Spontaneous superior patellar dislocation in young age: case report and reduction technique

Superior patellar dislocation is a very rare pathology, which happens in middle age. We report a case of spontaneous superior patellar dislocation, which occurred at 30 years of age. Differential diagnosis is patellar tendon rupture, which could be reliably excluded by clinical examination and radiographs. Reduction manoeuvres should be tried with diluted intra-articular local anaesthetic for hydrodilatation to gain mechanical advantage. Splinting the knee in gentle flexion is recommended if general anaesthetic is employed. Recurrent dislocation or osteochondral fractures warrants surgical treatment.

Superior dislocation of the patella: a pathognomonic finding and review of literature

A 59-year-old woman with a painful right knee that became locked in extension after a trivial trauma was seen at the emergency room. This was caused by unloaded hyperextension in bed. She was diagnosed with a superior dislocation of the patella. A closed reduction was performed, but a recurrent episode was seen within a week. An arthroscopy was performed, in which the causative osteophytes were removed. In the 12-month follow-up after treatment, no recurrence was seen. A superior dislocation of the patella is caused by patellofemoral osteophytes that interlock. This can cause a degenerative knee to become locked in extension. Beside interlocking osteophytes of the patella and the distal femur, the superior part of the patella is tilted away from the femur. This is caused by the pull of the patella tendon and the simultaneous relaxation of the quadriceps tendon. This is a pathognomonic finding on radiographs that, to the best of our knowledge, has been identified but not been appreciated as such in previous reports. As illustrated in this report, a superior dislocation of the patella can easily be recognized on physical examination and radiographic imaging alone when familiar with the specific abnormalities. This will reduce unnecessary diagnostic imaging studies and delay in treatment. This case report illustrates a recurrent case of superior dislocation of the patella. We summarize and evaluate previous reports, discuss trauma mechanisms, physical examination, classification, and treatment including recurrent cases. After reading this case report the reader will be able to diagnose a superior dislocation of the patella with near certainty on physical examination and radiographic imaging of the knee alone.

Superior Patellar Dislocation Misdiagnosed as Patellar Tendon Rupture: The Value of Ultrasonography

Superior dislocation of the patella with intact patellar tendon is a rare condition. Most cases in literatures were diagnosed by clinical examination and plain radiography; however there are many cases that were misdiagnosed as patellar tendon rupture. In this case, we demonstrate the use of ultrasound for diagnosis of superior dislocation of the patella in the emergency department. We also include a literature review of similar cases and discuss the advantages of different types of imaging for diagnosis in this condition.