Patellar apprehension test
Is a sign of an unstable kneecap. While the examiner places pressure
on the kneecap, the patient may complain of the sensation that the
knee cap is going to "pop out" of its groove.
Surgery for patella mal-alignment involves releasing tight structures
on the lateral side (lateral release), reconstruction of the medial
patellafemoral ligament and sometimes repositionning the tibial
Lateral release is an operation to cut the overly tight lateral
ligament of the patella (lateral retinaculum). It can be performed
from the skin side ("open" lateral release) or from inside
the knee in the arthroscopic technique. An isolated lateral release
is rarely indicated.
Reconstruction of the medial patellafemoral ligament : this ligament
is stretched or torn when the patella dislocates. I use a hamstring
graft to reconstruct it. The difficulty is not to over-tighten it.
Repositioning of the tibial tubercule (on which the patella tendon
is attached) :
- either medially (towards the inside) : this diminishes the tendency
of a patella to slide laterally (to the outside).
- or towards the foot if the patella is too high
- or both
To be continued...
Docteur Jean Etienne Perraudin,
last updated 1 Sept 2012