Translate case to... Physiotherapy after surgical treatment of secondary habitual patellar dislocation with a transfer of patellar tendon procedure

Keywords: post-operative physiotherapy; Habitual dislocation of the patellofemoral joint; Transfer of patellar tendon

Description:
This case is related to other described in this web: “Secondary habitual patellar dislocation”
It shows a 27-year-old women who underwent thirteen years ago a realignment surgery for recurrent patellar dislocation in her left knee (see picture 1). She continued to have dislocations episodes which became habitual in the last year with more than 30º flexion. Besides, she had the impossibility of doing complete extension, with a very low functional capacity in situations that required this movement (see video 1). She also had an extra valgus on her left Knee and recurvatum on both Knees(see picture 2)

On March 5th 2007, she received a tibial tubercle medialization of 10 mm with a mild Fulkersson effect (5º lateral osteotomy inclination), a vastus medialis advancement and a lateral release as far as the vastus lateralis obliquus
Three days later, the patient started a rehabilitation program based on early ROM exercises.

During three her leg was put in an extension brace and she received the following physiotherapy treatment:

- Passive motion as well as isometric exercises
- electrotherapy
- assisted and active motion with 90º limit of flexion
- closed kinetic chain strengthening program exercises
- walking with crutches
- criotherapy at the end of the session

Six weeks after surgery the patient began:

- a functional program of propioception exercises
- progressive strengthening of muscles with a pain level control

Eight weeks after she started to perform an isokinetics exercise program:

- first of all, sessions of adaptation to the isokinetics device with 6-8 series of 10 repetitions at high speed
- lately, changing to more series and repetitions at low speed to reach progressive strengthening of muscles (see video 2)

The patient is tested with the isokinetics device every 3 months to know she has improved and if the parameters have to be changed.

On March 6th, 2008 she is going to have next test.

Results: since the surgical procedures, she has showed excellent results in her Knee She has not reported an episode of patellar dislocation in any situation and she has decreased the discomfort during daily life activities. Joint range of motion is complete and that allows a return to unrestricted activity, including sports: She runs nowadays.