The patella, formerly known as the kneecap, is the front bone of the knee, responsible for transmitting the strength of the thigh muscles. In some situations, this bone can move out of its normal location, called patellar instability or patellar dislocation, explains the orthopaedic in Delhi.
If the patellar dislocation occurred for the first time, it is called a primal patellar dislocation. From the second episode, it is called recurrent patellar dislocation.
When a patellar dislocation occurs, there is severe pain and an inability to mobilize the knee. It is possible to see and feel that the patella has moved out of place.
Most of the time, the patella comes back into place on its own almost immediately. Rarely, a doctor needs to put it in place with a knee extension maneuver.
After a patellar dislocation, there may be a feeling of insecurity with the knee, even without the patella clearly moving out of place. This sensation is called a patellar seizure. It is a very uncomfortable symptom, which can interfere with normal activities, says the orthopaedic in Dwarka.
Patellar dislocation can occur from trauma, such as a blow or twist to the knee, or without trauma, in a common movement of the joint.
Some people have knee features that favor patellar dislocation. Among the main ones are:
The medial patellofemoral ligament is the structure that prevents dislocation of the patella. When the patella is displaced, it is injured or loosened.
When the patellar dislocation is treated without surgery, what is expected is that this ligament will heal. In the surgical treatment of patellar dislocation, reconstruction of the medial patellofemoral ligament is performed in most cases, explains the orthopaedic surgeon in Delhi.
Learn more about patellar dislocation treatments below.
The diagnosis of patellar instability is made through a careful assessment of the patient’s clinical history and physical examination, complemented with imaging tests.
The main test to be evaluated is magnetic resonance imaging, which shows indirect signs of dislocation, injury to the medial patellofemoral ligament, and the anatomical changes that favor instability. In addition, MRI is essential to look for cartilage lesions. Other tests, such as radiographs in special positions and computed tomography, are useful for evaluating the shape of the knee and predisposing factors, states the orthopaedic in west Delhi.
In the case of a patient with an episode of patellar dislocation, both non-surgical and surgical treatment are possible. The decision for one or the other must be individualized, after a detailed discussion between the patient and the orthopaedic surgeon in Dwarka.
Non-surgical treatment involves immobilization for a period, followed by rehabilitation focused on exercises to strengthen and control the thigh and hip muscles. The goal of successful non-surgical treatment is the absence of new episodes of dislocation and patellar apprehension, the feeling of discomfort or buckling caused by instability, explains the orthopaedic surgeon in Dwarka.
Situations that indicate treatment with patellar dislocation surgery are:
Patients with a single episode of dislocation, although they can be treated without surgery, can also opt for surgical treatment. Surgery has the advantage of a lower chance of re-displacement or seizure symptoms for activities, says the orthopaedic surgeon in west Delhi.
According to the orthopaedic surgeon in Delhi, there are several procedures available for patellar instability, which are chosen according to the characteristics of each patient, and there may be a combination of procedures. This concept of individualized treatment is known as à la carte treatment, influenced by the French school.
These are the most common procedures performed for patellar dislocation.
Postoperative care depends on the technique used. They usually involve a period of support with crutches and a knee brace. However, from the beginning, it is already allowed to put the foot on the floor and remove the immobilizer to move the knee in most situations. Rehabilitation includes restoring knee mobility and restoring strength and control of the musculature of the thigh, hip, and trunk.
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