A patellar dislocation is a knee injury in which the patella (kneecap) out of its normal position. Often the knees are partially bent, sore and swollen. Patella also often feels and looks out of place. Complications may include patellar fracture or arthritis.
A patellar dislocation usually occurs when the knee is straight and the lower leg is bent outwards when rotated. Sometimes it occurs when the knees are bent and the patella is affected. Commonly related sports include soccer, gymnastics, and ice hockey. Dislocations almost always appear far from the midline. Diagnosis is usually symptomatic and supported by X-rays.
Reduction is generally done by pushing the patella toward the midline while straightening the knee. After the reduction the foot is generally striped in a straight position for several weeks. This is then followed by physical therapy. Surgery after the first dislocation is generally unclear. Surgery may be indicated in those who have broken a piece of bone inside the joint or where the patella has sprained several times.
Patellar dislocations occur in about 6 per 100,000 people per year. They make up about 2% of knee injuries. This is most common among those aged 10 to 17 years. Prices on men and women alike. Recurrence after initial dislocation occurs in about 30% of people.
Video Patellar dislocation
Signs and symptoms
People often describe the pain as "inside a knee cap." Feet tend to flex even when relaxed. In some cases, the injured ligament involved in a patellar dislocation does not allow the legs to flex altogether.
Maps Patellar dislocation
Risk factors
Predisposing factors are spasms of the tensor fasciae latae muscle and iliotibial canal in combination with quadriceps imbalance between the lateral vastus and the medial vastus muscle can play a major role. However, individuals with larger Q angles are genetically more prone to this type of injury due to an increase in lateral angles at which the femur and tibia meet.
Another cause of patellar symptoms is lateral patellar compression syndrome , which can be caused by a lack of balance or inflammation in the joints. The pathophysiology of the kneecap is complex, and is associated with osseous soft tissue or abnormalities in the patellofemoral groove. Patellar symptoms lead to knee extensor dysplasia, and minor, sensitive variations affect the muscle mechanisms that control joint motion.
24% of diseased patellites have brothers who have a patellar dislocation.
Athletic population
A patellar dislocation occurs in a sport that involves turning the knee. Direct trauma to the knee can knock the patella out of the joint.
Anatomical factors
People with larger Q angles tend to be more susceptible to knee injuries such as dislocations, because the centerline of the pull found on the quadriceps muscles running from the anterior superior iliac spine to the center of the patella. The range of normal Q angles for men ranges from & lt; 15 degrees and for women & lt; 20 degrees, placing women at a higher risk for this injury. A corner greater than 25 degrees between the patellar tendon and the quadriceps muscle may affect a person for patellar dislocation.
In patella alta, patella sits higher on the knee than normal. The normal function of the VMO muscle stabilizes the patella. Decreasing of VMO function causes patella instability.
Team
When there is too much pressure on the patella, the ligaments will weaken and are vulnerable to tearing the ligaments or tendons due to shear forces or twist forces, which subsequently replace the kneecap from its origin. Another cause that a patellar dislocation can occur is when a fully flattened trochlear groove is defined as troklear dysplasia. Not having a groove because the trochlear bone has been flattened out can cause the patella to slip as nothing holds the patella in its place.
Injury Mechanism
Patellar dislocation occurs because:
- The direct impact that dropped the patella out of the connection
- Knee-twisting, or ankle movement
- The lateral cut is suddenly
Knee anatomy
Patella is a triangular sesamoid bone embedded in the tendon. It lies in a patellofemoral groove, an articular hollow cartilage at the end of the femur (thighbone) where the femur meets the tibia (tibia). Some ligaments and tendons hold the patella in place and allow it to move up and down on the patellofemoral groove when the legs bend. The upper part of the patella attaches to the quadriceps muscle through the quadriceps tendon, the middle to the medial medialis obliquus and the lateral vastus muscles, and the lower portion to the tibia's head (tibial tuberosity) through the patellar tendon, which is a continuation of the femoral tendon of the quadriceps. The medial patellofemoral ligament attaches horizontally to the inner knee to the adductor magnus tendon and is the most frequently damaged structure during patellar dislocation. Finally, collateral lateral ligaments and medial collateral ligaments stabilize the patella on both sides. Each of these structures can sustain damage during a patellar dislocation.
