Congenital Dislocation of the Patella

Abstract

This is a report of 2 rare, neglected congenital irreducible complete lateral dislocations of the patella. The patients were boys, 10 and 13 years old. The dislocations were designated irreducible because closed manipulative effects were invariably failures and the dislocations are permanent because they persist from birth until openly reduced. The deformity was neglected for years (one patient through childhood, the other into adolescence) during which time the anomalous defects were exacerbated by adverse growth changes. The propitious time (late infancy or early childhood) for open reduction and patellar stabilization with an excellent prognosis had long since passed by the time the patients were first seen by an orthopedic surgeon. Neglect had not only caused them to grow up as cripples, but had also rendered their patellae more difficult to reduce surgically. Neglect also increased the challenge to their surgeon to stabilize their patellae and to cope with their needless and preventable secondary deformities by multiple surgical interventions with decreased prospects of emerging free of residual problems and disabilities. In the growing child with active proximal tibial epiphyseal cartilage, interference with growth was avoided by patellar stabilization using the W. T. Green technique for quadricepsplasty. In the adolescent boy, who was closer to skeletal maturity, patellar stabilization was effectually accomplished by transplanting the tibial tuberosity medially and distally with relative impunity and reinforcing it with a Campbell sling. Angular and linear limb deformities were treated by epiphysiodeses. Prolonged dislocations result in loss of normal articular contours, and nonuse of articular cartilages has a morbid effect; both predispose the joint to early degenerative arthritis. Early diagnosis and early referral for orthopedic care are imperative because delay vitiates the ultimate result.