ORTHOPEDICS/HIP & KNEE/KNEECAP (PATELLA) DISORDERS
What is patellar subluxation?
The Patella, or the kneecap, is one of three bones that constitute the knee joint. Each of these bones possesses a protective cartilage coating. The patella is also covered by a tendon. This tendon attaches the quadriceps muscle of the thighbone to the shinbone (tibia) below the knee.
When the knee bends. the kneecap slides up and down a groove on the end of the thigh bone. This groove is called the trochlea.
The kneecap is shaped to fit in the center of the trochlear groove and slide consistently within the groove.
When there is a problem, the kneecap is pulled towards the outside of the trochlear groove, and the kneecap does not slide centrally within its groove. This disorder is called patellar subluxation.
Signs
With patellar subluxation, sometimes, an inappropriate tracing may not reflect any sign, or it could lead to the patella dislocation (when the kneecap entirely comes out of the groove).
Most frequently, patellar subluxations cause pain ( also called patellofemoral pain syndrome, or PFPS) and uneasiness with activity.
Many people with kneecap pain sign are diagnosed with patella subluxation.
These issues range from knee pain to the kneecap dislocation.
Reasons
Many factors may be implicated in causing patellar subluxation, since several factors may lead to the kneecap unsteadiness.
From these factors we note: a wider pelvis, a shallow groove for the kneecap, and some abnormalities in walking.
Classically, patellar subluxation pain is related PFPS.
Other kneecap pain reasons may include: knee arthritis, patellar tendonitis (Jumper’s knee), and plica disease.
It is important to define pain cause and launch the appropriate therapy.
Therapy
Therapy alternatives to repair a patellar subluxation are numerous.
The most appropriate alternative depends on the disorder severity and the kneecap abnormal positioning reason.
Therapy should first ensure that the patella is not disrupted. (X-rays to check if the kneecap is outside of its groove is recommended).
Physical Therapy:
Traditional physical therapy is used to strengthen the muscles that surround not only the knee but also the complete lower extremity.
Braces and Tape:
The kneecap bracing and taping is also a debated subject in the rehabilitation of kneecap complications. However, it is definitely appropriate to perform this therapy if a patient has characteristic relief with a brace or tape.
Shoe Choice:
Footwear subsidizes to the walking cycle. Motion control walking shoes may help controlling this movement to alleviate the pressure on the kneecap.
Surgery
surgery may be recommended once all above therapy are lasting and pain is not released.
An arthroscopy may asses the knee joint mechanics to determine if there is a topic that can be repaired.
Surgery alternatives
Lateral Release:
A lateral release is a surgical technique performed to loosen the pull of the tight ligaments and joint capsule on the knee outer side.
Medial Ligament Reconstruction:
Correcting or reforming the ligaments on the inner side of the knee that pull the kneecap inwards.
This surgery is classically performed to correct the medial patellofemoral ligament (MPFL) on the inner side of the knee.
Bone Realignment:
This technique is performed when a bone realignment may be compulsory.
To conclude
Kneecap role is very serious to normal knee mechanics.
Severe pain and infirmity may occur if the kneecap is not held inits appropriate position.
Physical therapy is the important support that aims at improving the lower extremity mechanics.