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.
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.