Injuries and Conditions: Patella Malalignment/Dislocation : Patella Malalignment/Dislocation :
A dislocated patella will not necessarily require surgery for a full recovery. Differences in the severity and mechanism of injury will affect the treatment decision, as will the degree of athletic activity that the patient wishes to pursue after treatment. The patella itself may be manually shifted back into place by a doctor, other dislocations will demand surgery to correct. However, patella dislocations may also cause collateral injuries. These are injuries that are caused as the patella is dislocated, such as bone fragmenting, slivers of which may become lodged in the joint. The severity of these surrounding injuries may range from minor disruptions to very damaging tears of the internal structure and surrounding ligaments.
Patients who suffer dislocations that cause severe damage to the joint and who also expect to return to highly active lifestyles are typically recommended to undergo surgery. Due to the damage of the surface of the knee joint and the supporting structures around the knee that can occur during a patella dislocation, surgery may be necessary to repair these structures in order to restore normal function of the knee.
A dislocated patella may require surgery to be correctly repositioned. In these cases, surgery will be immediately after the occurrence of the injury to reduce further damage to the knee.
Surgery will also be necessary to remove from the joint any bone or cartilage fragments that may have broken off during the dislocation. This procedure can be completed during the surgery to reposition the patella.
Patients are given a complete physical examination which provides an assessment of the patients overall health.
An examination is given of the range of movement in both the injured and uninjured knee.
Strength and walking (gait) ability is measured and analyzed.
Knee arthrometry is utilized to measure the tightness and stability of the knee.
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
Post-op instructions:
After surgery, bracing may be recommended until the patient has regained strength and stability of the knee and he/she can easily extend the leg and do deep knee bends without difficulty.
Close examination of the knee during the subsequent 4-6 weeks is needed to ensure that the knee is correctly healing.
Athletic activities like jogging are usually allowed one month after the procedure. Although often only in a controlled environment such as on a treadmill.
Sport-specific exercises are allowed dependant upon their intensity level and stress placed on the recuperating knee.
A surgically relocated patella, which has been properly rehabilitated, will allow the patient to regain complete strength, stability, and motion of the knee.
Patients that are in good physical condition are likely to recover within four months and will then usually be able to perform at previous levels of athletic intensity.
Patients that are in poorer overall condition will be able to return to previous activity levels, although rehabilitation and physical therapy will tend to be more lengthy and involved.
In all cases, physical therapy is required to restore the muscle strength, flexibility and stability lost during the injury.
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
Loss of extension in the knee is among the most common complications after patella dislocation surgery. Although this complication is not completely preventable, the risk can be minimized if a patient follows a disciplined physical therapy program.
Dislocations may recur during activity if the injury has not completely healed.
Repeated dislocations may cause the knee to become arthritic and unstable.
Injury to the joint is possible if physical therapy becomes overly strenuous for the condition of the knee.
The knee may be subject to arthrofibrosis, the development of a fiber like material that the body sometimes generates in joints after injury or surgery. This condition can limit movement and cause considerable stiffness.
Patients will usually be required to keep the knee stabilized for up to six weeks. The doctor will prescribe either a brace or splint to prevent further damage.
After the splint or brace is removed, physical therapy will be initiated to restore strength and correct alignment problems or muscle imbalances that may have contributed to the dislocation.
The goal of therapy is to re-establish a full range of motion in the knee with proper alignment or tracking of the patella.
Ongoing therapy rehabilitates the quadriceps and hamstrings, the muscles surrounding the knee which add strength and stability to the joint.
Therapists may recommend changes in activity and specialized bracing to support the knee during movement or while it is under stress.
| OrthoticsAn orthotic insert fits inside a shoe and helps position the foot in an anatomically correct position while walking, running, or jumping. Frequently, abnormal foot motion and gait occurs as a result of over-pronation of the foot; most orthotics are used to treat this condition. Over-pronation is a tendency to roll the foot onto the inner edge, loading the inside of the foot and leaving the outer edge almost weightless. A professionally made orthotic insert will exactly contour to the bottom of the foot, and can compensate for over-pronation or other abnormal foot mechanics.
One of two construction methods may be used to create an orthotic; one utilizes a plaster mold of the entire foot to make a moderately rigid insert, the other utilizes a foam impression of the bottom of the foot, creating a more flexible insert. In either case, the finished product must be tilted with small wedges, while other accommodations are made to protect sensitive areas of the foot. The choice of orthotics and design will vary according to the expected use, foot type, and body weight.
Orthotics can be used to treat:
abnormal foot mechanics
patella dislocation or maltracking
patellar tendonitis
general knee pain
ankle instability
| Patella Supports
| | Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion
and provide compression to aid healing and reduce pain and swelling.
Patients suffering from knee strains or inflammation will usually be
directed to use a support during daily activities.
The thin and flexible construction of the support allows for normal
movement of the knee and also allows the support to be worn under
loose fitting clothing. To prevent harmful pressure to certain
structures, the support applies differing compression around the
knee. The sides of the joint receive intermittent pressure to help
stimulate blood flow while the rear of the support fits relatively
loose to prevent constriction of circulation. The kneecap is aided
in positioning, but remains free of compression to allow its natural
movement.
Knee supports can be used to treat:
Strains
Sprains
Inflammation
Chondromalacia patella
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The knee may be immobilized for up to six weeks. After that time, injured ligaments and tissue may take an additional six weeks to heal.
With physical therapy to recondition the surrounding muscles and reduce stiffness after immobility, a patient may expect to participate in athletic activities at their pre-injury level.
Patients that have not achieved full recovery will need to reduce their level of physical activity to prevent re-injury to the knee. In some cases this will mean completely eliminating certain activities that place particular stress on the knee.
Recovery is more dependent upon the condition of the joint and how the internal structures have repaired, than on the number of days, weeks or months since the injury occurred.
Re-injury to the joint is possible if physical therapy becomes overly strenuous for the condition of the knee.
For patients with a severely dislocated patella which has caused damage to the internal structures of the knee, physical therapy may not sufficiently recondition or prepare the knee for vigorous athletic activities.
Dislocations may recur during activity if the injury has not completely healed.
Repeated dislocations may cause the knee to become arthritic and unstable.
This procedure does not require the use of implantable surgical hardware.
This procedure does not require the use of tissue transplants.
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