Treatment Options Patellar dislocations are frequently encountered and treatment options depend on the clinical presentation.
Treatment Options Patellar dislocations are frequently encountered and treatment options depend on the clinical presentation. Many patellar dislocations will reduce on their own but some will require reduction. This is attempted many times in the field or on the sidelines during sporting events, but some may require sedation.
This is generally performed by placing medial pressure on the patella while extending the knee. Patellar dislocations can lead to cartilage injuries, osteochondral fractures, recurrent instability, chronic pain and patellar osteoarthritis. As with shoulder dislocations, recurrence is not uncommon.
Reports range from 15% to 80 % and after a second dislocation, the chance of patellar instability is greater than 50 percent. A heterogeneous patient population, challenging surgical techniques and lack of long-term and robust clinical outcome studies make the management of recurrent patellar instability very difficult. The first thing once reduction is confirmed is determine is whether or not this is the first occurrence.
The provider will need to take a thorough history as dislocations may be subtle or difficult to determine on some occasions. Reduction can sometimes occur if an athlete is rolling on the ground or when the patient is getting up. It is important to ask about knee effusion or one of multiple acute “pop” or “cracks.” Some providers will order advanced imaging on patients after a patellar dislocation to ensure there is no osteochondral fracture or acute osteochondral defect, nondisplaced fracture or large cartilage defects of the patella or femur.
Following acute injury, MRI can detect characteristic findings of a patellar dislocation, including cartilage damage that may be undetected on radiographs or bone bruising on the medial patellar facet and the lateral femoral condyle. Standard MRI was compared with intraoperative findings and was found to be 85% sensitive and 70% accurate in detecting injury to the MPFL. Concomitant cartilage injuries to the patellofemoral joint can be expected in 70% to 96% of knees with both acute and recurrent patellar dislocations.
If you are experiencing symptoms that may be related to patellar dislocation: treatment options, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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