Patellar Dislocation
Dislocation (subluxation) of the Patella
The patella, or kneecap, is the protective bone which lies in front of the knee joint. The patella bone glides up and down a groove (called the patellofemoral groove) at the front of the thigh bone (femur) as the knee bends.
The patella is attached to the quadriceps muscle via the quadriceps tendon and acts to increase the leverage from this muscle group when straightening the knee.
The patella normally lies within the patellofemoral groove and is only designed to slide vertically within it. Dislocation of the patella occurs when the patella moves or is moved to the outside of this groove and onto the bony head of the femur (lateral femoral condyle). The patella may also sublux rather than fully dislocate, meaning it moves partially out of position.
It is usually a result of an acute blow / twisting action of the knee. In most cases the patella will relocate to the patellofemoral groove on straightening of the knee, however this is known to be extremely painful.
Factors leading to Patella Dislocation:
Insufficient VMO strength - The VMO (vastus medialis obliquus) functions in maintaining the patella in its desired position within the patellofemoral groove during knee movements by pulling it towards the middle of the knee joint - an action known as 'tracking'. If the muscle is not strong enough, or its fibers are not adequately oriented, the patella is much more susceptible to dislocation.
Excessive pronation of the feet
Q-angle - Some people have a larger than normal femoral angle (known as the Q-angle) and may have a 'knock-kneed' appearance (genu valgum). When the person straightens their leg, the patella will be forced to the outside of the knee. Thus any extra force applied to the inside of the knee may result in patellar dislocation.
Symptoms of Patellar Dislocation
Swelling in the knee joint
Pain around the patella
Impaired mobility in the knee
Obvious displacement of the knee cap
What the athlete can do?
Apply RICE to the injured knee.
Immediately seek medical advice.
Rest from training.
Try wearing a knee support to help control the movement of the patella.
Take a glucosamine / joint healing supplement.
Follow a rehabilitation program..
A Sports Injury Specialist or Doctor could
Confirm the diagnosis - Patellar dislocations have similar symptoms to an anterior cruciate ligament injury, due to an audible 'crack or 'pop' and the feeling of the knee giving way
Reduce the pain by anaesthetic and reposition the patella if it has not already relocated.
Cyrotherapy (ice treatment)
Exercises to strengthen the VMO
Recommend NSAID's e.g. Ibuprofen to reduce pain and inflammation.
Patellofemoral taping techniques
Prescribe VMO strengthening exercises.
Examine the injury by X-ray and/or arthroscopy to evaluate the extent of the injury.
Operation may be necessary if there are loose fragments of bone or other major structural damage.
Rehabilitation (Patellar Dislocation)
The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Aims of Rehabilitation
Phase 1 - Control swelling.
Phase 2 - Eliminate swelling and increase range of motion.
Phase 3 - Full range of motion and begin to return to sport.
Phase 4 - Return to full fitness.
Phase 1
First week following injury.
An extension splint may be applied to hold the leg straight.
Cold therapy and compression may be applied to help control swelling.
Electrotherapy such as interferential or ultrasound may be applied by a physiotherapist.
Taping of the patella may be used to hold it in place following removale of the extension splint.
Static quadriceps strengthening exercises while lying on back.
Heel slides
Hamstring stretching
Isometric hamsting holds
Calf raises
Phase 2
This phase could last up to two weeks.
Continue with cold therapy and electrotherapies as above until swelling has gone.
Static quads exercises in standing position.
Squats to 30 degrees.
Single leg calf raises.
Phase 3
This phase could last up to six weeks.
Strengthening exercises - continue standing quad exercises.
Half squats (30 degrees)
Step ups
Heel slides
By now the athlete should be full weight bearing on the injured leg.
Phase 4
From week 6 to week 8.
Strengthening exercises as above
Half squats (30 degrees)
Step ups
Heel slides
Gym ball gluteus strengthening.
If exercises become easy progress to one leg at a time.
Begin light jogging and maintain cycling and swimming.
Start to introduce sports specific and functional exercises such as hopping, sideways and backwards running, etc.
Phase 5
Eight to ten weeks after injury.
Get back into noremal sports specific training routine.
Gradually introduce back into competition.
