AANA Lab Course 910 - Patellofemoral Joint Preservation-Patella Dislocation in the Elite Athlete-Dr. Seth L. Sherman, M.D.

Patella Dislocation in the Elite Athlete-Dr. Seth L. Sherman, M.D.

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This case report discusses a 20-year-old male Division 1 offensive lineman with NFL aspirations who sustained a left knee injury involving patella dislocation. The athlete had a prior history in 2017 of a grade 2 medial collateral ligament (MCL) sprain caused by a valgus force during a game, which had fully resolved after conservative management with a hinged knee brace and rehabilitation. The current injury occurred from a valgus and flexion mechanism while the foot was planted and externally rotated.<br /><br />On examination the day after injury, the athlete showed mild knee effusion and increased lateral patellar translation at 0 and 30 degrees of flexion without a firm endpoint, indicating lateral patellar instability. There was mild apprehension but no guarding, with stability restored beyond 30 degrees of flexion. Valgus stress testing revealed grade 1-2 medial opening at 30 degrees, but no tenderness over the MCL or associated structures. Varus stress tests and Lachman test (grade 1A), posterior drawer, as well as neurovascular status were normal. MRI imaging was obtained, with comparisons made to the 2017 MRI to assess for additional pathology.<br /><br />Management options discussed included nonoperative treatment with physical therapy aiming for return to play during the season, with the possibility of surgery afterward if instability or recurrent dislocations occur. Alternatively, immediate surgical intervention involving knee arthroscopy, chondroplasty, and medial patellofemoral ligament (MPFL) reconstruction was considered, which would preclude play for the rest of the season but potentially allow recovery in time for the NFL Combine.<br /><br />The case highlights decision-making in the elite athlete balancing the urgency of return to sport with the risks of recurrent instability, outlining both conservative and surgical pathways tailored to the athlete’s goals and clinical findings.

Keywords

patella dislocation

medial collateral ligament sprain

valgus force

knee injury

lateral patellar instability

knee arthroscopy

medial patellofemoral ligament reconstruction

physical therapy

NFL athlete

return to play