A 11-year-old 4-month-old girl was referred to our clinic from another hospital complaining of progressive difficulty in walking autonomously for several months.
He reported having suffered, three years before, an episode of right patellar dislocation secondary to a jump.
This episode of dislocation was described as medial dislocation by both the patient and the attending physician.
The dislocation was reduced by manipulation and not immobilized.
Subsequently, there were 10 other episodes of dislocation underneath the knee and another three more episodes of dislocation (the patient reported that the patella went out 'towards the knee' and 'no outward movement'), not having been.
In the month prior to the consultation, the patient reported having experienced three episodes of underestimation, after which only autonomously she could walk persistently and complain of pain.
On the left side, she reported three episodes of medial subtraction in the last six months.
The patient complained of progressive weakness knees, medial patellar palsy bilateral, chaplaining of persistent gait pain and severe limitation in her activities.
Medial displacement of the patella revealed painful symptoms.
At that time, he came to our outpatient clinic with wheelchairs due to the impossibility of walking, since he failed to respond to self-medication and mechanical pain.
The physical examination revealed a relapsing medial patella in both cases (most evident on the right side), grade +2 on the right side, and +1 on the left side (most mild to moderate dysplasia), both with
There was a facility to perform subtraction of patellas in medial direction, but not lateral.
The suppression test was (+).
Meniscal, Lachmann and pivot shift tests were negative.
Quadriceps isometric contraction caused medial patellar displacement.
The external condyle was more prominent than the internal condyle.
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Examination of the hip showed excessive femoral anteversion (EFA) (RI: 90o, RE: 30o).
The knee examination showed genu varum and neutral tibial torsion, with a 15o bilateral Q angle.
The radiographic study showed maloccleocutaneous malformations (patella alta), with an Insall-Salvati index of 1.25 (N: 1.04 ± 0.11), 6 displacement of the sulcus with an angle of 620.
Both labels were disoriented (Wiberg type III).
The clinical and radiological examination of our patient showed the 'miserably malaligned' syndrome.
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A week later, we performed a derotational subtrochanteric femoral subtrochanteric (35o) and bilateral proximal slip rotation realigning (two laterally centered narrowing) osteotomy separately.
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After the intervention and rehabilitation on the right side, objective and subjective clinical stability of the patella was achieved, but the patient could not walk normally due to pain and progressive instability on the left side.
After performing the surgery on the left side the stability of both sides was achieved, allowing him to perform normal gait and running.
The Smillie test and the Smillie test were negative, with a mobility of 65o of RE and 50o of IR of both hips.
Subsequently, quadriceps stretching was restarted, with increase in volume and strength, as well as disappearance of symptoms.
Three months later he was walking and running normally.
Five years later, asymptomatic patient presented with normal gait and axis of the lower extremities.
He performed normal physical exercise.
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Fifteen years after surgery the patient complained of pain in the antero-external area of the right knee after prolonged ambulation, climbing and descending stairs as well as in prolonged sitting position.
External hyperpressure syndrome was diagnosed.
She presented patellas centered on rest and displacement of the patellas by the centered trochlear groove.
A CT scan showed hypoplasia of the medial femoral condyle, already suspected for presenting less prominent medial condyle in the physical examination of the knee.
MRI showed grade I-II chondropathy of the external facet of the right patella.
