Patella tilting and subluxation, femoral condyle dysplasia

Anatomy of the structure

The knee joints in the human body have an important musculoskeletal function. The structure of each knee joint includes the patella or the so-called oval bone. The function of the patella is to prevent direct damage to the musculo-ligamentous apparatus of the joint itself, thus it seems to cover the soft tissue. The stability of the attachment and stability of the patella is provided by ligaments at the attachment points of the quadriceps femoris muscle, the muscles of the lower leg, as well as its own ligament. All these elements together provide sufficient strength to the quadriceps muscle to ensure movement of the limb. If a person receives a knee injury, including in the area of ​​the patella, it can lead to both limited mobility of the joint and result in various complications.

Symptoms of a luxated patella

Vivid clinical manifestations of patellar dislocation appear immediately after traumatic mechanical impact. The first symptom is sudden pain in the knee. The victim notes a sharp limitation of active mobility in the knee joint. Performing passive motor acts is not possible in full. Any passive movement or attempt to stand on the injured leg is accompanied by acute pain and palpable clicks.

When examining the patient, the fact of displacement of the patella relative to the knee joint is determined. The knee area is swollen and hyperemic. During palpation, a crunching sound (crepitus) may be detected in the area of ​​displacement. In case of soft tissue damage, subcutaneous hemorrhage is possible.

Types of patellar dislocations

The classification of patellar dislocations is based on the cause of occurrence - congenital or acquired. In addition, patellar displacements are divided into types depending on the direction:

• lateral;
• rotary;
• vertical.

Depending on the severity of the damage, dislocations can be:

• mild to moderate degree – insignificant displacement, which is not accompanied by damage to the ligaments;
• acute - dislocations that occurred for the first time, without complete displacement and damage to surrounding tissues;
• habitual - dislocations of the patella, repeated systematically, caused by pathological changes in the surrounding muscular-ligamentous apparatus.

Determining the type of patellar dislocation largely determines medical tactics and a program of restorative measures.

Useful tips

The success of rehabilitation is determined by many factors, including the type of traumatic injury, age, and concomitant diseases. However, following simple rules helps to achieve recovery. You should follow these tips:

1. The start of rehabilitation therapy is determined by the attending physician.
2. Physical activity is increased gradually, moving from simple exercises to more complex elements.
3. Pain and other unusual symptoms should not be ignored.
4. It is better to conduct training under the supervision of a specialist.
5. Exercise therapy must be performed daily, several times a day.

Competent rehabilitation allows you to restore motor function in a short time and return to a full life.

Congenital dislocation of the patella

Congenital dislocation of the patella is considered a fairly rare developmental anomaly. The pathology is diagnosed in one out of two hundred children. Among boys, congenital dislocation is observed twice as often as in girls.

According to traumatologists, a congenital anomaly occurs against the background of pathological formation of the hip bone. In this case, the quadriceps femoris muscle acts on the lateral condyle of the femur and prevents its normal development. As a result, the tibia deviates in an outward direction, and the patellar plate is fixed in a pathological position. The combination of these mechanisms leads to dislocation of the patella.

In some cases, pathological transformations begin with disturbances in the development of the lateral epicondyle. Muscle abnormalities are secondary. Experts believe that patellar displacement occurs when the condyle develops incorrectly. This same feature does not allow the knee joint to develop physiologically.

Typically, congenital luxation of the patella is detected in children with other genetic diseases. In healthy children, this condition occurs extremely rarely. The diagnosis is first made before the age of three. If the disease develops slowly and there are no provoking factors, congenital dislocation of the patella can be diagnosed at 7-8 years of age or later.

Traumatic dislocation of the patella

In traumatology, complete and incomplete dislocations of the patella are distinguished. In the first case, the patella plate shifts in the outer direction with localization on the lateral condyle of the femur.

If the dislocation is incomplete, then an incomplete displacement relative to the midline of the knee joint is recorded. In this case, there is a possibility of self-reduction of the patella when the leg is extended at the knee. Patients complain of rapid fatigue during walking, active movements, and unsteady gait. As a result, a psychological problem may develop in the form of fear of moving on uneven roads or surfaces.

When examining the patient, the presence of fluid, hemorrhages in the knee joint, and pathological mobility caused by instability of the ligamentous apparatus are detected.

Causes.

Those most susceptible to injury are those who lead an active lifestyle, play sports, and undergo severe physical activity. The most common mechanisms are a fall on the knees, a side blow to the joint area and a sharp extension of the lower leg.

Possible causes of this type of injury include:

• Meniscus tear.
• Anomalies in the development of the patella.
• Weak ligaments and muscles in this area.
• Patella position too high.
• Dysplasia.
• Arthrosis of the articular part of the knee.
• Valgus deformity.
• Injuries suffered.
• Hemorrhage into the joint cavity.

Recurrent patellar dislocation

Recurrent (repeated) dislocation of the patella appears in childhood. Up to 20% of all children suffer from this type of pathology, and the disease is more common in girls. Displacement of the patella occurs without any apparent traumatic cause, even with minor loads on the knee joint. In most cases, recurrent patellar dislocation occurs on both sides.

Patellar displacement occurs after contraction of the quadriceps femoris muscle during flexion of the joint. Dislocation always occurs outward, which is a distinctive feature of the injury. Repeated displacements lead to chronic damage to the articular surfaces of the knee plate and femoral condyle. As a result, flattening of the surfaces is formed, which subsequently leads to the development of deforming arthrosis and curvature of the lower leg bones.

Ultrasound

Ultrasound
Damage to the patella of the knee joint is diagnosed using techniques for visualizing its structures. These include:

• radiography;
• computed tomography or magnetic resonance imaging;
• Ultrasound;
• arthroscopy.

The most informative, but invasive procedure is arthroscopy. It involves inserting a tube with lighting and a camera into the cavity of the knee joint. This technique is often performed for therapeutic purposes.

Treatment of patellar luxation

To confirm patellar dislocation, hardware diagnostic methods are used - radiography, CT or MRI. This is necessary in order to assess the condition of the patella plate, osteochondral structures of the joint, femur and tibia bones. The treatment method is selected only after a thorough examination.

In most cases, patellar luxation is treated conservatively. First of all, its reduction is carried out. All manipulations are performed by a traumatologist or orthopedist under local anesthesia. After anesthesia, the specialist bends the injured leg at the hip joint to relax the tendons of the quadriceps femoris muscle. Then, the knee joint is carefully extended and the patella is shifted in the required direction. The correctness of the actions performed is controlled by radiographs.

After reducing the dislocation, it is necessary to apply a plaster cast. In some cases, it is allowed to use a special orthopedic orthosis. Fixation of the knee joint takes from 4 to 6 weeks. The patient is prescribed painkillers or non-steroidal anti-inflammatory drugs,

Old, recurrent patellar dislocations and acute traumatic dislocations may require surgical intervention. After surgery, it is necessary to plaster the knee joint for a period of 4 to 8 weeks (depending on the underlying cause and type of surgical treatment). Immediately after immobilization, rehabilitation of the joint begins, which continues for at least a month from the moment of injury until complete restoration of mobility. Unfortunately, the operation does not always maintain a lasting effect - in 15-40% of cases, patients experience an exacerbation of the disease.

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