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Congenital Dislocation of the Patella

¹ Department of Diagnostic Imaging, Hospital for Sick Children and the University of Toronto, Toronto, Canada.
² Present address: Department of Radiology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
³ Division of Orthopaedic Surgery, Hospital for Sick Children and the University of Toronto, Toronto, Canada.

View larger version (154K): [in a new window]   Fig. 1. —Congenital dislocation of patella in 22-month-old boy who had recurrent dislocation of both knees as part of Larsen's syndrome. Anteroposterior radiographs of both knees show bilateral genu valgum and decreased height of lateral femoral condyle and lateral tibial epiphysis. On left side, partially ossified patella (arrowheads) can be seen overlying hypoplastic lateral femoral condyle.

View larger version (84K): [in a new window]   Fig. 2A. —3-year-old girl with left leg deformity and limp due to congenital dislocation of patella. Shown are lateral views (A and B) and skyline views (C and D). Radiographs of left knee (A and C) show small, indistinct patella (arrowheads), seen as additional curvilinear soft-tissue opacity overlying lateral aspect of knee, with small, fragmented ossification center (arrow). In right knee (B and D), patella (arrowheads) is normal in size, configuration, and location, with well-developed ossification center.

View larger version (83K): [in a new window]   Fig. 2B. —3-year-old girl with left leg deformity and limp due to congenital dislocation of patella. Shown are lateral views (A and B) and skyline views (C and D). Radiographs of left knee (A and C) show small, indistinct patella (arrowheads), seen as additional curvilinear soft-tissue opacity overlying lateral aspect of knee, with small, fragmented ossification center (arrow). In right knee (B and D), patella (arrowheads) is normal in size, configuration, and location, with well-developed ossification center.

View larger version (86K): [in a new window]   Fig. 2C. —3-year-old girl with left leg deformity and limp due to congenital dislocation of patella. Shown are lateral views (A and B) and skyline views (C and D). Radiographs of left knee (A and C) show small, indistinct patella (arrowheads), seen as additional curvilinear soft-tissue opacity overlying lateral aspect of knee, with small, fragmented ossification center (arrow). In right knee (B and D), patella (arrowheads) is normal in size, configuration, and location, with well-developed ossification center.

View larger version (89K): [in a new window]   Fig. 2D. —3-year-old girl with left leg deformity and limp due to congenital dislocation of patella. Shown are lateral views (A and B) and skyline views (C and D). Radiographs of left knee (A and C) show small, indistinct patella (arrowheads), seen as additional curvilinear soft-tissue opacity overlying lateral aspect of knee, with small, fragmented ossification center (arrow). In right knee (B and D), patella (arrowheads) is normal in size, configuration, and location, with well-developed ossification center.

View larger version (111K): [in a new window]   Fig. 3A. —22-month-old boy with congenital dislocation of patella (same patient as in Fig. 1). Longitudinal sonogram along anterolateral border of right knee shows hypoplastic, laterally displaced patella (calipers).

View larger version (103K): [in a new window]   Fig. 3B. —22-month-old boy with congenital dislocation of patella (same patient as in Fig. 1). On left, normal, well-developed cartilaginous patella (P) is seen in anterior midline sonogram.

View larger version (123K): [in a new window]   Fig. 4. —8-month-old girl with congenital dislocation of patella. On sagittal T1-weighted MR image of flexed knee, hypoplastic cartilaginous patella (arrowheads) is hardly visible, showing marked lateral and superior displacement.

View larger version (108K): [in a new window]   Fig. 5A. —6-year-old boy with left knee deformity due to congenital dislocation of patella (arrowheads). Skyline view radiograph shows lateral displacement of patella (arrowheads), which is still mostly cartilaginous.

View larger version (145K): [in a new window]   Fig. 5B. —6-year-old boy with left knee deformity due to congenital dislocation of patella (arrowheads). On sagittal high-resolution proton-density (B), coronal fast spin-echo T1-weighted (C), and axial fast spin-echo fat-suppressed T2 (D) sequences, anatomic relations between femoral epiphysis (E), tibial epiphysis (T), and fibular head (F) illustrate marked lateral and superior displacement of hypoplastic patella (arrowheads). Arrow indicates quadriceps tendon.

View larger version (129K): [in a new window]   Fig. 5C. —6-year-old boy with left knee deformity due to congenital dislocation of patella (arrowheads). On sagittal high-resolution proton-density (B), coronal fast spin-echo T1-weighted (C), and axial fast spin-echo fat-suppressed T2 (D) sequences, anatomic relations between femoral epiphysis (E), tibial epiphysis (T), and fibular head (F) illustrate marked lateral and superior displacement of hypoplastic patella (arrowheads). Arrow indicates quadriceps tendon.

View larger version (176K): [in a new window]   Fig. 5D. —6-year-old boy with left knee deformity due to congenital dislocation of patella (arrowheads). On sagittal high-resolution proton-density (B), coronal fast spin-echo T1-weighted (C), and axial fast spin-echo fat-suppressed T2 (D) sequences, anatomic relations between femoral epiphysis (E), tibial epiphysis (T), and fibular head (F) illustrate marked lateral and superior displacement of hypoplastic patella (arrowheads). Arrow indicates quadriceps tendon.

View larger version (90K): [in a new window]   Fig. 6A. —6-year-old boy with left knee deformity due to congenital dislocation of patella (same patient as in Fig. 5A, 5B, 5C, 5D). Lateral radiographs (A and B) and skyline views (C and D) before (A and C) and after (B and D) surgical repair. Before surgical repair, dislocated patella (arrowheads) is small, and its ossification center is fragmented and irregular. Postoperative follow-up radiographs show well-developed, regular ossification center within centrally located patella (arrowheads). Incidental finding of fibrous cortical defect in distal femur can also be seen.

View larger version (84K): [in a new window]   Fig. 6B. —6-year-old boy with left knee deformity due to congenital dislocation of patella (same patient as in Fig. 5A, 5B, 5C, 5D). Lateral radiographs (A and B) and skyline views (C and D) before (A and C) and after (B and D) surgical repair. Before surgical repair, dislocated patella (arrowheads) is small, and its ossification center is fragmented and irregular. Postoperative follow-up radiographs show well-developed, regular ossification center within centrally located patella (arrowheads). Incidental finding of fibrous cortical defect in distal femur can also be seen.

View larger version (109K): [in a new window]   Fig. 6C. —6-year-old boy with left knee deformity due to congenital dislocation of patella (same patient as in Fig. 5A, 5B, 5C, 5D). Lateral radiographs (A and B) and skyline views (C and D) before (A and C) and after (B and D) surgical repair. Before surgical repair, dislocated patella (arrowheads) is small, and its ossification center is fragmented and irregular. Postoperative follow-up radiographs show well-developed, regular ossification center within centrally located patella (arrowheads). Incidental finding of fibrous cortical defect in distal femur can also be seen.

View larger version (88K): [in a new window]   Fig. 6D. —6-year-old boy with left knee deformity due to congenital dislocation of patella (same patient as in Fig. 5A, 5B, 5C, 5D). Lateral radiographs (A and B) and skyline views (C and D) before (A and C) and after (B and D) surgical repair. Before surgical repair, dislocated patella (arrowheads) is small, and its ossification center is fragmented and irregular. Postoperative follow-up radiographs show well-developed, regular ossification center within centrally located patella (arrowheads). Incidental finding of fibrous cortical defect in distal femur can also be seen.

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