Maintain and increase finctional exercises such as hopping etc.
http://www.sportsinjuryclinic.net/gallery/products/cold-therapy-180.jpg
Dislocation (subluxation) of the Patella
The patella, or kneecap, is the protective bone which lies in front of the knee joint. The patella bone glides up and down a groove (called the patellofemoral groove) at the front of the thigh bone (femur) as the knee bends.
The patella is attached to the quadriceps muscle via the quadriceps tendon and acts to increase the leverage from this muscle group when straightening the knee.
The patella normally lies within the patellofemoral groove and is only designed to slide vertically within it. Dislocation of the patella occurs when the patella moves or is moved to the outside of this groove and onto the bony head of the femur (lateral femoral condyle). The patella may also sublux rather than fully dislocate, meaning it moves partially out of position.
It is usually a result of an acute blow / twisting action of the knee. In most cases the patella will relocate to the patellofemoral groove on straightening of the knee, however this is known to be extremely painful.
Factors leading to Patella Dislocation:
Insufficient VMO strength - The VMO (vastus medialis obliquus) functions in maintaining the patella in its desired position within the patellofemoral groove during knee movements by pulling it towards the middle of the knee joint - an action known as 'tracking'. If the muscle is not strong enough, or its fibers are not adequately oriented, the patella is much more susceptible to dislocation.
Excessive pronation of the feet
Q-angle - Some people have a larger than normal femoral angle (known as the Q-angle) and may have a 'knock-kneed' appearance (genu valgum). When the person straightens their leg, the patella will be forced to the outside of the knee. Thus any extra force applied to the inside of the knee may result in patellar dislocation.
Symptoms of Patellar Dislocation
Swelling in the knee joint
Pain around the patella
Impaired mobility in the knee
Obvious displacement of the knee cap
What the athlete can do?
Apply RICE to the injured knee.
Immediately seek medical advice.
Rest from training.
Try wearing a knee support to help control the movement of the patella.
Take a glucosamine / joint healing supplement.
Follow a rehabilitation program..
A Sports Injury Specialist or Doctor could
Confirm the diagnosis - Patellar dislocations have similar symptoms to an anterior cruciate ligament injury, due to an audible 'crack or 'pop' and the feeling of the knee giving way
Reduce the pain by anaesthetic and reposition the patella if it has not already relocated.
Cyrotherapy (ice treatment)
Exercises to strengthen the VMO
Recommend NSAID's e.g. Ibuprofen to reduce pain and inflammation.
Patellofemoral taping techniques
Prescribe VMO strengthening exercises.
Examine the injury by X-ray and/or arthroscopy to evaluate the extent of the injury.
Operation may be necessary if there are loose fragments of bone or other major structural damage.
Rehabilitation (Patellar Dislocation)
The following guidelines are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Aims of Rehabilitation
Phase 1 - Control swelling.
Phase 2 - Eliminate swelling and increase range of motion.
Phase 3 - Full range of motion and begin to return to sport.
Phase 4 - Return to full fitness.
Phase 1
First week following injury.
An extension splint may be applied to hold the leg straight.
Cold therapy and compression may be applied to help control swelling.
Electrotherapy such as interferential or ultrasound may be applied by a physiotherapist.
Taping of the patella may be used to hold it in place following removale of the extension splint.
Static quadriceps strengthening exercises while lying on back.
Heel slides
Hamstring stretching
Isometric hamsting holds
Calf raises
Phase 2
This phase could last up to two weeks.
Continue with cold therapy and electrotherapies as above until swelling has gone.
Static quads exercises in standing position.
Squats to 30 degrees.
Single leg calf raises.
Phase 3
This phase could last up to six weeks.
Strengthening exercises - continue standing quad exercises.
Half squats (30 degrees)
Step ups
Heel slides
By now the athlete should be full weight bearing on the injured leg.
Phase 4
From week 6 to week 8.
Strengthening exercises as above
Half squats (30 degrees)
Step ups
Heel slides
Gym ball gluteus strengthening.
If exercises become easy progress to one leg at a time.
Begin light jogging and maintain cycling and swimming.
Start to introduce sports specific and functional exercises such as hopping, sideways and backwards running, etc.
Phase 5
Eight to ten weeks after injury.
Get back into noremal sports specific training routine.
Gradually introduce back into competition.
Maintain and increase finctional exercises such as hopping etc.
http://www.sportsinjuryclinic.net/gallery/products/cold-therapy-180.jpg
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