Don’t Do This Case Report: Do Not Do This Case Report: Recurrence of Knee Flexion Contracture after Extension Osteotomy in Congenital Patellar Dislocation: The Importance of a Thorough Patient Evaluation
Abstract
Background: Congenital patellar dislocation (CPD) is a rare disorder which presents with hypoplastic and irreducible patellae. It is accompanied by flexion contracture of the knee joint, genu valgum, and external tibial rotation.
Case Report: A seven-year-old girl with CPD who was misdiagnosed as having cerebral palsy (CP) crouch gait and underwent distalfemoral extension osteotomy (DFEO) without paying attention to the dislocated patellae, is presented. Recurrence ensued, and the patient was referred for further evaluation. After a second surgery to address the dislocated patellae, the flexion contracture andgait pattern improved significantly.
Conclusion: The case underscores the importance of a systematic, thorough physical examination, without which uncommon diagnoses will be overlooked, exposing the patient to further morbidity and complications.
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Knee flexion contracture will lead to mechanical overload in both limbs: A simulation study using gait analysis. Knee. 2008;15(6):467-72. doi: 10.1016/j.knee.2008.07.003. [PubMed: 18760608].
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7. Wada A, Fujii T, Takamura K, Yanagida H, Surijamorn P. Congenital dislocation of the patella. J Child Orthop. 2008;2(2):119-23. doi: 10.1007/s11832-008-0090-4. [PubMed: 19308591]. [PubMed Central: PMC2656798].
8. Langenskiold A, Ritsila V. Congenital dislocation of the patella and its operative treatment. J Pediatr Orthop. 1992;12(3):315-23. doi: 10.1097/01241398-199205000-00007. [PubMed: 1572994].
9. Ghanem I, Wattincourt L, Seringe R. Congenital dislocation of the patella. Part II: Orthopaedic management. J Pediatr Orthop. 2000;20(6):817-22. doi: 10.1097/00004694-200011000-00024. [PubMed: 11097262].
10. Drennan JC. Congenital dislocation of the knee and patella. Instr Course Lect. 1993;42:517-24. [PubMed: 8463700].
11. Sever R, Fishkin M, Hemo Y, Wientroub S, Yaniv M. Surgical treatment of congenital and obligatory dislocation of the patella in children. J Pediatr Orthop. 2019;39(8):436-40. doi: 10.1097/BPO.0000000000000973. [PubMed: 31393310].
12. Clark D, Metcalfe A, Wogan C, Mandalia V, Eldridge J. Adolescent patellar instability: Current concepts review. Bone Joint J. 2017;99-B(2):159-70. doi: 10.1302/0301-620X.99B2.BJJ-2016-0256.R1. [PubMed: 28148656].
2. Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM. The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty. 2007;22(8):1092-6. doi: 10.1016/j.arth.2006.11.009. [PubMed: 18078875].
3. Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y.
Knee flexion contracture will lead to mechanical overload in both limbs: A simulation study using gait analysis. Knee. 2008;15(6):467-72. doi: 10.1016/j.knee.2008.07.003. [PubMed: 18760608].
4. Perry J, Antonelli D, Ford W. Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975;57(7):961-7. [PubMed: 1194303].
5. DelBello DA, Watts HG. Distal femoral extension osteotomy for knee flexion contracture in patients with arthrogryposis. J Pediatr Orthop. 1996;16(1):122-6. doi: 10.1097/00004694-199601000-00025. [PubMed: 8747369].
6. Boyer ER, Stout JL, Laine JC, Gutknecht SM, Araujo de Oliveira LH, Munger ME, et al. Long-term outcomes of distal femoral extension osteotomy and patellar tendon advancement in individuals with cerebral palsy. J Bone Joint Surg Am. 2018;100(1):31-41. doi: 10.2106/JBJS.17.00480. [PubMed: 29298258].
7. Wada A, Fujii T, Takamura K, Yanagida H, Surijamorn P. Congenital dislocation of the patella. J Child Orthop. 2008;2(2):119-23. doi: 10.1007/s11832-008-0090-4. [PubMed: 19308591]. [PubMed Central: PMC2656798].
8. Langenskiold A, Ritsila V. Congenital dislocation of the patella and its operative treatment. J Pediatr Orthop. 1992;12(3):315-23. doi: 10.1097/01241398-199205000-00007. [PubMed: 1572994].
9. Ghanem I, Wattincourt L, Seringe R. Congenital dislocation of the patella. Part II: Orthopaedic management. J Pediatr Orthop. 2000;20(6):817-22. doi: 10.1097/00004694-200011000-00024. [PubMed: 11097262].
10. Drennan JC. Congenital dislocation of the knee and patella. Instr Course Lect. 1993;42:517-24. [PubMed: 8463700].
11. Sever R, Fishkin M, Hemo Y, Wientroub S, Yaniv M. Surgical treatment of congenital and obligatory dislocation of the patella in children. J Pediatr Orthop. 2019;39(8):436-40. doi: 10.1097/BPO.0000000000000973. [PubMed: 31393310].
12. Clark D, Metcalfe A, Wogan C, Mandalia V, Eldridge J. Adolescent patellar instability: Current concepts review. Bone Joint J. 2017;99-B(2):159-70. doi: 10.1302/0301-620X.99B2.BJJ-2016-0256.R1. [PubMed: 28148656].
| Files | ||
| Issue | Vol 5, No 2 (2019) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v5i2.3754 | |
| Keywords | ||
| Congenital dislocation of the patella flexion contracture distal femoral extension osteotomy crouch gait | ||
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How to Cite
1.
Baghdadi S, Baghdadi T. Don’t Do This Case Report: Do Not Do This Case Report: Recurrence of Knee Flexion Contracture after Extension Osteotomy in Congenital Patellar Dislocation: The Importance of a Thorough Patient Evaluation. J Orthop Spine Trauma. 2020;5(2):50-2.
