Patella dislocation
“During the acute phase of a patellar injury or dislocation, the immediate goals are to reduce inflammation, relieve pain, and stop activities that place excessive loads on the patellofemoral joint. Patients with an acute patella dislocation typically have been evaluated in an emergency department, with radiographic evaluation, and have often had a consultation with an orthopedist to assess for intra-articular pathology.
Acute phase management should apply the PRICE principle: protection of the injured joint, relative rest, ice, compression, and elevation to control inflammation.
A study by Maenpaa and Lehto suggested that a period of immobilization may be beneficial. Quadriceps strengthening is initiated during the acute phase. In the event of acute patella dislocation, these should be static exercises initiated during the period of immobilization. Quadriceps electrical stimulation is an option for muscle re-education if the patient has difficulty activating the muscle secondary to pain. Electrical stimulation may also play a role in the management of knee joint effusion.
Therapy should also include a protocol for hamstring muscle stretching. Tight hamstring muscles functionally counteract their agonist group, the quadriceps.
In the acute phase, surgical interventions are reserved for complicated dislocations with associated fractures. The most common site of cartilage injury to the patella occurs as osteochondral fractures of the medial patellar facet or cracks in the central dome of the patella. Cartilaginous injuries are also frequently seen on the lateral femoral condyle. Arthroscopy can repair or remove fracture fragments. However, acute surgical interventions are unnecessary in most cases of patellofemoral syndromes.”
https://reference.medscape.com/article/90068-treatment
Patellar tracking disorder
Patellar tracking disorder means that the kneecap (patella) shifts out of place as the leg bends or straightens. In most cases, the kneecap shifts too far toward the outside of the leg. In a few people, it shifts toward the inside.
Patellar tracking disorder is usually caused by several problems combined, such as:
- Weak thigh muscles.
- Tendons, ligaments, or muscles in the leg that are too tight or too loose.
- Activities that stress the knee again and again, especially those with twisting motions.
- A traumatic injury to the knee, such as a blow that pushes the kneecap toward the outer side of the leg.
- Problems with the structure of the knee bones or how they are aligned.
If you have a patellar tracking problem, you may have:
- Pain in the front of the knee, especially when you squat, jump, kneel, or use stairs (most often when going down stairs).
- A feeling of popping, grinding, slipping, or catching in your kneecap when you bend or straighten your leg.
- A feeling that your knee is buckling or giving way, as though all of a sudden your knee can't support your weight.
Patellar tracking disorder can be a frustrating problem, but be patient. Most people feel better after a few months of treatment. As a rule, the longer you have had this problem, the longer it will take to get better.
Treatment of patellar tracking disorder has two goals: to reduce your pain and to strengthen the muscles around your kneecap to help it stay in place. If you don't have severe pain or other signs of a dislocated kneecap, you can try home treatment for a week or two to see if it will reduce your pain.
- Take a break from activities that cause knee pain, like squatting, kneeling, running, and jumping.
- Put ice on your knee, especially before and after activity. After 2 or 3 days, you can try heat to see if that helps.
- Take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling. Read and follow all instructions on the label.
Your doctor or physical therapist may also suggest that you:
- Tape your knee to hold the kneecap in place.
- Use a knee brace for extra knee support.
- Try shoe inserts (orthotics) to improve the position of your feet.
Surgery usually isn't needed for patellar tracking disorder. You may need surgery if your kneecap dislocates after other treatments haven't worked. There are several types of surgery that can correct a tracking problem. You and your doctor can decide which surgery is best for you.
You can take steps to prevent patellar tracking disorder.
- Avoid activity that overloads and overuses the knee.
- Keep the muscles around your knees and hips strong and flexible.
- Stretch your legs and hips well, both before and after activity.
- Do activities that work different parts of the leg, especially if you're a runner. Cycling and swimming are good choices.
- Stay at a healthy weight to reduce stress on your knees.
https://www.webmd.com/pain-management/knee-pain/tc/patellar-tracking-disorder-topic-overview#1
