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Patient 1: knee X-rays at follow-up (age 15).
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After 11 years of observation, the patellar dislocation had evolved from reducible to permanent, inducing a femorotibial subluxation with tibia external rotation in flexion (Figure 1).
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Patient 2: preoperative CT scan 3D reconstructions showing patella subluxation and femorotibial rotation (a) and normal state (b).
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Clinical and CT scan (Figure 2) workups of the right knee showed then an extension deficit of about 30 , patella luxation, and tibial external rotation of about 90 .
Peroperative pictures: after LLR and MPFL tenoplasty with allograft (a); a portion of vastus medialis was individualised and translocated to the lateral aspect of the patella (Krogius tenoplasty) (b); final sutures (c).
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It was conducted in two steps: first, an extensive lateral retinaculum release allowing patella reduction, then MPFL double-bundle reconstruction using tendon allograft, associated to Krogius tenoplasty (Figure 3).
Patient 2: X-ray at follow-up. The patella is centered.
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His patella kept a centered position on X-ray (Figure 4) and physical checks at last follow-up.