Patellar Dislocation and Patellofemoral Instability
A patellar dislocation happens when the kneecap (patella) moves out of its normal position and slides out of the femoral groove. It can occur after a direct blow to the knee or during a rotational movement of the joint. In a dislocation, the medial patellofemoral ligament (MPFL), which helps keep the kneecap in place, usually tears. Most of the time, the kneecap will spontaneously return to its normal position. The first dislocation rarely requires surgery, but if there’s significant cartilage damage or a fracture, surgery is often needed.
Risk Factors for Recurrence and Patellofemoral Instability
Certain factors increase the risk of recurrent dislocations or developing ongoing patellofemoral instability:
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Young age
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Femoral dysplasia (a very flat femur)
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Patella alta (a high-positioned kneecap)
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Valgus alignment (knock knees or knees pointing inward)
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Rotational issues in the leg
TREATMENT
01. CONSERVATIVE MANAGEMENT
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Physical Therapy: Focus on strengthening the quadriceps, especially the vastus medialis, and improving the balance of muscles around the knee to stabilize the patella.
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Bracing or Taping: To provide support and prevent further dislocations during physical activity.
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Activity Modification: Avoiding movements that trigger instability or dislocations, such as deep knee bending or twisting.
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Medications: NSAIDs for pain and inflammation management.
02. SURGICAL TREATMENT
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Medial Patellofemoral Ligament (MPFL) Reconstruction:
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Common for recurrent dislocations or severe instability.
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Involves reconstructing the ligament that helps stabilize the patella.
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Realignment Procedures:
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Tibial Tubercle Transfer: Moves the attachment of the patellar tendon to alter the alignment and reduce the risk of dislocation.
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Trochleoplasty: A procedure to reshape the femoral groove for better patellar tracking.
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03. POST-SURGICAL REHABILITATION
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Gradual rehabilitation to restore strength, flexibility, and proper patellar tracking.
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Return to full activity is typically 4-6 months after surgery, depending on the severity of the injury and the procedure performed. Key Point
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Conservative treatments are effective for mild cases or after a single dislocation. Surgical intervention is often necessary for recurrent episodes or significant instability, with MPFL reconstruction being a common and successful option.
