A 9yr old male child was presented by his mother in our
opd with complaints of
pain in the right knee since two years and
difficulty in walking since two years
opd with complaints of
pain in the right knee since two years and
difficulty in walking since two years
HOPI: (Informant is mother)
Pt was apparently alright 2 years back when the
child injured his right knee while playing for which no
medical advice was sought following which child developed
limp and pain while walking
Pain is localized to right knee which is dragging type which
is aggravated by activity and relieved by rest. No history of
radiation.
Mother noticed limp while her child walks and has difficulty
walking and running after the event which is non-progressive.
no h/o similar complaints in family members.
Patient was operated at a local government hospital 4months
back for his condition with no improvement
On General Examination:
A 9 yr old male child who is moderately built and moderately
nourished who is afebrile and is otherwise healthy with
stable vitals
Local examination:
Decubitus:
Pt is lying comfortably on couch with umbilicus central both
ASISs at same level with both hips in neutral position with
apparent wasting in thigh component with right patella facing
the wall left facing the roof both knees in neutral position
and foot plantigrade.
Inspection:
On inspection a surgical healed scar of 5cms long is noted
over the lateral aspect of right knee and a post traumatic
healed scar of 1X1 cm noted in the supero-medial aspect of
right knee. The medial aspect of the knee is more prominent
in comparision to opposite knee. No swellings are noted. No
Parapatellar fossa fullness is noted. Patella appears to be
laterally displaced in comparision to opposite knee. No
sinuses noted.
Palpation:
No local rise of temperature
tenderness is present in the joint line of the right knee and
also elicited in the patellofemoral joint and lateral margin
of patella. Patella is found to be subluxated and its more
mobile laterally compared to opposite knee. The medial
prominence is continuous with the femoral medial condyle
whose size is comparable to the opposte knee. Inspectory
findings of scars and parapatellar fossae are confirmed.
Movements:
patient is having a fixed flexion deformity of 10 degrees
with further full range of flexion active and passive
possible with terminal 10 degrees of flexion painful.
Patient is flexing abducting and external rotating his right
hip to extend the knee and dragging the foot over the crouch
to actively extend his knee.
The patella is dislocating laterally with every flexion of
right knee.
Measurements
The size of the patella is comparable to opposite side. There
is two inches wasting noted in right thigh component.
Gait:
child avoids flexion of knee while walking and running
SPECIAL TESTS Q Angle
Apprehension test is positive as the patient avoids flexion of kneewhen lateral
dislocating pressure is applied over the patella.
Radiological examination:
x rays of right knee AP & Lat suggestive of normal sized
patella with hypoplastic lateral condyle of rt femur. Patella
on axial projections shows flattened lateral n medial
articulate facets with decrease in size of lateral articular
facet. Standing x rays suggestive of horizontal joint line
confirmed.
Insall ratio is around 1.5
Diagnosis:
Recurrent dislocation of Right patella in 9 years old pt.
and suggest the optimal management for the child's
condition.
 |
| AP view |
 |
| Lat view shows lat condyle hypoplasia |
Axial view of patella shows small lateral articular facet
 |
| X ray both knees AP in standing |
 |
| Displaced patella in flexion |
 |
| Lateral scar |
