A 73-year-old woman came to the emergency department after accidental fall by stumbling on the stairs at home.
He presented the left extremity with knee in fixed flexion of 40o and attitude in external rotation of the hip.
Femoral condyles were clearly fixed with a 'pseudo-hatch' proximal to the patella.
The flexion attitude was not modified by pain when trying to change the position.
The patella was fixed and tiring.
Any attempt at flexion-extension provoked intense pain in the quadriceps tendon and paw of the goose.
Radiological study showed low patella with its proximal pole in contact with intercondylar zone, compatible with lower horizontal dislocation of the patella.
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The reduction by manipulation was not successful, so epidural anesthesia was performed, resulting in an audible 'clunk' or tapewormlike chasquipus when performing the anatomical traction after the knee.
An internal Payr surgical approach was performed. It was proven that the tendinous and quadriceps tendons were functioning cuadricipital, without hematoma, with sliding and correct tension.
Anterior tibial tuberosity was also found under normal conditions.
The joint was stable in varus and valgus in extension and semi-flexure of 30o, with no hemorrhagic focus on LLE, LLI or on the paw of geese.
External arthrotomy was performed with extraction of 30 cc of synovial fluid seropositivity, where the anterior and posterior cruciate ligaments were normal.
There was evident femoral-patellar arthrosis with condylar and patellar osteophytosis (Ahlbach grade III).
We performed excision of intercondylar osteophytes and the groove.
Immobilization was performed with knee orthosis in extension for 2 weeks with support, after which physiotherapy was started for two weeks.
One month after the trauma, the patient presented flexion of -30o and full extension, with no pain.
Two months after the accident, the patient presented complete flexion-extension.
The radiological study at that time showed knee with predominantly patellofemoral arthrosis (Ahlbach grade III).
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A characteristic of the patient that helps explain the lesion is that the patient presented generalized hyperelasticity.
Four years later, she had no recurrence and only reported discomfort in the anterior area of both knees when descending stairs, compatible with her patellofemoral arthrosis.
Such symptoms were already present before the dislocation.
