You use your knees daily for activities such as walking, running, squatting, and kneeling. It’s no wonder there are a lot of healthcare issues associated with the knees and kneecap.
The kneecap, or patella, is held in place by tendons and is located in the femoral groove(at the end of the femur, or thighbone). When your kneecap moves freely from side to side, it could be a sign of a dislocation. Patellar instability can be painful, but this condition can be corrected through therapy and knee braces.
Types of Patella Instability
If your knee moves freely from side to side, it could be one of the two conditions.
Dislocation
When the kneecap completely moves out of place, i.e., out of the femoral groove laterally, it has been dislocated.
Subluxation
If the kneecap still has a connection to the femoral groove but is still out of place, it has been partially dislocated. This is known as a subluxation.
Causes of patella instability
As mentioned earlier, the patella is held in place by connective tissues like tendons and muscles, which have a connection to your femur and shinbone. These connective tissues support the kneecap by pulling it up when you straighten your legs and down when your legs are bent. When there is patella instability, this basic movement is flawed. Some of the common causes include:
- Collision or sharp hit to the patella
- Accidents
- Loose or flexible joints or ligaments:
- Lateral release surgery can increase the likelihood of loose ligaments that can cause patella instability.
Who can develop patella instability?
It is possible for anyone, but it is more common among;
- Athletes
- Women, due to their wider hips
- Massive, tall men
- People with Down syndrome, and cerebral palsy.
Symptoms and signs of patella instability
- The inability to walk or straighten one’s legs
- Excruciating pain in the knee
- Swelling around the affected area.
- Knee stiffness
Patellar instability diagnosis and tests
It is advised that you visit the doctor as soon as possible if you experience one or more of the following symptoms. Sometimes, you may feel the kneecap is out of place, but it pops right back in without intervention. If this is the case, you still need to see a doctor because there is a high chance that it could happen again.
Your doctor or physician will physically assess the leg by examining it, asking questions about your symptoms, and assessing how much function you can carry out with the affected leg.
The following tests are also carried out:
- An X-ray examination is to check if the kneecap is out of the femoral groove and if there are other affected bones.
- MRI Scan to check for Injuries to Connective Tissues like Ligament Tears
- CT scan
- Lateral radiography
The treatment plan for patella instability
Treatment may or may not involve surgery. The non-surgical treatments for this condition include
- Reduction
- Use of knee braces
- Pain medication
- Physical therapy
Reduction
Reduction is a non-invasive procedure where the physician or health care provider uses gentle force to push the patella back into place. The reduction can be painful or uncomfortable and may be accompanied by pain medications.
Use of knee braces
This is common for subluxations. The knee brace helps to return the kneecap to its original position by immobilizing it. Knee braces are kept on for several days to weeks and may also require the use of crutches to aid movement.
Pain medication
Pain medications such as non-steroidal anti-inflammatory drugs are given to patients to relieve the pain associated with this condition. Your doctor may also recommend ice packs and adequate rest for quick recovery.
Surgical procedures
Surgery or invasive therapy may be recommended for people with chronic patella dislocation. The surgery involved the use of an arthroscope and tiny incisions. The recovery process can take a few months to a year. Other invasive procedures include
- Medial patellofemoral ligament repair or reconstruction
- Tibial tubercle transfer or knee osteotomy to realign the tibia, femur, patella, ligaments, and tendons
- Knee replacement surgery is indicated when the patient presents with arthritis or has had recurrent dislocations.
Physical therapy
Physical therapy involves exercises that can help strengthen the muscles, ligaments, and tendons, enabling the kneecap to stay in place in the femoral groove. One major exercise that is done with the help of physiotherapists is biking. Using knee braces during such exercises will help improve the success of the exercises.
Recurrence
Sometimes, even after non-invasive therapy, nearly 50% of people dislocate their kneecap a second time, meaning it is unstable and still requires medical attention.
Regular recurrence of this condition can lead to an increased risk of coming down with conditions like damage to the connective tissues and arthritis. Surgery may be the next line of action for the patient.
Recovery for athletes
Athletes who have to return to sports must meet certain criteria to be considered healthy enough.
The following criteria have to be met in such instances within six weeks after trauma or injury:
- Restored/Complete range of motion
- Stability
- Complete absence of pain
- A limb symmetry index (LSI) of at least 90% is required.
- An absence of effusion
To evaluate the above criteria, these are some of the tests that can be carried out.
- Single-leg squat as a measurement of balance and stability
- Jump test to determine control during landing
- The side hop test assesses balance, agility, strength, and muscle coordination.
Conclusion
Patellar instability is a painful condition that can occur in both the young and the elderly as a result of injury, trauma, surgery, or as a result of a health condition. It is important that people who notice symptoms visit the hospital for treatment immediately to avoid the worsening of the symptoms.
It is a treatable condition. Therapy includes noninvasive procedures such as reduction, the use of exercises with the aid of knee braces, and pain medication. Surgery is sometimes recommended, especially for recurrent cases. Athletes who experience this condition must ensure they are physically fit to return to sporting activities.
