Patella question - really need advice!

[Darren Ireland]

Hi All,

Hoping for a bit of help. I had a patella dislocation of my right knee last May. Was taken to hospital and had joint reset and stabilised. MRI showed all ligaments intact but grade 1 medial collateral ligament strain and partial tear of medial patellar retinaculum. I had an arthroscopy in late July 2012 and the surgeon advised that he was happy knee would not dislocate again and that there had been some wear and tear on the knee which he had fixed. I have been attending physio throughout the injury and until now, the rehab has been going great and I am swimming, cycling, squatting with reasonable rom etc. Running has been difficult and I have been slower to recover due to significant positive apprehension in relation to my knee(I had 5 dislocations of my left patella as a teenager and surgery also so maybe understandable!) but have done some slow 5k runs and some interval sessions. I am involved as a referee in high performance sport so hoping to be fully recovered and training normally and quite frustrated at my own lack of progress.

In the last week only, I have been getting a minor lateral movement of my patella to the outside when I straighten my leg and then back in, sometimes accompanied with a click or pop. No real pain, just very awkward getting up from a chair., out of car etc and. Went to physio and he is not worried but I am unsure why this is happening - I have been stepping up my training and just wondering is it natural for this to happen - the movement laterally worries me as that is how my kneecap dislocated.

Should I just keep on training, or get a second opinion, or am I just paranoid?!!

Any help appreciated.

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[Stargazer]

In the last week only, I have been getting a minor lateral movement of my patella to the outside when I straighten my leg and then back in, sometimes accompanied with a click or pop. No real pain, just very awkward getting up from a chair., out of car etc and. Went to physio and he is not worried but I am unsure why this is happening - I have been stepping up my training and just wondering is it natural for this to happen - the movement laterally worries me as that is how my kneecap dislocated.
Should I just keep on training, or get a second opinion, or am I just paranoid?!!
Any help appreciated.

Some lateral movement of the patella during knee flexion is physiological although it shouldnt be a "sudden hopping". Let a professional decide if the amount of motion of your patella is alright.

As both of your patellas seem to have had some issues i`d assume you have an unfavorable genetic component (i.e. a unfavorable shaped femoro-patellar joint) and/or a in-knee (genu valgum). Clicking sounds may be a sign of instability, especially in your case, but i have heard numerous other reasons why a joint may click during movement.

Unfortunately there isnt really anything that can be done about it though unless you want to undergo surgery to correct the shape of the femoro-patellar joint (which is what was done for your left knee if i understood correctly).

You can try wearing various bandages/taping/Orthesis especially while you work out or when you are back in your referee job.

Also you can try strengthening all muscles which are connected to the medial collateral ligament/retinaculum pars medialis - this can increase the stability and also reduce a genu valgus. If you do notice you have a strong genu valgum you should also try to decrease it by improving general posture e.g. by strengthening your foot arch and/or use shoe inlays whenever you are working out. Your physio + doc should be able to help you with that.

Exercise should be concentrated on strengthening hip adduction with a straight leg - Use resistance close to your knee for this to avoid unnecessairy tilt up due to resistance which is applied near the foot. You might also try applying muscle stimulating power (electricity - no idea whats the correct word) to the medial parts of your Quadriceps while doing squats.

You should try to avoid turning around very far while your foot is still stuck to the ground and in the process twisting your knee heavily - this happens very often especially in indoor sports where you have rubber soles and the shoes basically stick to the ground like glue. Avoid it by either turning around in smaller archs and repositioning your foot more often or by putting weight on only your heel or your forefoot and having your foot turn with you. The latter suggestion will not work in indoor sports. (edit jumping and turning around in midair also works pretty well)



All the aforementioned things are not going to help too much if the shape of your femoro patellar joint is simply very bad. In that case only surgery will help.
Just try to adhere to the aforementioned things as best as you can and if your knee dislocates again get surgery. As mentioned before - not much else you can do.

Cheers

[nmarman]

I would agree with star gazer.

I would invest in a good strap for sporting activities that enhances patella tracking passively, while also protecting the ligament from further strain.

However a active a approach will be very good as well but in my experience both are needed.

the electrical stimulation is called EMS machine, very good as well.

best of luck,

Niall