Physiotherapeutic approach post-quadricepsplasty for habitual patellar dislocation with patella alta in a paediatric patient: a case report Doi: https://doi.org/10.55522/jhpo.V2I5.0043

Abstract

Habitual patellar dislocation (HPD) with patella alta in children is rare and severely affects mobility and quality of life. Patella alta delays engagement of the patella in the trochlear groove, predisposing it to recurrent lateral dislocation during knee flexion. A 9-year-old female presented with habitual lateral dislocation of the left patella since age 4, progressively worsening and restricting physical activity. Pre-operative assessment revealed patella alta, trochlear dysplasia (Dejour Grade C), complete medial patellofemoral ligament tear, increased Q-angle, quadriceps weakness, and proprioceptive deficits. Conservative management failed, and she underwent a 4-in-1 quadricepsplasty comprising lateral release, vastus medialis oblique (VMO) advancement, distalization of the patellar tendon, and quadriceps lengthening.
post-operative physiotherapy commenced three weeks after surgery using a structured, phase-wise protocol. Interventions included cryotherapy, neuromuscular electrical stimulation for quadriceps reactivation, gradual range of motion exercises, isometric and isotonic strengthening, proprioceptive retraining, balance training, and gait re-education. Continuous parent and patient education were integral components. Over 10 weeks, the patient progressed from partial weight-bearing to independent ambulation. Knee ROM improved from 16–53° to 0–130°, quadriceps strength increased from MMT grade 2+ to 4+, and functional outcomes showed significant improvement (LEFS: 24→70; TSK: 38→22). Pain, oedema, and Kinesio phobia decreased, while proprioception and dynamic balance were restored. Early, individualized physiotherapy following quadricepsplasty in paediatric HPD with patella alta yields excellent recovery. A progressive rehabilitation program emphasizing neuromuscular re-education, strength, balance, and family involvement is crucial to reduce recurrence and promote safe return to activity.