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The patella (commonly referred to as the kneecap) sits in front of the knee and is held in place by a ligament (the patellar ligament) that extends above it and below it to attach it to the thigh and the lower leg. As stated in our blog post on the knee’s structure and function, the patella serves to protect the articular surface of the joint. It also increases the leverage that the patellar ligament can exert on the femur based on its angle. The patella sits in a groove (the patellofemoral groove), where it can slide up and down according to the actions occurring at the knee. When this goes smoothly, we don’t have any problems. But if the patella shifts out of alignment with this groove, it can cause all sorts of problems.
Patella dislocations occur most commonly when the patella shifts laterally to the outside of the knee. This can be the result of a blow to the knee or a twisting injury. Those at increased risk for such an occurrence include those with a weak vastus medialis oblique (VMO), which is one of your quadriceps muscles towards the middle and front of your thigh (just above the patella), those who hyperpronate at the ankle (or roll in excessively), and those with something called an increased Q angle (or those that appeared knock-kneed). If the patella shifts out of line, it can sublux, which is a bit more subtle, or it can totally dislocate to the outside of the femur. Once it is out of proper alignment, it can sometimes spontaneously reduce (go back on its own). If not, it must essentially be popped back into place (hopefully, by a healthcare professional). This type of injury may require surgery, but not always.
If you’ve dislocated your patella, chances are that you’ll be out of dance (or other activities) for a while, especially if you’ve had surgery. This sort of injury will often require a brace, and post-operatively, you’ll be using crutches with limited weight bearing that will increase gradually over time. Whether you’ve had surgery or not, the acute phase begins with RICE. If you’ve read the previous blog posts on recovering from injury, you may start to notice a theme here. Once your doctor allows more activity, you’ll proceed as with ligament strains or meniscus tears with AROM activities (including some stretching), followed by gait training, strengthening exercises (in non-weight bearing positions before weight bearing exercises take their place), balance activities, and finally, agility training. Your doctor and physical therapist will guide you with when weight bearing is appropriate (and how much), how much you’re allowed to bend you knee (which can be mediated by the brace), when you’re allowed to do exercises without the brace (and which exercises, specifically), etc.
Your AROM activites may include such as quad sets and heel slides as well as quadricep, calf, and hamstring stretches. Your strengthening exercises may include Therbands for resistance, ankle weights, and exercise equipment, such as a leg press or a Pilates reformer. Here, you may do things such as squats, step exercises, hamstring curls, terminal knee extension, and something physical therapists call short arc quads (SAQ). Your agility and balance exercises may include the Bosu ball (ball side up or down), balance activities on two legs, one leg, and then on your toes, and jumping techniques/landing training. If surgery was performed, then you’ll be following your doctor’s specific protocol. Rehab will definitely target the VMO and ensure that all muscles around the knee are as strong as possible. Your therapist will focus on how your knee and patella track with activity and make any corrections possible to ensure proper alignment. You may also be dancing with a brace or taping for a while, as well, and it may be a while before your back to dancing full-out again (especially if you’ve had surgery).
That’s it for patellar dislocations and subluxations. Stay tuned next week as we find out what exactly chondromalacia patella is.
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