title: Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation.
abstract: OBJECTIVE
  To describe the correlation between medial patellar ossification and prior patella subluxation and/or dislocation.
  
  
  METHODS
  A retrospective billing database search identified 544 patients who had been diagnosed with patellar instability over a 13-year period. One hundred twenty-eight patients met the inclusion criteria. After review by a staff orthopedic surgeon and two musculoskeletal radiologists, 28 patients were found to have medial patellar ossification. The size and location of medial patellar ossification was recorded.
  
  
  RESULTS
  Of the 28 patients (20 males, eight females, age 13-66 years, mean 28 years) who were found to have medial patellar ossification, 22 had radiographs, 16 had magnetic resonance imaging, and ten had both. The medial patellar ossification ranged in size from 2 to 18 mm with an average of 6.8 mm. Twelve were located in the medial patellofemoral ligament (MPFL), 14 in the medial joint capsule, and two in both the MPFL and joint capsule. Twenty-seven of 28 patients had a single ossification, and one patient had two ossifications. The timing from injury to first imaging of the lesion ranged from 10 days to a chronic history (> or = 35 years) of patellar instability.
  
  
  CONCLUSIONS
  Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. The presence of this lesion will prompt physicians to evaluate for patellar instability.
authors.affiliation: Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA 02114, USA. sjerabek@partners.org
authors.forename: Seth A
authors.initials: SA
authors.lastname: Jerabek
authors.forename: Peter D
authors.initials: PD
authors.lastname: Asnis
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Bredella
authors.forename: Hugue A
authors.initials: HA
authors.lastname: Ouellette
authors.forename: Steven K
authors.initials: SK
authors.lastname: Poon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000175:diagnosis* / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000175:diagnosis* / Q000453:epidemiology*; D031222:Patellar Dislocation / Q000175:diagnosis* / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult