Monday, March 3, 2014

from the Doctor's Desk: So my knee cap has moved... Doctor, what do I do now?



Patellar dislocation (kneecap) tends to happen in a younger patient with a plantar flexed foot in a rotation maneuver to the upper thigh.  For instance, someone golfing with the lead leg can hit a long drive, torquing his upper extremity, and the patella can sublux, which means partially slide out, or completely slide out, dislocate laterally.  This can also happen with slips and falls and is certainly not the privilege of young athletic individuals. 

 
What are the symptoms?
 
1.     Pain and deformity of the patella. 
2.     Weakness of the leg.
3.     Difficulty in flexing the leg with it dislocated.
4.     Inability to bear weight.
5.     Swelling and instability.

Treatment:  Relocation of the patella is paramount and then placement into a knee immobilizer is what normally would take place in the emergency room setting.  Followup with an orthopedist is the norm. 
 
Things that I look for with a patellar dislocation.  You will have swelling and we sometimes will take the blood that is in the knee joint out for pain control.  MRIs are commonly obtained along with plain films.  These are to determine if there is persistent subluxation of the patella or if there are fragments of cartilage and bone that have been knocked off.
 
Not all patellar dislocations need to be treated surgically; however, if there is bony damage that is noted, then arthroscopy and perhaps even open repair of the torn ligament would be recommended.  Acute patellar dislocations that are treated non-operatively that re-dislocate are an operative candidate in my view.
 
There are certain congenital abnormalities that predispose some patients to patellar dislocation such as a shallow trochlear groove or ligamentous laxity.  These are treated differently.

The Essential Lesion:  The medial patellofemoral ligament has now become the mainstay
for treatment in patellar dislocations.  Acutely one can attempt to repair this; however, there are times that if it is stretched out, then we need to replace with a tendon.  This tendon is normally a hamstring autograft or allograft.  This would be harvested at the time of surgery and secured into the patella and the femur, giving us a static checkrein.  Rehab is remarkably fast for this debilitating injury with surgery of this type.

If you have this problem and would like to know more, the Academy of Orthopedic Surgery website can be accessed or you can make an appointment to see sports medicine physician, Dr. Paul M. Spezia.

Paul M. Spezia,D.O.

Disclaimer:
There is a fine line between blogging and giving medical advice. The content of this blog is for informational purposes only and should not be construed as medical advice.  Nothing contained in this blog is intended to replace the medical advice of a trained, licensed physician.
In all matters relating to your health, you are urged to consult a physician. You can contact Advanced Bone & Joint to set up a formal consultation appointment with Dr. W. Anthony Frisella, Dr. Dane Glueck, Dr. Brandon Larkin, Dr. Anthony Lombardo, Dr. John McAllister, II, Dr. Brian Meek, Dr. Paul Spezia, Jennifer Eickhoff, FNP-BC, or Matt Pliske, PA-C

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