الفهرس 
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Abstract
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Malalignment of patella include isolated patellar tilt,
subluxation, subluxation & tilt and recurrent patellar
dislocationThe combination of large muscle forces acting
on smalll mobile patella, with its incongruent contact
geometry, leads to high degree of joint instability.
Thorough evaluation of specific symptoms and signs
should be carried out. Symptoms include: Pain, Giving
way, Swelling and Locking. Then patient should be
examined for lower limb Malalignment and genu valgum
or varum. Then patient is checked for presence or
absence of atrophy especially VMO atrophy and tested
for patellar glide test, apprehension test & patellofemoral
grindinl~test. And Q angle is measured. Lastly, Patient
was eXllminedfor generalized hypermobility tests and
associated pathology like torn menisci or cruciate
Iigament- All patients are examined radiologically by
lateral view to measure the patellar height using Insall-
Salvati or Caton ratio preoperatively and Caton ratio
postopE:ratively. Axial view was taken pre- and
postopt~ratively to measure patellar tilt angle, sulcus
angle and congruence angle. If the patient gives history
of recurrent dislocation and radiological parameters on
plain X-ray within normal, C.T or MRI was requested.
All patients are treated initially conservatively for 3-6
months. Patient is asked to avoid knee position& activity
that n~produce pain and to take pain killer (NSAID or
aspirin). If still there is no improvement on symptoms,
patient was referred to physiotherapy. Surgery is done
when conservative treatment failed to significantly
Improve the symptoms. Revaluation of the symptoms and
signs was done to predict which type of surgery is
suitable for every patient Surgical treatment consisted of
lateral release, proximal realignment, distal realignment
and eembined proximal &distal realignment. For patient
with isolated patellar tilt, lateral release is selected.
Patient with subluxation or dislocation; I) without
patella alta or patellofemoral osteoarthritis or 2)
skeletally immature, proximal realignment is selected. If
intra.-operativelyafter proximal realignment still there is
pateillar maltracking, distal realignment is added
(combinedproximal & distal realignment).
119
Patient with patellar subluxation or dislocation,
skeletally mature with patella alta or patellofemoral
subluxation;distal realignment is selected.