{"id":68,"date":"2008-10-16T10:36:13","date_gmt":"2008-10-16T09:36:13","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=68"},"modified":"2008-10-16T10:37:39","modified_gmt":"2008-10-16T09:37:39","slug":"patient-information-sheet-patellar-instability-dislocation-or-subluxation-of-the-kneecap","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bjsm\/2008\/10\/16\/patient-information-sheet-patellar-instability-dislocation-or-subluxation-of-the-kneecap\/","title":{"rendered":"Patient Information Sheet: Patellar Instabilities (dislocation or subluxation of the kneecap)"},"content":{"rendered":"<p>By Dr Chris Milne, Sports Physician\t<\/p>\n<p><strong>What is it? <\/strong><br \/>\nIt occurs when the patella moves out of its usual groove in front of the knee.<\/p>\n<p><strong>What causes it?<\/strong><br \/>\nIt is caused by a variety of factors including muscle imbalance, a small or high riding patella, a shallow groove for it to track in, plus excess joint mobility and flat feet.<\/p>\n<p><strong>Symptoms \u2013 what you notice<\/strong><\/p>\n<ul>\n<li><strong>Pain<\/strong> \u2013 usually along the inner border of the patella as the muscle attachments are torn away from the bone.  The pain may be very severe.<\/li>\n<li><strong>Deformity <\/strong>\u2013 the patella may appear as a lump on the outside of the knee.  It usually pops back into its usual groove when you straighten your knee.<\/li>\n<li><strong>Instability<\/strong> \u2013 you may lack confidence in the knee, and feel it is about to give way.<\/li>\n<li><strong>Swelling<\/strong> \u2013 this usually comes on virtually immediately and is related to bleeding into the knee joint.<\/li>\n<p><strong>Signs \u2013 what the doctor finds<\/strong><\/p>\n<ul>\n<li><strong>Effusion<\/strong> \u2013 usually there is a tense swelling in the knee that will last for a week or two after the injury.<\/li>\n<li><strong>Tenderness <\/strong>\u2013 usually down the inner border of the patella, related to tearing of muscle attachments as above.<\/li>\n<li><strong>A positive apprehension sign <\/strong>\u2013 this occurs when the doctor tries to push your patella towards the outside of your knee.<\/li>\n<li>There may be associated flat feet, or generalised hypermobility of many joints in the body.<\/li>\n<p><strong>Investigations<\/strong><br \/>\nX-rays can show an associated fracture of the inner border of the patella.  A \u2018skyline\u2019 view is most useful for this.  X-rays can also show a small or high riding patella, plus a shallow groove for the patella to track in.  MRI scans are rarely needed but may show bone bruising, which is an additional clue in tricky cases; patellar instability is often quite subtle and may be overlooked by less experienced doctors.  CT scans are usually only ordered if surgical stabilisation is being considered.<\/p>\n<p><strong>Treatment<\/strong><\/p>\n<ul>\n<li>First aid \u2013 try to push the knee out straight, as this will often be enough for the patella to clunk back into its proper place.  Apply an ice pack.<\/li>\n<li>Whether or not your patella is back in place, you need to go to an A &amp; M Clinic to get the knee immobilised in a brace in full extension (out straight).  Leave the brace on for 6 weeks.<\/li>\n<li>You should take painkillers or anti-inflammatory tablets regularly for the first few days after injury.<\/li>\n<li>If the blood in the joint is causing lots of pain, this can be sucked out of the joint by a doctor.<br \/>\nPerform quadriceps exercises to strengthen the muscles in front of the thigh.<\/li>\n<li>If you have flat feet, orthotics can help correct the faulty alignment in your legs.<br \/>\nIn severe cases of recurrent patellar instability, surgery to stabilise the patella may be required.<\/li>\n<p><strong>Recovery time<\/strong><br \/>\nAverage recovery time is 4-6 weeks, but recurrences are common.<\/p>\n<p><strong>Recovery sequence<\/strong><br \/>\nStep 1\tGet the knee out straight and the patella back in position.  Ice packs, pain relief.<br \/>\nStep 2\tImmobilise the knee in a brace for six weeks.<br \/>\nStep 3\tPerform quadriceps exercises every day.<br \/>\nStep 4\tPhysiotherapy supervised exercises when you come out of the brace.<br \/>\nStep 5\tCycling and swimming.<br \/>\nStep 6\tRestart gentle running and progress to stop-start then multidirectional activity.<br \/>\nStep 7\tTeam training and skill sessions.<br \/>\nStep 8\tResume playing, half game at first.<\/p>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Dr Chris Milne, Sports Physician What is it? It occurs when the patella moves out of its usual groove in front of the knee. What causes it? It is caused by a variety of factors including muscle imbalance, a small or high riding patella, a shallow groove for it to track in, plus excess [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bjsm\/2008\/10\/16\/patient-information-sheet-patellar-instability-dislocation-or-subluxation-of-the-kneecap\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-68","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/68","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=68"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/68\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=68"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=68"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=68"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}