Single-Stage Combined Technique of Lateral Release, Quadriceps Lengthening, Semitendinosus Tenodesis and Anteromedial Tibial Tubercle Transfer in Adult Obligatory Patellar Dislocation: A Case Report.

Obligatory dislocation of the patella is a type of patellar instability characterized by the consistent lateral dislocation of the patella during knee flexion. Adult cases are uncommon and frequently difficult to manage, with no consensus on the most effective reconstructive approach. We report a-31-year-old male with lifelong ambulatory difficulty and a painless, irreducible lateral patellar dislocation. Surgical management included lateral release, quadriceps lengthening, semitendinosus tenodesis, and anteromedial tibial tubercle transfer. Postoperative imaging confirmed proper patellar alignment (Insall-Salvati ratio 1.2; Caton-Deschamps ratio 0.8). At six- and twenty-months follow-up, the patient achieved improved range of motion, flexion of 115 degrees and extension of 0 degrees with satisfactory function Tegner Lysholm score of 85 and the IKDC score of 80.5. Obligatory dislocation of the patella often involves proximal abnormalities, proximal realignment is generally prioritized, though distal realignment via tibial tubercle anteromedial transfer also reduces patellofemoral contact stress. Given the limited literature on adult obligatory dislocation of the patella, combining proximal and distal realignment may offer superior outcomes. This case demonstrates that a combined proximal and distal realignment technique can successfully restore patellar tracking and function in adult obligatory dislocation of the patella. Considering the limited evidence available, this strategy could potentially be a significant option for addressing complex adult cases.