Patella Instability Treatment in Kirkland, WA
Patella instability occurs when the kneecap moves out of position or dislocates– usually to the outside of the knee. This can occur from an injury, or in some cases, people who are predisposed can have their patella dislocate with normal activity.
The kneecap is normally held in position by the bones, ligaments, and muscles around the knee. There is a groove, called the trochlea, in which the kneecap sits while the knee is bent. A ligament, called the medial patellofemoral ligament (MPFL), attaches the kneecap to the inside of the femur and is critical for holding the kneecap in position. The muscles around the knee, especially the inside of the quadriceps or VMO, also help hold the kneecap in position and help with kneecap tracking. Multiple factors predispose people to patella dislocations including, prior trauma, high-riding knee cap (patella alta), shallow trochlea, loose ligaments and lower extremity alignment.
Initially, treatment for a patellar or kneecap dislocation usually involves bracing and physical therapy to work on strengthening. When patellar dislocations become recurrent they cause functional limitations and they can even cause cartilage damage. IF there is cartilage damage associated with a patella dislocation and/or there are recurrent dislocations surgery is usually recommended to prevent further damage.
The medial patellofemoral ligament or MPFL is the main soft tissue restraint to patella dislocation. When a patella dislocation has occurred this ligament is usually torn or stretched out. Reconstructing the MPFL can stabilize the kneecap. During this surgery, the knee is inspected arthroscopically. Following this, a tendon graft is placed between the medial epicondyle on the femur and kneecap. This procedure has been proven to be very successful in treating recurrent patellar instability. Patients are usually braced for 6 weeks after surgery and are able to return to sports in 4 to 6 months.
In some patients, if there is abnormal bone alignment predisposing to patella dislocation they may also require tibial tubercle transfer.