Challenges of evaluating recurrent patellofemoral instability in a skeletally immature child and the use of roux Goldwaithe procedure case of a “slipping knee cap”: Rare case report

Author(s): Dr. Daivik T Shetty, Dr. Abhiram Krishnan and Dr. Shradha Shetty

Abstract: Background: Recurrent Patellofemoral instability (PFI) is a significant disability in the childhood and structural adolescent population. It is mainly due to the high-risk activities involved and the variants of the patellofemoral joint. Numerous surgical procedures to address this instability have been described in skeletally immature patients, with variable outcomes. This has led to considerable confusion in the literature on how to treat patellofemoral problems in children. Here, we present a unique case of a 14-year-old skeletally immature female with recurrent patellofemoral instability. We would like to discuss the challenges in diagnosing the condition and the treatment protocols followed while proposing a unique diagnostic workup protocol to evaluate and decide on surgical intervention for a case of patellofemoral instability.
Case Report: The case is of a 14-year-old skeletally immature female patient with complaints of ‘slipping of the knee caps'. A systematic diagnostic work up was done for evaluating the exact cause of patellar instability along with determination of the pathological structure. The diagnostic work up included a unique chart to document the soft tissue and bony structure status. The diagnostic workup revealed ‘No osseous cause, soft tissue pathology included MPFL tear, Medial retinacular tear, contracted lateral structures and Patella alta. Based on the results of the work up treatment planned was Lateral retinacular release, medial imbrication, Roux goldwaithe procedure and medial femoral epiphysiodesis. Patient was clinically evaluated considering relapse, pre- and postoperative range of motion (ROM), Kujala score, and modified Lysholm score.
Result: The patient was followed up for two years. No relapse of dislocation and an improved ROM was noted. The Kujala score showed significant improvement from a preoperative value of 39 to a mean postoperative value of 92 at the final follow-up and the modified Lysholm score improved from preoperative 55 to postoperative 94. Radiographs performed at the latest follow-up showed a tendency to normalization of all the parameters considered, with a restored patellofemoral congruence and trochlear groove shape.
Hence, the Roux-Goldthwaite procedure is a valid surgical option for the treatment of patellar dislocation in children with only soft tissue pathologies.

DOI: https://doi.org/10.22271/ortho.2019.v5.i4r.3128