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Does form follow function in trochlear dysplasia? Case report of patellar instability in a below-knee amputee.
[trochlear dysplasia]
Patellar
instability
can
be
considered
as
a
rapidly
increasing
musculoskeletal
subject
of
interest
.
It
is
now
well
accepted
that
multiple
factors
can
produce
this
pathological
condition
,
isolated
,
but
more
often
in
concert
.
One
major
static
compound
is
found
to
be
in
trochlear
dysplasia
.
It
has
been
stated
that
the
form
of
the
trochlear
surface
is
primary
and
genetically
bilaterally
determined
already
before
use
.
According
to
these
data
,
recurrent
dislocation
of
the
patella
has
been
described
as
a
hereditary
disease
with
autosomal
dominant
transmission
.
Against
this
assumption
,
we
hypothesize
that
subjects
may
devise
a
flattened
trochlea
when
there
is
no
significant
biomechanical
interplay
and
thus
input
between
the
patella
and
the
distal
femur
during
developmental
growth
;
according
to
the
assumption
form
follows
function
.
In
this
context
,
we
report
the
case
of
a
16
-
year
old
male
who
previously
suffered
from
a
traumatic
patellar
dislocation
during
sporting
activity
in
his
below-
knee
amputated
lower
extremity
,
which
occured
at
age
of
18
months
.
The
patient
was
allocated
with
a
high
-grade
trochlear
dysplasia
in
his
previously
amputated
limb
,
while
presenting
a
normal
trochlear
shape
at
his
healthy
contralateral
leg
.
This
rare
case
therefore
reprents
the
history
of
an
individuum
with
identic
genetic
predisposition
and
different
biomechanical
influences
during
childhood
,
which
makes
it
of
high
clinical
interest
.
In
presence
of
trochlear
dysplasia
the
patient
suffered
reluxation
and
concurrent
subjective
instability
on
the
lower
limb
affected
by
the
amputation
which
was
treated
with
medial
patellofemoral
ligament
(
MPFL
)
plasty
using
an
autologous
gracilis
graft
.
One
has
to
consider
that
a
certain
biomechanical
input
may
be
required
for
the
development
of
a
physiologic
trochlear
groove
.