Patella Instability
Patella instability refers to the condition where the kneecap (patella) does not move properly within its groove on the femur (thighbone), often slipping out of place or dislocating. This instability can result in pain, swelling, and difficulty in performing activities that involve bending or straightening the knee.
Causes
Patella instability can be caused by several factors:
Anatomical Variations: Differences in the shape or alignment of the bones and tissues around the knee.
Trauma or Injury: Direct impact or sudden twisting motions can dislocate the patella.
Ligamentous Laxity: Loose ligaments that do not hold the patella firmly in place.
Muscle Imbalance: Weakness in the quadriceps or other supporting muscles can contribute to instability.
Symptoms
Common symptoms of patella instability include:
Pain around the kneecap, especially when sitting with bent knees, standing up, or going down stairs.
A sensation of the knee giving way.
Swelling and tenderness around the knee.
Visible displacement of the patella during an episode.
Diagnosis
Diagnosis typically involves:
Physical Examination: Assessing knee movement and stability.
Imaging: X-rays, MRI, or CT scans to visualize bone and soft tissue alignment and detect any damage.
Treatment
Treatment options depend on the severity and underlying cause and can include:
Conservative Measures: Physical therapy to strengthen muscles, bracing, and activity modification.
Medication: Pain relievers and anti-inflammatory drugs.
Surgical Intervention: Procedures to realign the patella or reconstruct damaged ligaments, especially in recurrent or severe cases.
Prevention
Preventative measures focus on:
Strengthening and conditioning exercises for the muscles around the knee.
Proper techniques during physical activities.
Use of supportive devices if necessary.
Patella instability is a manageable condition with appropriate diagnosis and treatment, allowing individuals to return to their normal activities with minimal discomfort.
FAQs
Will my instability get worse over time if left untreated?
Without appropriate management, patellofemoral instability can lead to increased pain, further dislocations, and potentially more significant damage, such as arthritis, to the knee joint over time.
When do I need surgery for Patella Instability?
Deciding when to undergo surgery for an unstable kneecap depends on several factors, including the severity of the instability, the effectiveness of non-surgical treatments, and the impact of the condition on your daily life. Here are some key considerations to help determine if surgery might be necessary:
Indications for Surgery
Recurrent Dislocations: If your kneecap dislocates multiple times despite conservative treatments, surgery might be recommended to prevent further dislocations and associated damage.
Severe Instability: If the kneecap frequently slips out of place, causing significant pain and functional limitations, surgical intervention may be needed to stabilise the joint.
Failure of Non-Surgical Treatments: If physical therapy, bracing, and other non-surgical treatments have not improved your symptoms, surgery might be the next step.
Associated Injuries: If you have accompanying injuries, such as torn ligaments or cartilage damage that do not heal with conservative treatments, surgery could be necessary to repair these structures.
Structural Abnormalities: If imaging studies reveal significant anatomical abnormalities that contribute to the instability, surgical correction might be required.
What are the surgical options?
There are a number of surgical options including MPFL Reconstruction, Tibial Tubercle Transfer, Lateral Release and Trochleoplasty. Currently a Medial Patellofemoral Ligament (MPFL) Reconstruction (a procedure that reconstructs the ligament that helps keep the patella in place) has been demonstrated to be a reliable procedure to stabilise the patella. However, the decision on optimal procedures depends on your anatomy, situation and the discussion we have regarding your knee issues.