Post by Dr. med. Theodoros Zafeiris, MHCM

⚕️Complex case: patellar instability ⚕️ • 17 years old slim female 🙍‍♀️ - does not play sports regularly • 📝 History: bilateral patellar dislocation 04/2021 🦵 🚨 • ⬅️ Left: 1st dislocation traumatic (uncertain) during school sports - 🔪 1st surgery 04/21: arthroscopy, excision flake fracture + medial retinaculum tightening 🔜 several atraumatic dislocations afterwards with self-reduction - 🔪2st surgery 04/24: arthroscopy + MPFL reconstruction (gracilis) • ➡️ Right: 1st dislocation without significant trauma - 🔪1st surgery 04/21: arthroscopy, excision flake fracture + medial retinaculum tightening 🔜 several atraumatic dislocations afterwards with self-reduction - 🔪2st surgery 01/23: arthroscopy + MPFL reconstruction (gracilis) • After the MPFL surgeries: satisfactory result without recurrence ✅ • 🧨 08/25: kick to the back of the left knee: recurrent patellar dislocation 🤒 • 🩻 Current MRI left knee: partial tear of the MPFL graft, lateral subluxation of the patella with corresponding bone bruise, cartilage defect/chondromalacia patellae especially lateral facet, trochlea dypslasia dejour A, trochlear sulcus angle 145°, patella tilt angle 16°, Caton-Deschamps 1.1, TT-TG 12 mm, TT-PCL 20 mm, no flake fracture • 🩻 Long leg standing x-ray: valgus 6.5°, JLCA 2°, mLDFA 85°, mMPTA 89° • 📝 Clinical examination: medial pain (!), valgus knees bilateral, no j-sign, no significant objective instability, free ROM, Patella-Tilt-Test negative, Patella-Apprehension-Test negative, no hyperextension, dynamic valgus, roughly oriented no rotational error in prone position • PIS score: 2 (2/7) • Patellar Instability Probability score: 71% ‼️ main problem for/of the patient: pain 😖😖 ❓ What would be your approach? Nifon Gkekas MD, MSc Michael Hantes Wolfgang Zinser Dr. Hatim ALShareef Matthias Krause PD Dr. Ralph Akoto Prof. Dr. med. Christoph Kittl MD(Res) Nikolaos Koukoulias Dr. med. Sebastian Leutheuser Guillaume DEMEY Prof. Dr. med. Daniel Günther, MHBA, FACS Dr. Christian Eberle Alexander Mildner Dr. Carsten Fischer Jacek Mazek Matic Ciglic Mohammed Nabawy MRCS, EFBO Kristian Schneider Halil Damla Kamarul Arifin Abdul Razak MBChB, Dr. Orth and Tr Rouven Neudeck Dr. Waseem Siddiqui Dr Akis Loizides Kaya Turan Frank Wein Dr. Deepak Bhatia nicholas colyvas MD, FAAOS Liudas Bazaras Boudard Guillaume Dr. med. William Pedraza, MSc. Michael Lujc Etienne Cavaignac David H. DEJOUR Simon Talbot Prof. Dr. Mirco Philipp Niemeyer Amit Momaya Lukas Willinger PD Dr. med Theresa Diermeier, MBA Amit Momaya