Patellar Instability or Dislocation
Recurring Kneecap Dislocations Leading to Knee Instability
Patellar dislocation occurs when the kneecap (patella) moves out of its normal position, often causing significant pain and instability. The patella normally sits in a groove at the front of the knee called the trochlear groove, where it moves up and down as you bend and straighten your knee. When it dislocates, the patella moves out of this groove, often towards the outside of the knee, leading to instability and the potential for further dislocations if not properly treated.
Dr Antony Liddell, a specialist in orthopaedic surgery, is highly experienced in treating patellar dislocations and associated knee conditions. His comprehensive approach is designed to restore knee stability and prevent recurrent dislocations.
WHAT CAUSES A PATELLA DISLOCATION?
Patellar dislocation often occurs due to traumatic injuries or anatomical factors that predispose the knee to instability. Common causes include:
- Sports Injuries: A direct blow to the knee, or twisting motions while the foot is planted, can push the kneecap out of place. This is common in sports like soccer, basketball, or skiing.
- Falls or Accidents: Sudden impacts, such as from a fall or car accident, can force the kneecap out of its normal position.
- Anatomical Predisposition: Some individuals have naturally shallow trochlear grooves, which make their patella more prone to dislocation with little force.
- Ligament Laxity: Weakness or looseness in the ligaments surrounding the patella can allow it to move more freely, increasing the risk of dislocation.
SYMPTOMS OF PATELLAR INSTABILITY AND DISLOCATION
When the patella dislocates, patients often experience immediate and severe symptoms, including:
- Severe Knee Pain: A sharp, sudden pain occurs when the kneecap dislocates.
- Swelling: Rapid swelling around the knee joint.
- Knee Deformity: A noticeable change in the shape of the knee, often with the kneecap visibly shifted out of place.
- Instability or Buckling: A sensation that the knee is unstable or giving way.
- Popping Sound: Some patients report hearing or feeling a popping sensation during the dislocation.
Even if the kneecap relocates itself, it is crucial to have a thorough medical evaluation to assess the extent of the injury and prevent future dislocations.
DIAGNOSING PATELLAR INSTABILITY OR DISLOCATION
Accurate diagnosis is essential for effective treatment. Dr Liddell will begin by taking a detailed medical history and performing a physical examination of the knee. He will assess the range of motion and stability of the knee joint, as well as any tenderness or deformity.
Imaging studies are often required to confirm the diagnosis and evaluate the extent of damage to the ligaments and cartilage:
- X-Rays: Used to determine if there are any fractures or bone abnormalities that contributed to the dislocation.
- MRI Scans: Provide detailed images of the soft tissues, including the ligaments and cartilage, to assess for tears or other damage.
TREATMENT OPTIONS FOR PATELLAR DISLOCATION
Treatment for patellar dislocation will depend on the severity of the injury and whether the patient experiences recurrent dislocations. Dr Liddell offers both non-surgical and surgical options to restore knee stability and reduce the risk of future dislocations.
Non-Surgical Treatment
For first-time dislocations or mild cases, non-surgical options may be sufficient:
If the patella does not return to its normal position on its own, Dr Liddell will perform a gentle manual manoeuvre to reposition the kneecap.
Following a dislocation, the knee may need to be immobilised in a brace for a few weeks to allow the soft tissues to heal.
A tailored physiotherapy program is essential for strengthening the muscles around the knee, particularly the quadriceps, which helps stabilise the kneecap and reduce the risk of future dislocations.
These methods help reduce swelling and alleviate pain in the immediate aftermath of the injury.
A supportive knee brace may be recommended to prevent the patella from moving out of place during the healing process.
In many cases, conservative treatment may lead to full recovery, particularly if the condition is diagnosed early and the bone fragment remains attached.
Surgical Treatments
In cases where non-surgical treatments are ineffective, or the patient experiences recurrent dislocations, surgery may be necessary.
Dr Liddell offers several surgical techniques to address patellar instability:
This procedure loosens the tight ligaments on the outer side of the knee that may be pulling the patella out of position.
The MPFL is a key ligament that helps keep the patella in place. If this ligament is torn or damaged, it can be reconstructed using a graft, which helps stabilise the kneecap.
For patients with a shallow trochlear groove, realignment surgery may be necessary. This procedure reshapes the groove to better accommodate the patella, reducing the risk of future dislocations.
This technique tightens the soft tissues on the inner side of the knee to stabilise the patella and prevent it from dislocating again.
Recovery from patellar dislocation depends on the severity of the injury and whether surgery was required. Dr Liddell will provide a detailed rehabilitation plan tailored to your specific needs.
PREVENTING FUTURE PATELLAR DISLOCATIONS
To reduce the risk of future patellar dislocations, Dr Liddell recommends focusing on targeted muscle strengthening exercises, particularly for the quadriceps and hip stabilising muscles, as these play a key role in maintaining proper alignment and support for the kneecap. Strong quadriceps muscles, especially the vastus medialis (inner thigh muscle), help keep the patella tracking smoothly in its groove, reducing the likelihood of dislocation. Additionally, strengthening the hip muscles can further stabilise the knee, as they assist in controlling leg alignment during movement.
- Flexibility Exercises can also support patellar stability by preventing muscle imbalances that may place strain on the knee. Regular stretching of the hamstrings, quadriceps, and calves can improve joint flexibility and reduce stress on the knee, making dislocations less likely.
- Wearing Appropriate Footwear that offers good support, particularly for activities involving high-impact or quick directional changes, can help safeguard against patellar instability. Using proper techniques in sports and physical activities is also crucial; this includes avoiding sudden, uncontrolled movements that place stress on the knee, such as abrupt pivots or awkward landings, which are common causes of patellar dislocations.
For individuals who have experienced a patellar dislocation or suffer from chronic knee instability, Dr Liddell offers expert diagnosis and personalised treatment plans tailored to restore knee stability. These plans may include a combination of physical therapy, activity modifications, bracing, and in some cases, surgical interventions to realign or stabilise the patella. By addressing the underlying factors that contribute to instability, Dr Liddell aims to improve knee function and enhance overall quality of life.