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Joint Diseases and
Related Surgery
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Case Report · Open access

Total knee arthroplasty with “Collar Tightening Technique” for advanced knee osteoarthritis with concurrent chronic posterolateral knee dislocation and lateral patellar dislocation: A case report

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Wen-Shuo Chang

Department of Orthopedics, Chi Mei Medical Center, Tainan, Taiwan

ORCID: 0000-0002-9934-6970

Chi-Sheng Chien

Department of Orthopedics, Chi Mei Medical Center, Tainan, Taiwan Department of Electrical Engineering, Southern Taiwan University and Technology, Tainan, Taiwan

ORCID: 0000-0001-7880-3282

Tsung-Mu Wu

Department of Orthopedics, Chi Mei Medical Center, Tainan, Taiwan

ORCID: 0000-0002-0540-6283

Kin-Weng Wong

Department of Orthopedics, Chi Mei Medical Center, Tainan, Taiwan Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan

ORCID: 0000-0002-9223-2225

Abstract

Chronic posterolateral knee dislocation with concurrent lateral patellar dislocation is a rare and challenging pathology. Without appropriate treatment, it invariably leads to advanced osteoarthritis, frequently necessitating total knee arthroplasty. However, achieving optimal patellofemoral tracking remains a primary challenge, and no consensus on a definitive surgical technique exists. In this article, we introduce a novel “Collar Tightening Technique” to address this complex clinical scenario. A 66-year-old male with a complex medical history, including prior right knee medial collateral ligament/posterior cruciate ligament reconstruction, presented with chronic right knee pain with difficulty in ambulation. Imaging revealed advanced osteoarthritis, posterolateral knee dislocation, and lateral patellar dislocation with a fixed 20-degree tibial external rotation deformity. The patient underwent total knee arthroplasty, during which the collar tightening technique was employed to restore patellofemoral stability. This technique consisted of three key components: (1) an extensive lateral release, (2) distal and lateral advancement of the quadriceps tendon, and (3) medialization of the patellar component. A hinged prosthesis was utilized to address the underlying global instability. Postoperatively, the patient could walk smoothly with single cane assistance. In conclusion, restoring stable patellofemoral tracking is of paramount importance in complex total knee arthroplasty. The collar tightening technique provides an effective solution by combining dynamic stabilization from muscle advancement with static stabilization from component positioning. This comprehensive approach warrants consideration when a simple lateral retinacular release is insufficient to achieve proper patellofemoral alignment.

Declarations

Author Contributions

Collected the data and wrote the manuscript: W.S.C.; Assisted in the study implementation, figure preparation and the manuscript revision: T.M.W., C.S.C.; Performed the surgery, obtained patient consent and revised the manuscript: K.W.W. All the authors read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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