Disclosures: Evan Plunkett: Nothing to disclose

Case Description: Left knee dysfunction and chronic pain in the setting of congenital knee dislocation, congenital hypoplastic patella and patella alta.

Setting: Outpatient sports medicine office.

Patient: A 22-year-old female with a history of congenital knee dislocation, congenital hypoplastic patella and patella alta, and chronic left knee pain with dysfunction.

Assessment/Results: A 22-year-old female presented to an outpatient sports medicine office for further evaluation of chronic left knee pain and dysfunction in the setting of congenital knee dislocation, congenital hypoplastic patella and patella alta. She found descending stairs and strenuous exercise difficult, leading to inactivity and weight gain. Obvious patellar abnormalities were noted on plain films with likely underlying ligamentous issues based on the examination. An MRI was subsequently ordered which showed a small patella, severe trochlear dysplasia and anterior cruciate ligament (ACL) insufficiency. Despite these findings, her patella tracked well without any dislocations. The instability was felt to be secondary to quadriceps and hip weakness. Though no osteoarthritis was present, she was at risk for this in the future. After discussion, she elected to proceed with bracing for ACL stabilization along with physical therapy.

Discussion: Patients with congenital hypoplastic patella and patella alta are at a high risk of developing knee osteoarthritis due to subluxation of the patella. There are limited surgical options for the treatment of congenital hypoplastic patella and patella alta. The current standard of treatment is to stabilize the patella through bracing and strengthening of the quadriceps and hip with physical therapy.

Conclusion: Patients with congenital hypoplastic patella and patella alta would benefit from strengthening of the quadriceps and hip with physical therapy and bracing to prevent subluxation and risk of progression to osteoarthritis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-subluxation-in-congenital-hypoplastic-patella-and-patella-alta-a-case-report/