Kneecap injuries
A partial dislocation of a bone is known as subluxation. A partial dislocation of the kneecap is known as patellar subluxation (patella). Patellar instability, or kneecap instability, is another name for it.
The kneecap is a little protecting bone that links to your thigh bone near the bottom (femur). Your kneecap glides up and down in a groove at the bottom of your leg called the trochlea as you bend and straighten your knee.
Your kneecap is held in place by a number of muscles and ligaments. Your kneecap may migrate out of the groove if one of these is injured, causing pain and difficulties flexing the knee.
Whether the dislocation is referred to as a patellar subluxation or a dislocation is determined by the size of the dislocation.
The kneecap is usually pushed to the outside of the knee in most injuries. This can also harm the medial patello-femoral ligament, which is located on the inside of the knee (MPFL). The MPFL can set the scene for a second dislocation if it does not heal adequately.
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| Patellar Subluxation: Symptoms | Causes | Diagnosis | Nonsurgical treatment |
What are the signs and symptoms?
Patellar subluxation can result in the following symptoms:
- Knee buckling, catching, or locking is a condition in which the knee buckles, catches, or locks.
- Kneecap slipping to the outside of the knee
- ache after a long period of sitting
- Knee discomfort in the front that gets worse after activity
- In the knee, there is a popping or cracking sound.
- Swelling or stiffness of the knee
You will need to see a doctor for treatment, even if you are able to self-diagnose.
What causes patellar subluxation?
Patellar subluxation can be caused by any high-intensity activity or contact sport.
Patellar subluxations and dislocations are most common in young, energetic people, especially those between the ages of 10 and 20. Sports account for the majority of first-time injuries.
The chances of a second dislocation after an initial injury are extremely significant.
Patellar subluxation is diagnosed in one of two ways.
Your doctor will bend and straighten the affected knee and feel the area surrounding the kneecap to identify a patellar subluxation.
X-rays may be performed to examine how the kneecap fits into the groove at the bottom of the patella, as well as to rule out any other potential bone problems.
The ligaments and other soft tissue surrounding the patella may be visualized via magnetic resonance imaging (MRI). Patellar dislocations can occur in children and adolescents who are unaware of it. It can be confirmed with an MRI.
What nonsurgical treatments are available?
For the majority of persons who have a first-time patellar subluxation or dislocation, nonsurgical therapy is suggested.
The following are examples of nonsurgical treatments:
- Nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen (Advil, Motrin) physical therapy RICE (rest, ice, compression, and elevation)
- To take weight off the knee, use crutches or a cane.
- Knee braces or casts are used to keep the knee immobilized.
- customized footwear to relieve kneecap pressure
You have a 33 percent likelihood of recurrence after a patellar subluxation.
A systematic evaluation of 70 prior research published in 2007 indicated no significant differences in long-term outcomes between individuals who had surgery for patellar dislocation and those who did not. Those who underwent surgery were less likely to get a second dislocation, but they were more likely to develop knee arthritis.
In a 2015 study, those who received surgical treatment for full dislocation of the kneecap had a decreased rate of recurrence. However, whether the person underwent surgery or not, the rate of recurrence of patellar subluxation was nearly the same (32.7 versus 32.8 percent).
What surgical treatments are available?
The majority of first-time patellar subluxation cases are handled without surgery. If you have a repeat episode or if you have a particular condition, surgical treatment is indicated.
The following are some of the most prevalent methods of surgery for patellar subluxation or dislocation:
Reconstruction of the medial patellofemoral ligament (MPFL).
The medial patellofemoral ligament (MPFL) pulls the kneecap inward. The kneecap might dislocate toward the outside of the leg if the ligament is weak or injured.
MPFL repair is performed through two tiny incisions during arthroscopic surgery. The ligament is rebuilt with a little piece of tendon either from your own hamstring muscle or from a donor in this procedure. It takes around an hour to complete. You normally go home the same day, wearing a brace to keep your knee stable.
While walking, the brace holds your leg straight. It's supposed to be worn for six weeks. Physical treatment begins after six weeks. After MPFL restoration, most people can return to sports and play activities four to seven months later.
Transfer of the tibial tuberosity
Your shin bone is also known as the tibia. The tibial tuberosity is a swelling in the tibia immediately below the knee that is oblong in shape.
The tibial tuberosity is where the tendon that guides your kneecap as it glides up and down in the trochlear groove attaches. The attachment point for this tendon may have been destroyed by an injury that caused the kneecap to dislocate.
The tibial tubercle transfer procedure necessitates a three-inch incision above the shin bone. During this procedure, your doctor moves a little section of the tibial tuberosity to enhance the tendon's adhesion. As a result, the kneecap is able to move freely in its groove.
One or two screws will be inserted into your leg by the surgeon to secure the bone that has been transferred. The procedure takes around an hour.
Following surgery, you'll be given crutches to utilize for six weeks. Following that, physical therapy will commence. After two weeks, most people are able to return to work or school. You'll be able to return to sports in roughly nine months.
Lateral ejection
Although lateral release was the conventional surgical treatment for patellar subluxation until about ten years ago, it is now uncommon since it raises the chance of recurrence of kneecap instability.
Ligaments on the outside of the knee are partially severed in this surgery to prevent the kneecap from being pulled to the side.
How long does it take to get back on your feet?
- Without surgery
If you don't undergo surgery, your rehabilitation will begin with RICE, a four-letter acronym that stands for Rest, Ice, Compression, and Elevation. This denotes
- rest
- icing
- compression
- elevation
You shouldn't force yourself to move about more than you're comfortable with at first. To ease the weight off your knee, your doctor may prescribe crutches or a cane.
Within a few days following the injury, you'll most likely see your doctor again. When it's time to start increasing activity, they'll let you know.
For the first six weeks, you'll most likely be given physical therapy two or three times each week. Your physical therapist will assist you in determining when you are ready to resume sports and other demanding activities.
- With surgery
If you've undergone surgery, your recuperation will take longer. It may take four to nine months before you may begin sports, however mild exercises should be resumed within two to six weeks.
Patellar subluxation and how to avoid it
Certain exercises, such as patellar subluxation exercises, can assist strengthen your leg muscles and minimize your risk of knee problems. Add some of the following exercises to your regimen to decrease your risk of this sort of injury:
- exercises to strengthen your inner and outer thighs, such as squats and leg lifts exercises to develop your quadriceps, such as squats and leg lifts techniques to strengthen your quadriceps, such as squats and leg lifts
- curls for the hamstrings
- Wearing a brace if you've already had a kneecap injury can assist avoid recurrence.
Another key approach to avoid any sorts of kneecap injuries is to use adequate protective gear when participating in contact sports.
Outlook
A frequent injury in children and adolescents, as well as some adults, is patellar subluxation. The initial incidence usually does not necessitate surgery. If surgery is required, a variety of innovative methods make it possible to restore all or almost all of your prior strength and activities.
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