing the use of a brace and muscular imbalance correction. After a 6-month period, the patient still referred to the persistent sensation of "giving away," so surgery was advised. The surgical operation consisted of an open medial retinacular release with complete dissection of the hypertrophic medial patellofemoral ligament and a transfer of the vastus medialis oblique to the superior border of the patella. Seven years after surgery, the patient declared to be satisfied with the procedure, referring only slight difficulty in squatting, jumping, and running. So far, no further episodes of dislocation occurred. Conclusions: The present case report showed the favorable result of surgical correction of a unique case of bilateral non-iatrogenic medial patellar luxation, in the absence of any underlying bony-structural abnormality. No other papers dealing with medial traumatic bilateral patellar dislocation are found in current literature.
ABSTRACT
PURPOSE: Bipolar fresh osteochondral allografts (BFOA) recently became a fascinating option for articular cartilage replacement, in particular in those young patients non-suitable for traditional replacement because of age. While the use of osteochondral allografts for the treatment of focal osteochondral lesions in the knee is well established, their use in the treatment of end-stage arthritis is far more controversial. The purpose of this paper is to describe our experience in a series of seven patients who underwent a resurfacing of both tibio-femoral and patello-femoral joints by BFOA. METHODS: From 2005 to 2007, seven patients (mean age 35.2 ± 6.3 years) underwent BFOA for end-stage arthritis of the knee. Patients were evaluated clinically, radiographically and by CT scan preoperatively and at established intervals up to the final follow-up. RESULTS: No intra-operative complications occurred. Nevertheless, joint laxity and aseptic effusion, along with a progressive chondrolysis, lead to early BFOA failure in six patients, which were revised by total knee arthroplasty at 19.5 ± 3.9 months follow-up. Only one patient, who received the allograft to convert a knee arthrodesis, gained a satisfactory result at the last follow-up control. CONCLUSIONS: BFOA in the knee joint still remains an inapplicable option in the treatment of post-traumatic end-stage arthritis of the young patient, due to the high rate of failure. Further studies are necessary in order to investigate the causes of failure and improve the applicability of this method. Still, after extensive counselling with the patient, BFOA may represent a salvage procedure aimed to revise scarcely tolerated knee arthrodesis. LEVEL OF EVIDENCE: Retrospective case series, Level IV.
