Injuries due to instability in the patella
Functions of the Patella
The Patella is an oval-shaped bone located in the front of the Knee, which moves when we bend or stretch it. It is also known as the patella and its job is improve the mechanism by which the quadriceps muscle stretches the knee, and make the transmission of force more efficient when kicking, running or walking. This bone also serves the function of protecting the Knee.
What is patella instability?
This name is used when there are repeated episodes of Dislocation o Subluxation; that is, when the kneecap continues to move from its natural position in front of the Knee. This can happen with intense exercisessuch as dancing, but also in activities of daily living such as walking, bending or turning. When the kneecap comes out of place, the patient experiences pain, inflammation and, especially, great discomfort.. However, the most serious thing is that each episode contributes to the damage of the cartilage of the joint between the kneecap and the femur. This wear and tear can have consequences such as chronic pain, trachidism and limitation in knee function.
Patella Dislocations can occur from one moment to the next
A Dislocation is the displacement of the kneecap from its natural position in front of the knee, placing it on one side of it. Dislocation can happen due to a blow or sudden movement while playing sports or other types of activities. However, in some people it can occur without trauma, when making a turn or landing badly after a jump. Usually the way to reposition it or reduce it is by straightening the knee. Sometimes this happens spontaneously at the time of the trauma, but in others the assistance of a Specialist in a clinic or hospital is required..
In most patients, a correct physical rehabilitation protects from new episodes of dislocation. However, in some cases early surgical intervention may be needed, such as when an osteochondral fracture (fragment of bone with cartilage) of the Patella or Femur occurs, which may occur at the time of Dislocation. To rule it out, it is important to consult a doctor and perform diagnostic images of the Knee.
Non-surgical management of patella dislocation
In the first instance, after reducing the Patella Luxation, the patient’s lower limb is immobilized, with the Knee in extension, to avoid a new immediate Dislocation. This helps reduce inflammation, reduce the intensity of pain and promotes the initial healing of the structures that are broken by the Dislocation (medial patellofemoral ligament and medial retinaculum).
During the first days it may be necessary use crutches to reduce support. After 7-14 days, the rehabilitation phase begins with Physiotherapy. The objective is to reduce inflammation through sedative therapy or modalities that include the application of cold, heat, Ultrasound and Radiofrequency, among others. In addition, the range of mobility of the Knee begins to recover and muscle contraction in the extremity is promoted.
The last phase consists of strengthen the muscles around the kneeHip and in the trunk area to improve the stability of the Patella, the biomechanics of knee movement and the patient’s overall balance, which reduces the risk of new episodes of dislocation.
Conservative treatment is successful in more than 80% of these patients., recovering function and the patient’s return to sports activities. However, some people may continue to dislocate and eventually require surgery. There are predisposing risk factors for the Patella to continue shifting, including: being growing (being under 18 years old), having a high Patella or Femoral Groove Dysplasia (these conditions are evaluated with special measurements on X-rays).
when is the surgery needed?
Each patient requires a complete evaluation that includes an interview with an Expert to analyze how the first episode and the following ones occurred. It is important to know if they only occur with sports activities or occur in everyday life. I also know must determine if the dislocation occurs in knee flexion or extension.
Then, in the physical examination, we evaluate if there are signs of instability such as increased displacement of the Patella, a feeling that it is going to come off when manipulated (apprehension), abnormal movements of the same (the “J” sign), atrophy of the thigh muscles or poor alignment of the limb (genu valgus, genu varus). The medial patellofemoral ligament of the Knee is the main static stabilizer of the Patella to prevent its lateral displacement. Therefore, the pillar of surgical treatment focuses on the reconstruction of this ligament..
Diagnostic images that include X-rays, Magnetic Resonance and/or Scanography, are essential to make the decision on the type of surgical treatment that must be done. The planning of the surgery is very important and must consider the aspects that cause the displacement of the Patella to correct them and evaluate the procedures to follow, in order to minimize the risk of a new Dislocation..