A kneecap dislocation can be a frightening and painful experience. The term (patella) instability covers a range of symptoms from a feeling of disease and mistrust in the knee to regular kneecap dislocation. Dislocations most often begin in the teenage years but can present at any time. However, we have made considerable advances in the treatment of this condition in recent years.
Literature tells us that after the first dislocation there is approximately a 50% chance of a further dislocation. But even if not dislocating the patella won’t be moving normally. Patients often curtail sports or even simple activities to avoid instability episodes.
The underlying anatomy sets us up for dislocation and loss of the usual restraints that lead to dislocation. Hypermobility (being double-jointed) also increases the risk. The risk factors are minor abnormalities in abnormality:
There is considerable variation. Some patients recover almost fully and will have no further issues. Unfortunately often the kneecap may not feel right after a first dislocation and activity levels can decline.
A dislocation may be a sign that the kneecap is not tracking (moving) properly and that it will develop painful arthritis later in life. A case-controlled study (from Bristol) demonstrated an odds ratio (an increased probability) of 3.2 for developing PFJ OA severe enough to require arthroplasty in patients with previous patella dislocations. Patients with adolescent pain symptoms had an odds ratio of 7.5.
Although it does not always change the course of this condition it can accelerate rehabilitation. In some cases, the benefit of physiotherapy can be very significant.
No! They are terrible. The extension splint or cast should be avoided as this just leads to wasting of the quadriceps.
Yes, there have been radical changes in recent years. The treatment now aims to correct the underlying anatomic problem rather than introducing a new abnormality. These include:
If surgery is required then we can determine a schedule that fits in with you and coordinate your rehabilitation appropriately.
“Mr Clark managed to fit my operation in at a time that suited me best in between exams and university… My recovery was quick and easy and I am now pain-free. Thank you, Mr Clark!”
Emma, Bristol University student