Quadriceps Tendon Lengthening for Obligatory (Habitual) Patellar Dislocation in Flexion

Betina B Hinckel; Charles A Baumann; Elizabeth A Arendt; Riccardo G Gobbi; Andrew J Garrone; Elliot Voss; Donald Fithian; Najeeb Khan; Seth L Sherman

doi:10.1016/j.eats.2022.05.003

Quadriceps Tendon Lengthening for Obligatory (Habitual) Patellar Dislocation in Flexion

Arthrosc Tech. 2022 Aug 17;11(9):e1589-e1595. doi: 10.1016/j.eats.2022.05.003. eCollection 2022 Sep.

Authors

Betina B Hinckel^{1

2}, Charles A Baumann³, Elizabeth A Arendt⁴, Riccardo G Gobbi⁵, Andrew J Garrone⁶, Elliot Voss⁷, Donald Fithian⁸, Najeeb Khan⁸, Seth L Sherman⁹

Affiliations

¹ Oakland University, Rochester, Michigan, U.S.A.
² Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, U.S.A.
³ University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
⁴ Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.
⁵ Instituto de Ortopedia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, USP, São Paulo, SP Brazil.
⁶ Ohio State University, Columbus, Ohio, U.S.A.
⁷ Wake Forest University, Winston-Salem, North Carolina, U.S.A.
⁸ Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, California, U.S.A.
⁹ Orthopedic Surgery, Stanford University, Stanford, California (S.L.S.), U.S.A.

Abstract

Obligatory patella dislocation in flexion is an uncommon form of patellar instability, where the patella is located in extension and dislocates with every episode of knee flexion. This results in dramatically altered patellofemoral kinematics and can be extremely debilitating due to extensor strength deficits and lack of knee confidence in flexion. Concomitant pathology, which is often seen, includes a tight lateral retinaculum and a shortened extensor mechanism. Lengthening the extensor mechanism is a critical part of successful patellar stabilization, and has not been well-reported. Herein, we present a technique of quadriceps lengthening for the treatment of obligatory patellar dislocation.