Abstract
Acute traumatic patellar dislocations are encountered with relative frequency, making up 3% of all knee injuries. Typically witnessed in younger patients following sporting injuries, this injury can be debilitating, potentially leading to recurrent dislocation, pain, reduction in activity and patellofemoral osteoarthritis.Management of this injury remains controversial, and as such detailed magnetic resonance imaging (MRI) is increasingly recommended to help illustrate the exact nature of osteochondral and soft tissue injury, with a view to assessing the anatomical sequelae of patellar dislocation as well as the potential of recurrence and dictating the need for either conservative or surgical management in the acute setting. As such, awareness of the typical MRI findings in traumatic patellar dislocations may potentially aid in pursuing appropriate intervention for this pathology.This case describes a 33-year-old gentleman presenting to the emergency department following patellar dislocation. After failed departmental closed reduction, this patient progressed on to definitive anatomical MRI assessment followed by acute surgical intervention in the form of medial patellofemoral ligament (MPFL) repair. This case allows for both illustration and discussion of typical radiological features associated with traumatic patellar dislocation.
Highlights
Received 12/05/2018 Review began 12/06/2018 Review ended 12/12/2018 Published 12/14/2018Acute traumatic patellar dislocations are encountered with relative frequency, making up 3% of all knee injuries [1]
Witnessed in younger patients following sporting injuries, patellar dislocations generally occur laterally following either a twisting injury or direct impact, with resultant disruption of the medial patellofemoral ligament (MPFL), the primary restraint to lateral patellar subluxation, and accompanying retinaculum occurring in approximately 90% of affected patients [1,2]
While plain radiographs are useful in confirming the diagnosis, magnetic resonance imaging (MRI) is frequently recommended for definitive radiological evaluation following acute traumatic patellar dislocation, so to further assess soft tissue pathology and osteochondral injury and dictate the need for surgical intervention [2,3]
Summary
Received 12/05/2018 Review began 12/06/2018 Review ended 12/12/2018 Published 12/14/2018. Witnessed in younger patients following sporting injuries, patellar dislocations generally occur laterally following either a twisting injury or direct impact, with resultant disruption of the medial patellofemoral ligament (MPFL), the primary restraint to lateral patellar subluxation, and accompanying retinaculum occurring in approximately 90% of affected patients [1,2] While infrequent, this injury can be debilitating, potentially leading to recurrence in up to 40% with associated pain, reduction in activity and patellofemoral osteoarthritis [2]. While plain radiographs are useful in confirming the diagnosis, magnetic resonance imaging (MRI) is frequently recommended for definitive radiological evaluation following acute traumatic patellar dislocation, so to further assess soft tissue pathology and osteochondral injury and dictate the need for surgical intervention [2,3]. In the context of failed closed reduction as well as confirmation of the diagnosis, associated soft-tissue injuries and presence of risk factors for recurrent dislocation, this patient subsequently proceeded to definitive surgical treatment in the form of MPFL repair, with excellent postoperative function and no further dislocation at 46 months postoperatively
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