Extensive Lateral Release and Medial Patello-femoral Ligament Reconstruction in 25 years of Chronic Fixed Lateral Patellar Dislocation: A 5 year follow up Case Report

OBJECTIVES: Chronically fixed lateral patellar dislocation is uncommon and mostly associated with disruption of the medial patellofemoral ligament (MPFL) which is a major risk factor for this condition, as it functions as the main patella medial stabilizer. This paper focuses on the reconstruction of the MPFL after an extensive lateral release in a fixed lateral patellar dislocation. We aim to explain the technique that was used to reduce and maintain the position of the patella and prevent it from re-dislocation. Extensive lateral release and modified MPFL reconstruction for a chronically fixed patellar lateral dislocation provide a satisfactory result. We aim to explain a modified technique to treat a chronically fixed patellar lateral dislocation CASE PRESENTATION: We present a case report of a 49-year-old Caucasian male with a history of falling on his right knee 25 years before. He complained of pain on his knee for 8 months before. Physical examination showed chronically fixed lateral patellar dislocation with a normal range of motion. The diagnosis of patellar dislocation was confirmed with a conventional radiograph. The patient underwent extensive lateral release of the knee followed by a modified technique for MPFL reconstruction. Semitendinosus tendon was used as the graft because of the chronic nature of this condition. The graft was inserted into the patellar tunnel and fixed using endobutton®. The graft was inserted into the femoral tunnel that was made at Schottle point from the medial through the lateral side. After that, the cortical screw with the washer was inserted on the lateral femoral side just above the femoral tunnel as an anchor to make sure the tendon is secured. We follow-up the patient for 5 years. RESULTS AND CONCLUSION: On a 5 year follow-up, there was no complaint of recurrent patellar dislocation. The result of this extensive lateral release followed by modified MPFL reconstruction for a chronically fixed lateral patellar dislocation is satisfactory. The extensive release was needed to reduce the fixed dislocated patella and this modified technique of MPFL reconstruction by using screw and washer as an anchor on lateral sides of the femur could be an alternative to prevent re-dislocation.