Abstract
Background. The change patellar height is a well-known complication in prosthetic surgery, anterior cruciate ligament reconstruction, high tibial osteotomy and post-traumatic outcomes.
To our knowledge, it has never been described during distraction osteogenesis with Ilizarov method.
Case report. A 17-year-old man was injured in high-speed, head-on motor vehicle collision in 2017. He suffered an open fracture of the left femur and left leg. He was treated elsewhere with Ilizarov fixator for osteosynthesis of the femur, leg and proximal tibial osteotomy for bone transport to fill the distal bone defect. At the end of treatment, he showed modest limitation of knee flexion range of motion (ROM 180° -80°).
In 2018 he came to our attention due to osteomyelitis at level of previous docking site for which a new resection of infection site and proximal osteotomy for bone transport was performed. During treatment, he developed limitation of knee flexion (ROM 180°-120°) and radiographic evidence of patellar drooping. Given the progressive lowering of the patella during the treatment with Caton-Deschamps ratio of -0.51, we were forced to bring back the patient to the operating room so to restore the correct height of the patella.
Conclusion. The case report underlines the need to evaluate the height of the patella more carefully after proximal tibial surgery treated with the Ilizarov method and to provide further diagnostic investigation with MRI to better study the initial position of the anterior tibial tubercle. In any case, the early evaluation of the complications allowed the complete resolution without any sequelae.