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Treatment Algorithm for Complex Patello-Femoral Problems

February 19, 2016

Contributors: Michael G Saper, DO, ATC; David A Shneider, MD; David A Shneider, MD

Treatment of complex patella-femoral problems using a treatment algorithm will allow accurate evaluation and assessment, development of a treatment plan, and a systematic surgical correction. At each step, the algorithm suggests the correct path to get to the next step. Examination under anesthesia and arthroscopy can then be used to validate the treatment plan. The surgical plan is then carried out, each step suggested by the algorithm and changed if necessary based on the surgical findings and correction obtained by the prior steps. Various techniques to accomplish each step of the correction are available, for instance, medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon, semitendonosis tendon, or allograft tendon all without drilling into the patella and even if a patellar prosthesis is in place. Tibial tubercle transfer is included with correction of patella alta if needed. The use of the algorithm and steps are illustrated with a complex case of fixed patella dislocation in a 23 y/o woman whose patella had been dislocated since age 8 and never treated. Articular cartilage was widely absent on the femoral trochlea and the patella had extensive damage. Clinical follow up with video of range of motion and ambulation is included. This alogrithm allows a systematic approach to complex patellar problems including evaluation, assessment, surgical plan, monitoring of progress during surgery, and final outcome. The principles of this algorithm can be used for treatment of all patellar problems as well and are not confined to complex cases.

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