Patellar Instability

1. Anatomical Factors: Abnormalities in patellar alignment, such as patella alta (high-riding patella) or trochlear dysplasia (shallow trochlear groove), can predispose individuals to patellar instability.
2. Soft Tissue Laxity: Ligamentous laxity or muscular imbalances around the knee joint, particularly the quadriceps and vastus medialis obliquus (VMO) muscles, can contribute to patellar instability.
3. Traumatic Injury: Acute traumatic events, such as a direct blow to the knee or a sudden twisting motion, can cause patellar dislocation or subluxation, leading to subsequent instability.
4. Overuse or Repetitive Stress: Activities that involve repetitive knee flexion and extension, such as running, jumping, or sports that require cutting and pivoting movements, may exacerbate patellar instability over time.

1. Pain: Patients with patellar instability often experience pain in the front of the knee, particularly during activities that involve bending or straightening the knee.
2. Swelling: Swelling or joint effusion may develop around the knee joint, particularly after episodes of patellar dislocation or subluxation.
3. Feeling of Instability: Patients may describe feelings of the knee “giving way,” “buckling,” or feeling unstable, particularly with activities that require weight-bearing or changes in direction.
4. Audible Popping or Clicking: Some individuals may report audible popping or clicking sensations in the knee joint, particularly during movements that involve flexion or extension.

Diagnosing patellar instability typically involves a combination of clinical evaluation and imaging studies, including:

• Physical Examination: Assessment of patellar alignment, stability, and provocative tests to reproduce symptoms, such as the apprehension test or lateral patellar glide test.
• X-rays: Plain X-rays of the knee may be ordered to assess patellar alignment, joint congruity, and identify any bony abnormalities, such as patellar tilt or trochlear dysplasia.
• MRI or CT Scan: Advanced imaging studies, such as MRI or CT scans, may be used to evaluate soft tissue structures, assess the integrity of ligaments and cartilage, and identify any associated injuries or abnormalities.

Conservative Management:

• Non-operative treatment may be considered for patients with mild to moderate symptoms of patellar instability and no structural abnormalities.
• Physical therapy focusing on strengthening exercises, stretching, proprioceptive training, and patellar taping can help improve muscle balance, joint stability, and functional capacity.

Surgical Intervention:

• Indications: Surgical intervention may be considered for patients with recurrent patellar instability, structural abnormalities, or failure of conservative management.
• Procedure: Surgical techniques for patellar stabilization may involve medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle osteotomy, lateral retinacular release, or trochleoplasty, depending on the underlying pathology and patient factors.
• Rehabilitation: Postoperative rehabilitation typically involves a period of immobilization followed by a progressive rehabilitation program focused on restoring knee range of motion, strength, and functional activities.

Recovery from patellar instability depends on various factors, including the severity of the instability, chosen treatment approach, and individual patient factors. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring knee range of motion, strength, and stability while protecting healing tissues and minimizing the risk of complications. Rehabilitation protocols are tailored to the specific surgical procedure and patient needs, with a gradual progression of exercises aimed at achieving a safe return to activities and optimizing long-term outcomes.