Patellar dislocation: Difference between revisions
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A luxating patella or patellar dislocation is a severe acute injury where there is a shift of the patella. Because of this shift the patella will leave the patellofemoral groove. <br> | A luxating patella or patellar dislocation is a severe acute injury where there is a shift of the patella. Because of this shift the patella will leave the patellofemoral groove. <br> | ||
It is important to make a differentiation between acute primary patellar dislocation, which accounts for 2-3%, and habitual dislocation for recommendations with varying treatment approaches. Primary (first-time) patellar dislocation is defined as a clinical entity that usually causes a traumatic disruption of the previously uninjured medial peripatellar structures [14,15,16].<br>One of the common findings related to acute, primary, traumatic patellar dislocations is hemarthrosis (bleeding into joint spaces) of the knee, caused by rupture of the medial restraints of the patella. [13] | |||
<br> | <br> | ||
[[Image:336px-Patellaluxation ap 002.jpg|patella dislocation]] | [[Image:336px-Patellaluxation ap 002.jpg|patella dislocation]] | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
Revision as of 15:55, 17 June 2016
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Original Editors - Jeremy Luytens as part of the Vrije Universiteit Brussel's Evidence-based Practice project
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Definition/Description
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A luxating patella or patellar dislocation is a severe acute injury where there is a shift of the patella. Because of this shift the patella will leave the patellofemoral groove.
It is important to make a differentiation between acute primary patellar dislocation, which accounts for 2-3%, and habitual dislocation for recommendations with varying treatment approaches. Primary (first-time) patellar dislocation is defined as a clinical entity that usually causes a traumatic disruption of the previously uninjured medial peripatellar structures [14,15,16].
One of the common findings related to acute, primary, traumatic patellar dislocations is hemarthrosis (bleeding into joint spaces) of the knee, caused by rupture of the medial restraints of the patella. [13]
Clinically Relevant Anatomy[edit | edit source]
The patellofemoral joint is the portion of the knee joint between the patella and the femoral condyles. The patellofemoral articulation totally depends on the function of the quadriceps. It increases the angle of pull of the patellar tendon, improving the mechanical advantage of the quadriceps in knee extension.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The articular surfaces consist of the patella and the trochlear surface of the femoral condyles. The articular cartilage on the medial facet is thicker than on the lateral facet, with the lateral facet bigger than the medial.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The femoral condyles only project slightly in front of the shaft of the femur but project quite a distance posteriorly. The anterior aspects of both condyles are included in the articular area of the patella. The patellar articular surface is larger on the lateral femoral condyle than on the medial. There is an anterior projection on the lateral femoral condyle lateral to the patellar groove. This is the bony factor, which prevents lateral dislocation of the patella. The trochlea is on the anterior, distal end of the femur. The groove is continuous posteriorly with the intercondylar notch of the femur. The lateral facet is more prominent and has a greater radius.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The suspension and movement of the patella is provided by passive and active stabilizers.
• Passive: fascia lata, ligamentum patellae, capsule of the knee, ligamentum patellofemorale medial and lateral and ligamentum meniscopatellare medial and lateral
• Active: the four heads of the quadriceps, ligamentum patellae and the retinacullumCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Epidemiology /Etiology
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Athletics are often associated with patellar dislocation ( Ficat ’77, Hugston ’84 ). It is most common in females in the second decade of life.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Patellar dislocation most often result results from a non-contact injury to the knee. It’s etiology is regarder as multi-factorial, being associated with: reduced osseous constraint form the lateral femoral condyle; an imbalance between stronger lateral tissues, such as the lateral retinacullum and vastus lateralis, which are able to overcome weaker medial structures, especially the medial patellofemoral ligament and the distal vastus medialis; and finally biomechanical issues such as femoral and tibial rotation, and pes planus.
The typical mechanism of injury is a twist of the leg, with the femur rotating internally on a fixed foot and tibia. Valgus stress is often associated with this rotating mechanism, thereby creating a strong laterally directed force, dislocating the patella ( Hugston ’84 ). A direct blow as well to the lateral side of the knee, producing a valgus stress, as to the medial side of the knee producing a direct dislocating force can also create this injury ( Fu ’90 ).Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
A knee tape with a lateral reinforcement will reduce the movement of the patella so that can be used as prevention.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The patient will experience pain, instability of the knee and blocking of the knee after the trauma. After de dislocation there will be a swelling on the medial side of knee because on this side a lot of tissue will be hit.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Differential Diagnosis[edit | edit source]
A radiography to exclude osteochondral fractures and avulsion fractures, patellar apprehension test is also needed, where the patella will provide resistance,Patella tracking assessment .Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
This is recommended to determine whether there are predisposing factors for dislocation, such as Patella alta, genu recurvatum, increased 'Q' Angle and patellar hypermobilityCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Medical Management
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Immediately after the trauma there is an immobilization in a cylinder cast for 6 weeks and medication, supplements like glucosamine and NSAID’s that could be used to keep the knee strong. If required arthroscopy with or without retinacular repair, surgical repair of the torn retinacullum or immediate patellar realignment.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleSmith TO., Davies L., Chester R., Clark A., Donell ST. CLinical outcomes of rehabilitation for patients following lateral patellar dislocation: a systematic review. Physiotherapy. Volume 96. Issue 4. December 2010. p. 269 – 281 Level of evidence: A1</ref>Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Physical Therapy Management
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Conservative treatment have included:Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
• Manual Therapy: Knee and Knee Mobilizations to improve the ROM of the knee
• Combination Therapy
• Strengthening exercises for quadriceps, hamstrings, adductors, muscles of the hip and lower abdomen. Important, is the use of closed kinetic chain exercises because of a greater number of advantages over the other forms of exercise.
• Stretching and flexibility training for hamstrings and quadriceps
• Proprioceptive exercises to improve the stability of the knee
Bracing and re-education can play an important role in the treatment and prevention of patellar dislocation.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
