26 year old man who is a railway employee presented with left anterior knee pain and frequent dislocation of the patella since 3 months. To start with he fell down and twisted his knee while climbing down a ladder for which he visited a physician and was diagnosed to have left patella dislocation that was treated by immobilization in a long leg knee brace for 3 weeks. He had frequent anterior knee pain and frequent dislocations of the patella (probably 6) which were less painful than the primary episode and were self reducible. The patient was evaluated in the OPD, there was diffuse swelling and tenderness over medial patellofemoral joint, a positive apprehension test, no hyperlaxity and a Q-angle of 15°. Radiographs showed lateral patellar tilt, lateral patellar subluxation, sulcus angle 136° [] and Insall-Salvatti Index-1.1 []. MRI showed efussion of knee joint with tear in the MPFL at the patellar attachment. Of note, he had no other surgeries performed to the same knee. A preprocedure arthroscopy showed patellofemoral joint maltracking.\nThe patient was treated definitively with MPFL reconstruction by the technique described by us. He returned to work in 6 weeks, at 24-month follow up, Modified Crosby and Insall scale was excellent and Kujala score was 95.
A 51-year-old healthy bricklayer male, born in eastern Europe, presented with right-knee pain caused by a fall on the knee during his work, a few weeks prior. During his childhood, a clinically evident bilateral dislocation of patella was observed and described without the assistance of imaging. Nevertheless, the pathology was asymptomatic, and he never reported difficulty in walking. Therefore, the malformation had never been treated and the patient conducted a normal life including time served in the army.\nPhysical examination revealed that the patient could walk normally, with a very mild stumble on the right knee, which was referred as absent before the trauma. There was conspicuous muscle wasting of each thigh (particularly on the medial side, with a clear depression on the vastus medialis) and 15° of genu valgum. The patellae were lying laterally to the lateral femoral condyle with the knee in the position of full extension () and they displaced more laterally during the flexion (). The proximal tibiae were rotated outward. The knees could be extended actively against maximum resistance, with full range of motion. Both the femoral quadriceps worked as knee extensors, and their strength was 5/5. The knees showed no signs of instability or ligamentous deficiency. The right knee was painful on the lateral side, and the clinical signs were positive for pathology of the lateral meniscus.\nRoentgenograms of bilateral knees revealed small, laterally displaced patellae with slight degenerative changes in the tibiofemoral joints with subluxated tibia (). The medial joint spaces were widened. Lateral roentgenograms showed marked lateral rotation deformities of the tibiae (). A skyline view showed an increased deep of the trochlear groove, with laterally dislocated patellae forming a sort of new joint with the lateral aspect of the condyle ().\nMagnetic resonance imaging (MRI) showed a lesion with dislocation of the lateral meniscus on the right knee. On both sides, the MRI confirmed the dislocation of the patellae, a severe hypoplasia of the medial side of the femoral quadriceps, and an external rotation of the proximal tibia particularly evident on the tibial tuberosity ().\nIn order to identify a possible aetiology of the malformation, the patient underwent electromyography/electroneurography, which showed normal function of all the separate portions of the quadriceps muscles thus not explaining the origin of this malformation.\nThe clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore, we performed a knee arthroscopy, whose intraoperative findings confirmed the MRI. During the surgery, we performed just a selective arthroscopic meniscectomy.\nAfter the operation, the patient followed a simple protocol of rehabilitation: 15 days of relative rest with partial bearing and low-molecular-weight heparin therapy, then progressive full recover of activities. Quickly, the knee showed satisfactory improvement, with no pain in walking and a complete range of motion, as before the operation, and comparable to the other knee.\nDuring the last clinical evaluation, 12 months after surgery, written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.