PATHOLOGY AND MANAGEMENT OF RECCURENT PATELLA DISLOCATION BY PINK TEAM

CASE SUMARIES AND RELEVANT ANATOMY OF THE KNEE JOINT BY DR. M. SHEHU

CASE NO.1 BIODATA NAME:Mrs H R AGE: 32year SEX: female ADD: polo, Maiduguri, borno state TRIBE: bura MARITAL STATUS: married

PC: Recurrent Left knee pain and deformity of 1/7 duration HPC: said to have fallen on to her knees while walking, developed left knee pain, deformity and inability to bend the knees.

Hx cont. No injury any other part of the body Had initial resuscitation at a peripheral hospital Pt has been having similar complain, the first episode was six week ago following fall from standing position TBS interventions with minimal improvement No family hx of similar illness She a known HTN, DM°, PUD°

O/E In painful distress, not pale afebrile -Left knee : Pt could not walk or stand unsupported Swollen and tender Pain prevent further examination of the knee Intact distal neurovascular status -Right knee : Appear normal but with Abnormal patella tracking and positive apprehension test

Dx: recurrent bilateral patella dislocation Mgt: Patient was admitted Had IVF, analgesics, muscle relaxant The knee was manipulated with above knee p. o. p back slab application for left lower limb Pt had arthroscopic shaving and medial plication for left knee Arthroscopic medial plication and lateral release for right knee (one week after)

Pt was commenced on physiotherapy She was later discharged home to continue physiotherapy as out patient after 4/52 of hospital stay

Case 2 Biodata Name: D N Age : 8year Sex: female Tribe: chub Primary 3 pupil From plateau state

PC: recurrent right knee pain and deformity /2day HPC: pt develop sharp pain in her right knee while walking with associated knee deformity and inability to bend the leg. Pt has had several episode of similar symptoms in the last 6 month

The first episode was following fall on the knee while playing No similar symptoms in any other joint No family history of similar illness Not a known scdx, not asthmatic

O/E Afebrile, not pale Mss: Right knee Cannot walk without support Swollen and tender Lateral displacement of patella Prominent medial femoral condyle Could not flex the knee Intact distal neurovascular status

DX: Recurrent right patella dislocation Mgt: Patient was admitted Had IVF, analgesics, muscle relaxant The was manipulated with above knee p. o. p back slab application Pt had arthroscopic medial plication and lateral release Pt was commenced on physiotherapy Later discharge home after 1week of hospital stay

Relevant anatomy of the knee joint Knee joint is the largest and most complex joint of human body. Basically it consist of three bones (femur, tibia and patella) and two joints (tibiofemoral and patellofemoral joints) The tibiofemoral joint is a complex hinge joint between tibia and femur while the patellofemoral joint between the femur and the patella is a gliding sinovial joint.

patella The patella is a sesamoid bone, the largest in the body, in the expansion of the quadriceps tendon, which continues from the apex of the bone as the ligamentum patellae

The posterior surface of the patella is covered with hyaline cartilage and articulates with the two femoral condyles by means of a larger lateral and smaller medial facet

Stability of the patella The patella is held stable by Ligamentous forces : tension of the medial patella retinaculum Muscle forces: the lowest fibres of vastus medialis insert into the medial border of the patella and hold the patella medialy when the quadriceps contract Bony anatomy: lateral femoral condyle is broader and more prominent anteriorly

Functions of Patello-femoral Joint (1) increases angle of pull of quads on tibia (2) centralizes divergent tension of quads into a single line of action (3) some protection of anterior aspect of knee without patellawith patella

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