patellar instability
Patellar dislocations
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Patellar dislocations, a frequent occurrence in adolescents and young adults, happen when the kneecap (patella) slips out of its normal position in the femoral groove. While some dislocations resolve spontaneously, others require medical intervention to reposition the patella.
Patellar Instability Diagnosis & Treatment
Typically physical therapy focusing on quadriceps strengthening, hip and core stability, and hamstring flexibility effectively treats patellar dislocations. Early MRI scans are crucial to assess cartilage and bone damage and identify anatomical predispositions to future dislocations. Risk factors for recurrence include trochlear dysplasia, patella alta, previous injury, MPFL disruption, age under 18, femoral anteversion, high tibial tubercle to trochlear groove distances, and family history of patellar dislocations. X-rays help identify these anatomical abnormalities and potential osteochondral fractures.
Understanding patellar dislocations
The injury can be traumatic, resulting from a direct blow, or atraumatic, occurring during sports or daily activities with a simple knee twist. The dislocation causes the medial patella to impact the lateral femoral condyle, potentially stretching or tearing the medial retinaculum and MPFL. This impact can also fracture cartilage and bone, creating a loose body that may cause irreparable damage if not addressed promptly. In some cases, timely intervention allows for reattachment of the osteochondral fragment.
surgical intervention
Surgical intervention is often considered after a thorough review of imaging results. Patients experiencing recurrent dislocations often favor surgical stabilization, as repeated dislocations can accelerate cartilage wear and lead to early arthritis. MPFL reconstruction is a common surgical technique to stabilize the patella.In cases involving osteochondral defects or fractures, surgical stabilization is often necessary. When an osteochondral fragment is present, the preferred approach is to reattach it to its original location. However, if the fragment lacks sufficient bone stock or the cartilage is severely damaged, a two-stage procedure may be required. The first stage involves a diagnostic arthroscopy to remove the fragment, debride the cartilage, and obtain a biopsy for potential future cartilage procedures. After a short period of physical therapy, a second procedure is performed for cartilage restoration and MPFL reconstruction.In rare cases with significant patella alta or trochlear dysplasia, a tibial tubercle osteotomy (TTO) may be necessary. This procedure involves cutting and repositioning the tibial tubercle to improve patellar tracking and potentially offload diseased cartilage.
Summary
Patellar dislocation treatment varies widely, ranging from physical therapy for benign cases to complex surgical interventions for recurrent or severe injuries. Thorough discussions with patients and their families are crucial to understand their goals, manage expectations, and develop an individualized treatment plan. The ultimate aim is to provide patients with a stable knee, enabling them to return to their desired activities and prevent future complications.