Lubis Andri Maruli Tua, Panjaitan Troydimas, Hoo Charles
Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Diponegoro 71, Jakarta, Indonesia.
Mitra Keluarga Kelapa Gading, Jakarta, Indonesia.
Int J Surg Case Rep. 2019;55:183-186. doi: 10.1016/j.ijscr.2019.01.031. Epub 2019 Jan 31.
Recurrent patellar dislocation can lead to articular cartilage injury. We report a 21-year old male with left patella instability and articular cartilage defect.
A 21-year-old male presented with left patellar instability and pain. Knee range of motion (ROM) was limited when patella was dislocated (0-20°). The J-sign positive, patellar apprehension test was positive, with medial patella elasticity/patellar glide >2 quadrants. The Q angle, in the 90° flexed knee position was still normal. The plain radiograph imaging showed no abnormality. Insall-Salvati index was 1.12. The patient was diagnosed with recurrent patellar dislocation and cartilage lesion of the left knee, and was treated with combining Fulkerson osteotomy with the lateral retinacular release and percutaneous medial plication, followed by microfracture procedure and MSCs implantation.
Recurrent patellar dislocation is uncommon problem while cartilage lesions following recurrent patellar dislocations are quite common, but still no consensus on the management.
Combination of Fulkerson osteotomy with the lateral retinacular release and percutaneous medial plication was effective in treating chronic patellar instability. The microfracture procedure and MSCs implantation was safe and could improve the cartilage regeneration in patients with articular cartilage defect due to recurrent patellar dislocation.
复发性髌骨脱位可导致关节软骨损伤。我们报告一例21岁男性，患有左髌骨不稳定及关节软骨缺损。
一名21岁男性因左髌骨不稳定及疼痛就诊。髌骨脱位时膝关节活动范围（ROM）受限（0-20°）。J征阳性，髌骨恐惧试验阳性，髌骨内侧弹性/髌骨滑动>2个象限。屈膝90°位时Q角仍正常。X线平片未见异常。Insall-Salvati指数为1.12。该患者被诊断为左膝复发性髌骨脱位及软骨损伤，采用Fulkerson截骨术联合外侧支持带松解及经皮内侧皱襞成形术治疗，随后进行微骨折手术及间充质干细胞植入。
复发性髌骨脱位并不常见，而复发性髌骨脱位后的软骨损伤却相当常见，但在治疗方法上仍未达成共识。
Fulkerson截骨术联合外侧支持带松解及经皮内侧皱襞成形术治疗慢性髌骨不稳定有效。微骨折手术及间充质干细胞植入安全，可促进因复发性髌骨脱位导致关节软骨缺损患者的软骨再生。
