Patella is a triangle shaped outer covering of the knee bone. Certain reasons may cause this cover to move out of place. Such a condition is known as patella or kneecap dislocation. The quadricep muscles in the leg are supported by patella. These muscles are useful in stabilizing the leg during extension. A stable patella is essential for performing any activities with lower extremities of body. Patella dislocation mainly occurs in the lateral part of the knee.
Generally, women are seen to be more prone to patella dislocation than men. Young people, specially athletes, in the age group of 16-20 are more commonly affected. Stress on the legs often leads to dislocated patella. Stress may occur by sudden change in leg direction or hyper extension of knee. Direct trauma can also result in dislocation.
The patella dislocation is usually indicated by pain in the knee. Other symptoms include:
- Deformed knee condition
- Unable to straighten knee
- Swelling and pain in knee
- Sloppy patella
Typically, there exists two treatment options:
- Non-surgical Treatment
The various non-surgical methods of treatment included are:
- Physical Therapy
The physical therapy is chosen as the best method for controlling the patella. The exercises and therapies in this program strengthens the quadriceps muscle of the knee. This realigns the pull on the knee. The physical therapy also focuses to improve the mobility of hip flexors and hip abductors. Thus dislocated petalla slowly recovers.
- Bracing and taping
Bracing and taping are an important aspect for treating petalla dislocation. Braces and tapes are used to protect the knee from further injuries. They enhances the healing of the affected part.
- Better footwear
The pressure on the knee can be reduced to an extent using proper footwear. They provide controlled motion of leg and hence decrease strain.
- Surgical Treatment
Prior to surgery, local or general anesthesia is given to the patient. Depending on the severity of dislocation, different surgery techniques may be chosen:
- Lateral Release
instability in patella is usually corrected through a simple surgery called lateral release. Initially, the knee joint capsule present outside the joint is cut down. This is done because kneecap is being pulled to the outside of knee. As a result, the outside pull is loosened. The kneecap is then centered to the groove. It is placed at the end point of the thighbone. In some people, the lateral release is done along with MPFL reconstruction or medial imbrication.
- Reefing/ Medical Imbrication
Medial imbrication procedure aims to tighten the inner tissue of the knee. The quadriceps muscles are situated on the inner part of knee. This method advances the attachment of the quadricep muscles on the kneecap. Thus patella dislocation is treated.
- MPFL Repair/ Reconstruction
MPFL reconstruction method is the most modern procedure for patella dislocation. This procedure mainly focuses on the medial patellofemoral ligament(MPFL) of the knee. The MPFL is placed in between the thighbone end and inner kneecap. Patella dislocation often damages the MPFL. During surgery, a new segment is made either from any other body part or a donor is used. This ligament is then attached to both patella and thighbone. This MPFL ligament is strong enough to hold patella in fixed position. However, chances of recurrence of dislocation are not decreased.
- Bone Realignment
In some people, abnormal anatomy results in dislocated patella. The abnormal anatomy may come from either irregular lower extremity alignment or shallow groove on thighbone end. To correct this condition, the tibial tubercle is shifted to the shin bone by surgery. This tibial tubercle is connected to the patellar tendon. As its position is changed, the patella comes more close to the inner side of knee. The common technique used for realignment is Fulkerson Procedure.
After surgery, the person is advised to take rest for a specific period of time. Along with rest, simple exercises are recommended to improve functionality. The exercises include walking, cycling and other stretching exercises. They help to strengthen the thigh muscles. As a result, the patella remains properly aligned. A stabilized brace is often prescribed for the knee. The operated area must be cleaned regularly and should be protected from further injuries. The complete recovery may take 6-8 months.
The possible risks in surgical treatment of dislocated patella are:
- Burning sensation at the site of surgery
- Irregularly aligned patella
- Reaction to anesthesia