29 year old woman who is a daily wage worker presented to the outpatient department (OPD) with right anterior knee pain since 4 months. She felt a popping sensation in her right knee after slipping from the foot board of a bus while running to catch it 4 months ago. After this episode, she had severe pain and was unable to move her knee. She was then taken to a quack, after a local manipulation and massaging by him she was relieved of acute symptoms but had persistent knee swelling and mild knee pain. Patient returned to her daily activities the next day with minimal knee pain and difficulty in knee movements. She had similar episodes frequently (around 8) episodes since then, particularly during stair climbing, squatting and while boarding or trying to get down a running bus. The patient was evaluated in the OPD, she had severe anterior knee pain, tenderness over medial patellofemoral joint, a positive apprehension test, no hyperlaxity. Her Q-angle was 18°. Radiographs showed lateral patellar tilt, bony fragment in the medial patellofemoral joint, lateral patellar subluxation, Insall-Salvatti Index-0.91, sulcus angle 133°. Magnetic resonance imaging (MRI) showed effusion of knee joint with tear in the MPFL at the patellar attachment, osteochondral defect in the lateral patellar facet and an osteochondral fragment in the medial patellofemoral joint. Of note, she had no other knee surgeries performed to the same knee. An arthroscopy showed chondromalacia of patella, patellofemoral joint maltracking and an osteochondral fracture of lateral facet of patella [].\nThe patient was treated definitively with MPFL reconstruction by the technique described by us. Her pain resolved in 3 weeks, she returned to her daily routine in 6 weeks after surgery and at 24-month followup, Modified Crosby and Insall scale was good and Kujala score was 88.
18 year old male, a basketball player presented with right anterior knee pain and frequent subluxations and dislocation of the patella since 5 months. To start with he fell down and twisted his knee while playing basketball for which he visited an orthopedician and was diagnosed to have right patella dislocation that was treated by immobilization in a cylindrical cast for 4 weeks. He returned to sports after the primary episode but experienced frequent anterior knee pain and multiple episodes of patellar subluxations and dislocations that is, 6 episodes of frank dislocations while playing which were reduced by his coach. The patient was evaluated in the OPD, he had severe anterior knee pain, tenderness over medial patellofemoral joint, a positive apprehension test, no hyperlaxity and a Q-angle of 14°. Radiographs showed lateral patellar tilt [], lateral patellar subluxation, Insall-Salvatti Index-1, sulcus angle 140°. MRI showed effusion of knee joint with tear in the MPFL at the patellar attachment []. Of note, he had no other frank knee injuries or surgeries performed on the same knee. A preprocedure arthroscopy showed patellofemoral joint maltracking but no chondromalacia of patella.\nThe patient was treated definitively with MPFL reconstruction by the technique described by us. He returned to practice in 3 months and professional sports in 4 months, at 24-month followup, Modified Crosby and Insall scale was excellent and Kujala score was 98.