Extensive Proximal Extensor Mechanism Realignment for Chronic Patella Dislocations in Revision Knee Arthroplasty: Surgical Technique

Patella dislocation after primary or revision total knee arthroplasty (TKA) is a major challenge in revision surgery. In practice, the main reason for patella maltracking and instability following TKA is malrotation of the femoral and/or tibial components. A number of soft tissue procedures, once component malrotation is corrected, have been described including proximal realignment, quadricepsplasty and distal realignment of patellar tendon with tibial tubercle osteotomy. Here, we describe our modified surgical technique in managing chronically dislocated patellae in knee arthroplasty which comprises of extensive lateral releases, vastus medialis obliquus (VMO) advancement and soft tissue reconstruction of the extensor mechanism with accompanying three case presentations achieving satisfactory clinical outcomes.