2 Since 1887, 64 cases of an intra-articular patella dislocation have been reported in the world literature. This rare condition was first described in the literature by Midelfart. The clinical examination after reduction revealed no haemarthrosis, no palpable dehiscence in the quadriceps tendon and an intact straight leg raise test. A cylindrical cast was applied for 3 days postprocedure, until the postreduction MRI was done to exclude any traumatic pathologies. The manipulation under anaesthesia was performed in the operating theatre as it was uncertain if a closed reduction would be possible. The closed reduction was straightforward, with direct pressure placed on the inferior pole of the patella and the knee put in flexion. The patient had a successful closed reduction of her intra-articular patella dislocation under a general anaesthetic. A fracture was not visible on the plain radiograph. X-rays revealed an intra-articular dislocation of the patella with an entrapment of the upper pole in the intercondylar notch ( figures 1 and 2). The patient presented with a locked knee in 100° flexion and was unable to actively extend her knee. As proposed in the literature, the hypothesis of an intra-articular entrapment of the patella due to the trapped osteophytes of the superior pole of the patella into the intercondylar notch was thought to be the cause of intra-articular dislocation in this elderly patient.Ī 92-year-old woman presented to the emergency department of Insel hospital in Bern, after a direct trauma to her right knee postmechanical fall. The patient presented in this case report was managed with a closed reduction under general anaesthesia, without the need of any surgical intervention. The following sources of data were searched until December 2017: PubMed, OVID, Google Scholar, Scopus, using the search strategy of (intra-articular dislocation of patella, horizontal patellar dislocation) with no limitation on the year or language of publication. We conducted a literature review looking at intra-articular patella dislocations, identifying 64 published studies (articles, case reports and papers). In this case report, we present an elderly patient with an intra-articular horizontal dislocation of the patella without any other bony or ligamentous lesions seen in a postreduction MRI. In some of these cases, closed reduction is not possible and an open reduction in the operating theatre must be performed. Acute traumatic intra-articular dislocation of the patella is not a common presentation in orthopaedic practice less frequently observed than extra-articular dislocation of the patella.
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