What patient and operative data should be collected for a case report on chronic patellar dislocation treated surgically?

Data Collection for Chronic Patellar Dislocation Case Report

Follow the SCARE 2018 guidelines systematically to ensure comprehensive documentation of your chronic patellar dislocation surgical case. 1

Patient Demographics and History

Essential Demographic Information

• Age, sex, ethnicity, and occupation 1
• Body mass index (BMI) - particularly relevant for patellar instability cases 1
• Limb dominance 1

Presentation Details

• Chief complaint and symptom duration - document how long the patella has been chronically dislocated 1
• Mode of presentation (self-referred, emergency department, outpatient clinic referral) 1
• Initial traumatic event details if applicable, including mechanism of injury 2, 3

Medical History

• Past medical and surgical history, including any previous knee surgeries or failed treatments 1
• Medication history and allergies 1
• Psychosocial history: smoking status, drug use, activity level, use of walking aids 1
• Family history of patellar instability or connective tissue disorders 1

Clinical Examination Findings

Physical Examination

• Knee alignment: document presence of genu valgum, flexion deformity, or rotational abnormalities 4, 3
• Patellar position: describe whether patella is laterally dislocated throughout range of motion 2, 3
• Quadriceps strength and function 4
• Range of motion measurements (flexion and extension) 2
• Apprehension testing and patellar tracking assessment 1
• Include clinical photographs with appropriate consent 1

Diagnostic Workup

Imaging Studies

• Plain radiographs: anteroposterior, lateral, and sunrise/skyline views 5
• Long-leg standing radiographs to assess mechanical axis and anatomic tibiofemoral angle 3
• Lateral distal femoral angle and medial proximal tibial angle measurements 3
• MRI findings: document medial patellofemoral ligament (MPFL) integrity, cartilage damage, trochlear dysplasia grade (Dejour classification), and presence of bone edema 6, 5
• CT scan measurements: tibial tuberosity-trochlear groove (TT-TG) distance 6, 5
• Patellar height measurements (Insall-Salvati or Caton-Deschamps ratio) 4, 5
• Include radiological images in the case report 1

Diagnostic Reasoning

• Differential diagnoses considered and why they were ruled out 1
• Diagnostic challenges encountered (financial, access, cultural barriers) 1

Timeline Documentation

Create a clear timeline showing:

• Date of initial injury or onset 1
• Duration of chronic dislocation 2, 3
• Previous treatment attempts and their outcomes 1
• Delay from presentation to surgical intervention 1

Pre-operative Considerations

• Patient optimization measures: management of anticoagulation, medical comorbidities 1
• Preoperative functional scores: Hospital for Special Surgery (HSS) knee score, Knee Society Score, Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala Knee Score 4, 6
• Activity level assessment: Noyes Sports Activity Rating Scale 6

Operative Details

Surgical Planning

• Rationale for chosen surgical technique based on anatomic risk factors 1
• Specific procedure(s) performed: MPFL reconstruction, lateral release, tibial tuberosity osteotomy, distal femoral osteotomy, or combined procedures 7, 2, 8, 3

Intraoperative Documentation

• Anesthesia type (general, regional, local) 1
• Patient positioning 1
• Tourniquet use and pressure/time 1
• Surgical approach and incisions 1
• Graft type and source (autograft vs allograft, specific tissue used) 7, 2, 3
• Fixation methods: suture type, anchors, screws with manufacturer and model numbers 1
• Surgical stages (single vs two-stage procedure) 1
• Intraoperative findings: cartilage damage, soft tissue quality, bone quality 1
• Concurrent procedures: arthroscopy findings, cartilage procedures, meniscal treatment 2
• Intraoperative photographs or video with consent 1

Surgeon Information

• Operator experience level and position on learning curve for the specific technique 1
• Specialization and relevant training 1

Perioperative Management

• Antibiotic prophylaxis 1
• Analgesia protocol 1
• Anti-emetic use 1
• Venous thromboembolism prophylaxis 1
• Any intraoperative complications or changes to the planned procedure 1

Postoperative Protocol

Immediate Postoperative Care

• Weight-bearing status: immediate, partial, or non-weight-bearing 5
• Bracing protocol: type, duration, and range of motion restrictions 5
• Initial mobilization instructions 1

Rehabilitation

• Physical therapy timeline and progression 6, 5
• Return to activity/sport timeline 9

Follow-up and Outcomes

Follow-up Schedule

• Timing of follow-up visits (e.g., 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years) 8, 6
• Location of follow-up (clinic, telemedicine) 1
• Methods of assessment: clinical examination, imaging, functional scores 1

Outcome Measures

• Functional outcome scores at each follow-up: KOOS, Kujala, HSS, Knee Society Score 4, 6
• Patellar stability assessment: recurrent instability, subluxation episodes 6
• Range of motion measurements 8
• Radiographic assessment: patellar tracking, patellar height, hardware position, signs of arthritis 8, 4
• Patient satisfaction with treatment 6
• Return to work/sport status 6

Complications

• Any adverse events: infection, wound complications, hardware failure, recurrent instability, stiffness, persistent pain 1, 4
• Management of complications 1

Patient Perspective and Informed Consent

• Patient's perspective on their condition and treatment 1
• Documentation of informed consent for surgery and publication 1
• Ethical approval if required by your institution 1