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Patellar Instability

Patellar Instability

Patellar instability is an umbrella term given to a range of injuries that occur when the kneecap or patella is displaced from its original resting place.  It is a common medical issue affecting lot of people (on an average of 7 out of 1 lakh).  However, not all patellar instabilities can be treated equally and the cause of the disease can be varied, so a clear understanding as to what caused the disease is essential to tailor an effective treatment.  The ultimate goal of any treatment modality is to provide good outcomes and prevent future incidences of the condition.

Patellar instability can arise out of traumatic dislocation, during a game of sport or during an activity of daily living.  The relative incidence of patellar instability is high among teenagers who take part in sporting activities.  Unfortunately, if a person had patellar instability at some point in his/her life, s/he is at an increased risk of recurrence.  It is estimated that about 15% to 44% of people has a relapse somewhere down the line.  First-line treatment of patellar instability is a combination of strengthening exercises to ameliorate pain and provide better function.

Let’s understand what exactly patellar instability is.  The patella or kneecap attaches to the thigh bone and shin bone by tendons.   The patella fits into a groove that is at the end of the femur and it goes up and down in accordance with the motion of the knee.  Normally, patella rests in the groove.  Instability happens when the patella moves out of the groove.  Patellar instability can be classified into two viz. traumatic patellar instability and chronic patellar instability.  When the patella is pushed completely out of its resting place, it is called traumatic patellar instability and when the patella slides partly out of the groove, it is known as traumatic patellar instability.  This is also referred to as patellar subluxation.  It cannot always be that patellar instability happens only during motion.  If the patella does not rest properly in the track instability can happen.

Patellar instability can come through either as a result of a sudden trauma or may gradually come through during daily activities.

Signs and symptoms of patellar instability:

Just like any other dislocation, you may feel pain, discomfort, tightness, difficulty walking on the affected leg, buckling and catching sensation.  The deformity in the knee becomes visually noticeable.  People can experience a feeling that their kneecap has shifted out of its original place.  Patients can experience intense pain when they do deep knee bending.  Generally, the kneecap moves back to its original place on its own, but if it does not happen, then the person has to be taken to the emergency room to get it done surgically.

The intensity of the pain is less severe in chronic patellar instability compared to a traumatic instability.

Do I have patellar instability?

You may be wondering how you can figure out if you are suffering from the condition.  In the first place, your ability to perform daily and recreational activities may be limited.  Climbing and descending stairs, squatting, running, jumping and sporting activities may be painful.  You can in fact feel kneecap shifting out of the patellar groove.  Walking on an uneven terrain or rolling over in bed may throw signs of instability in the knee.  Your knee may go weak and eventually give way.  If there is swelling and stiffness in the knee post a traumatic injury, then it is time to see an orthopedic.

How patellar instability is diagnosed?

After understanding your past medical history in detail, your doctor will perform a thorough physical exam.  Your doctor may do a physical examination of other body parts as well which s/he thinks might contribute to patellar instability, for e.g. hip and foot.  The doctor may ask for some x-rays, but if the patella has already returned to its groove, the x-ray findings may be normal.  The objective of the assessment is to find out the intensity of the instability, its cause and contributing factors if any.  If the instability is caused by a traumatic incident, to assess if there is any cartilage damage, an MRI may be ordered.

Treatment for patellar instability:

Non-traumatic kneecap instabilities are generally managed non-operatively.  In a good number of cases, a period of rest with a brace or crutch would do the trick.  In such cases, physiotherapy is initiated after a period of rest as a measure to bolster knee muscles and to prevent kneecap sliding out of the groove.  However, under some circumstances, the way out would be an operative intervention – in case of an acute patellar instability, cartilage may be knocked out of its place, ending up hanging loose over the knee.  In such cases, the loose body needs to be removed via surgically.  If the knee ligaments are ruptured, reconstruction of them is imperative to restore the functionality of the knee.  Moreover, if a person is suffering from frequent relapse of patellar instability despite conservative treatment techniques, an operative intervention is warranted to re-align the patella and place it in a better position.  It can be done through an “open” procedure or arthroscopically.  In an open procedure, the bone is cut in order to improve the tracking of the patella, that way the patellar movement when you bend and straighten the patella can be improved.  However, in case of an arthroscopic route, the procedure is minimally invasive and easier than traditional open procedures.  It should be understood that your surgeon is the best person to select the appropriate procedure in tune with the intensity and type of your instability.

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