Medial Patellar Dislocation with Traumatic Avulsion of Quadriceps Tendon in a Young Athlete: A Case Report

Abstract

Background: We presented an uncommon orthopedic case of medial patellar dislocation with traumatic avulsion of quadriceps tendon in a young healthy athlete. We were interested in this case because of its rarity. Case Presentation: A 32-year-old athletic male patient, not known to have any medical illness, with a history of falling down on stair 3 steps and sustained a direct trauma to his left knee. He has noticed that the patella was shifted to the medial side with severe pain. He sought medical advice in a polyclinic and they performed orthogonal x-ray on his left knee and then discharged home on NSAID and non-articulating, non-hinged knee brace. He came to our hospital a few days after his initial trauma with sever left knee pain. On Examination, he was vitally stable, walking only by crutches and having an antalgic gait. On inspection, there was a moderate left knee effusion with no ecchymosis or wounds. He had a gap felt above the patella, lateral patellar side tenderness and restricted range of motion as a result of the pain. He had a positive patellar apprehension test on medial translation and weak knee extension associated with pain. Initial X-rays showed moderate arthritic changes in medial joint space, so patient was advised to take NSAID and to wear hinged-knee brace with no weight bearing for 2 weeks until effusion subsides with an appointment with sport clinic after MRI. Later on, he seen in clinic still complaining of lateral side knee pain and restricted range of motion, MRI was done to the left knee which showed: mild knee effusion, arthritic changes, insertional quadriceps and lateral retinaculum tear. He was admitted and underwent primary repair of quadriceps tendon and lateral retinaculum through anterior mid-line knee approach. Then, a hinged locked knee brace was applied in full extension. Post operatively, he was advised to start mobilizing, no weight bearing by 2 crutches for 3 weeks. Then weight bearing was tolerated for 3 more weeks, and discharged on oral analgesic and to follow up in OPD after 2 weeks. Two weeks later, patient was presented to OPD for suture removal and referred to physiotherapy. Serial follow-up in OPD and physiotherapy showed significant improvement.  Conclusion: This case illustrates the importance of a thorough detailed history, physical examination, and imaging studies emphasizing on the important role of MRI during early diagnosis and management. Close follow-up and physiotherapy post operatively are highly needed for full regain of normal activity.