Patellar Instability

If you’re experiencing pain or swelling with your knee, you might be suffering from patellar instability. This is especially true if you notice any deformity or stiffness in your knee.

When you suffer from patellar instability, the right treatment will make a difference. Dr. John Andrachuk offers minimally invasive treatments with several options. With years of experience as an Orthopedic Sports Medicine surgeon in Atlanta, Dr. Andrachuk is the right option for your treatment.

What is Patellar Instability?

The kneecap or patella attaches to the thigh bone or femur and the shin bone or tibia with tendons. The kneecap fits into the groove located at the end of the femur, which is called the trochlear groove. It slides up and down as your knee straightens and bends. 

When patellar instability happens it’s due to the kneecap moving outside of the trochlear groove. 

What are the Types of Patellar Instability?

Patellar instability comes in two types: dislocation and subluxation. A dislocation happens when the knee has been injured and the patella is pushed all the way out of the groove. 

A subluxation is a chronic form of patellar instability. With subluxation, the kneecap only slides partially out of the trochlear groove.

What are the Causes of Patellar Instability?

Most commonly, patellar instability happens due to an injury. It’s common in younger, more active people, especially those playing a contact sport or a fast-paces sport. 

Once patellar instability happens, it’s common for a second dislocation to happen, especially as an athlete.

Patellar instability is common in athletes, dancers, those working in a field doing hard physical labor, and anybody obese or overweight. It’s common in women due to the wider pelvis and it can be found in older people as a gradual wear and tear type of injury.

Ligament sprains and tears are common causes of patellar instability. However, it’s also possible the injury could be caused due to muscle damage, fluid buildup, or even a birth deformity in very rare cases.

Patellar Instability Symptoms

You may notice several different symptoms if you suffer an injury causing patellar instability. Some of the most common symptoms include:

• The kneecap slipping outside the knee
• Pain after sitting for an extended period
• Knee locking, buckling, or catching
• Swelling and stiffness in the knee
• Pain located at the front of the knee that gets worse with activity
• Cracking or popping of the knee
• A sensation of your knee feeling loose
• It’s impossible or very difficult to straighten the knee

Symptoms may range from not very serious to very serious depending on the degree of the injury. If the injury is ignored, it can lead to a partial tear or a complete tear in the tendons.

Diagnosing Patellar Instability

Your doctor will likely start with a physical exam to help diagnose patellar instability. Questions about your medical history are common and most doctors will order X-rays or an MRI.

However, MRI scans are a bit less common during early diagnosis. Typically, an X-ray will be used to see if the kneecap is out of place or has returned to the correct position. An MRI is used to evaluate if the injury caused any cartilage damage. 

Patellar Instability Treatment

Both nonsurgical and surgical treatment options are offered for patellar instability.

Commonly, you will be asked to rest, ice, compress, and elevate your knee if the injury isn’t serious. Your doctor may also prescribe nonsteroidal anti-inflammatory drugs or NSAIDs. 

Physical therapy is another common nonsurgical option for treating patellar instability. Doctors also use braces and casts to help immobilize the kneed and allow it to heal. Specialized footwear can also be worn to take the pressure off the kneecap.

Surgical Treatment for Patellar Instability

Most first-time patellar instability injuries will be treated conservatively without the need for surgery. However, if the injury happens again or it’s very serious, surgery offers a treatment option.

Medial Patellofemoral Ligament Reconstruction

Also known as MPFL reconstruction, this surgery will pull the kneecap towards the inside of the leg. If the ligament is damaged or weak, the kneecap might become dislocated outside of the leg. MPFL reconstruction involves making two small incisions and it’s considered an arthroscopic surgery. The ligament will be reconstructed using a piece of tendon from the hamstring muscle. 

Once the surgery has been completed, you will likely need to wear a brace to keep your leg straight for about six weeks. Physical therapy will also be necessary for several months to achieve full recovery.

Tibial Tuberosity Transfer

Another surgical option to treat patellar instability is a tibial tuberosity transfer. This type of surgery includes an incision about three inches in length above the shin bone. The operation will transfer a small piece of the tibial tuberosity to help move the kneecap into the groove properly. 

Surgeons use one or two screws inside your leg to secure the bone that is transferred. You will likely be on crutches for about six weeks after the surgery. Physical therapy will weeks be needed to return to full strength.

Lateral Release

About a decade ago, lateral release would have been the most common option for patellar subluxation. However, it’s a rare procedure today due to the risk of recurrence of the injury. 

Lateral releases include partially cutting the ligaments found on the outside of the knee. This procedure will help to pull the kneecap to the side and back into the groove. 

Preventing Patellar Subluxation After Treatment

Those suffering from patellar instability are very likely to suffer from it again in the future. However, there are some patellar instability exercises you can do to help strengthen the quadriceps and other muscles around the knee. 

Reducing your risk of a repeat injury is a great way to ensure you don’t have to go through knee surgery. Adding the right exercises to your routine will help, including:

• Squats and leg lifts to strengthen the quadriceps
• Hamstring curl exercise
• Any exercise designed to strengthen the outer and inner thigh muscles

It’s also a good idea to wear a brace during athletic activities to help prevent recurrent of the injury. If you’re participating in a contact sport, the correct protective gear can also help.

Schedule an Appointment Today!

Dr. Andrachuk provides extensive experience in diagnosing and treating patellar instability injuries. If you’re dealing with pain, swelling, or a strange feeling in your knee, it’s time to seek proper medical help. Dr. Andrachuk offers the latest in conservative treatments, arthroscopic surgery, and minimally invasive options to get you back to normal. Whether you’ve suffered a serious knee injury or you’re just dealing with unexplained pain, Dr. Andrachuk offers the right treatment option. Contact us today and schedule your in-person or telemedicine appointment!