Patellofemoral Malalignment:

Sherif Mhamed Abdel Gaid

118Malalignment of patella include isolated patellar tilt,subluxation, subluxation & tilt and recurrent patellardislocationThe combination of large muscle forces actingon smalll mobile patella, with its incongruent contactgeometry, leads to high degree of joint instability.Thorough evaluation of specific symptoms and signsshould be carried out. Symptoms include: Pain, Givingway, Swelling and Locking. Then patient should beexamined for lower limb Malalignment and genu valgumor varum. Then patient is checked for presence orabsence of atrophy especially VMO atrophy and testedfor patellar glide test, apprehension test & patellofemoralgrindinl~test. And Q angle is measured. Lastly, Patientwas eXllminedfor generalized hypermobility tests andassociated pathology like torn menisci or cruciateIigament- All patients are examined radiologically bylateral view to measure the patellar height using Insall-Salvati or Caton ratio preoperatively and Caton ratiopostopE:ratively. Axial view was taken pre- andpostopt~ratively to measure patellar tilt angle, sulcusangle and congruence angle. If the patient gives historyof recurrent dislocation and radiological parameters onplain X-ray within normal, C.T or MRI was requested.All patients are treated initially conservatively for 3-6months. Patient is asked to avoid knee position& activitythat n~produce pain and to take pain killer (NSAID oraspirin). If still there is no improvement on symptoms,patient was referred to physiotherapy. Surgery is donewhen conservative treatment failed to significantlyImprove the symptoms. Revaluation of the symptoms andsigns was done to predict which type of surgery issuitable for every patient Surgical treatment consisted oflateral release, proximal realignment, distal realignmentand eembined proximal &distal realignment. For patientwith isolated patellar tilt, lateral release is selected.Patient with subluxation or dislocation; I) withoutpatella alta or patellofemoral osteoarthritis or 2)skeletally immature, proximal realignment is selected. Ifintra.-operativelyafter proximal realignment still there ispateillar maltracking, distal realignment is added(combinedproximal & distal realignment).119Patient with patellar subluxation or dislocation,skeletally mature with patella alta or patellofemoralsubluxation;distal realignment is selected.