Diagnosis
To assess the knee, a doctor can perform patellar apprehension by moving the patella forward and back while people flex the knee at about 30 degrees.
People can perform
Prevention
The patella is a floating sesamoid bone held in place by the tendons of the quadriceps muscles and the patellar tendon ligaments. Exercises should strengthen the quadriceps muscles such as rectus femoris, vastus intermedius, and vastus lateralis. However, strong and strong quads may be the underlying cause of patellar dislocations. If this is the case, it is advisable to strengthen the medial thighs, the medial vastus (VMO), and stretch the lateral muscles. Exercises to strengthen quadriceps muscles include, but are not limited to, squatting and lunge. Adding extra external support around the knee using devices such as knee [orthotics] or athletic bands can help prevent patellar dislocations and other knee-related injuries. External support, such as knee and athletic support, works by providing movement only on the desired plane and helps inhibit movement that can cause abnormal movement and injury. Women who wear high heels tend to develop muscles and short calf tendons. Exercises to stretch and strengthen calf muscles are recommended daily.
Treatment
Two types of treatment options are usually available:
- Surgery
- Conservative treatment (rehabilitation and physical therapy)
Surgery can inhibit the normal growth of structures in the knee, so doctors generally do not recommend knee surgery for young people who are still growing. There is also the risk of complications, such as adverse reactions to anesthesia or infection.
When designing a rehabilitation program, doctors consider related injuries such as cracked bone or soft tissue tears. The doctor takes into account the age of a person, the level of activity, and the time it takes to get back to work and/or exercise. Doctors generally only recommend surgery when other structures in the knee have been severely damaged, or specifically when present:
- Osteochondral simultaneous injury
- Advanced gross instability
- The palpable medial patellofemoral ligament ligament and medial vastus obliquus
- High-level athletic demands coupled with mechanical risk factors and early injury mechanisms unrelated to contacts
Supplements such as glucosamine and NSAIDs can be used to minimize annoying symptoms.
Rehabilitation
An effective rehabilitation program reduces the likelihood of reinjury and other knee-related problems such as patellofemoral pain syndrome and osteoarthritis. Rehabilitation focuses on maintaining the strength and range of motion to reduce pain and maintain muscle and tissue health around the knee joint. The goal of any good rehabilitation program is to reduce pain, swelling and stiffness and increase range of motion. The general rehabilitation plan is to strengthen the quads while focusing on the vastus medialists. Exercises to isolate these muscles include an isometric quadricep set with hip rotation in a semi-squat position, foot dips with internal tibial rotation, etc. The idea is that because the medial side is most often affected with dislocations, with reinforcement will add more stable support. With a series of more intense motion exercises, combined.
Epidemiology
The rate in the United States is estimated to occur among the population at risk of 1,774,210,081 people every year. The incidence rate published in the American Journal of Sports Medicine for ages 10-17 is found to be about 29 per 100,000 people per year, while the average adult population for this type of injury ranges between 5.8 and 7, 0 per 100,000 people per year. The highest level of patellar dislocation is found in the youngest age group, while the rate decreases with age. Women are more susceptible to patellar dislocations. Race is a significant factor for this injury, where Hispanic, African-American and Caucasian have slightly higher rates of patellar dislocation due to the type of athletic activity involved in: basketball (18.2%), soccer (6.9% ), and football (6.9). %), according to Brian Waterman.
Lateral patellar dislocations are common in the child population. Several studies have shown that the annual patellar dislocation rate in children is 43/100,000. The treatment of immature skeletal remains controversial due to the fact that they are still very young and still growing. Surgery is recommended by some experts to improve the initial medial structure, while others recommend to treat it without surgery with physical therapy. If the dislocation recurs the reconstruction of the medial patellofemoral ligament (MPFL) is the recommended surgical option.
References
External links
- Connecticut University: New England Musculoskeletal Institute - site on choice of knee injury care
Source of the article : Wikipedia
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