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Patellofemoral instability

Patellofemoral instability or recurrent patellar subluxation is a variant of patellofemoral syndrome in which there is actual lateral subluxation of the patella rather than excessive lateral tracking. It is more common in females than males. Patients with patellofemoral instability complain of a sensation of the patella slipping or moving laterally on certain movements. When this occurs acutely, it may be associated with pain and swelling. This condition has the same predisposing factors as patellofemoral syndrome and the pattern of tenderness around the patella may be similar. Examination reveals patellar hypermobility with apprehension and pain when the patella is pushed laterally by the examiner. If there has been an acute episode there may be hemarthrosis or effusion. Patella alta (a patella that is located more superiorly than normal) and/or dysplasia of the femoral groove predispose to this condition.

Treatment of patellofemoral instability parallels that of the patellofemoral syndrome. Acute management aims to reduce pain and swelling. A brace may provide temporary immobilization and the patient may use crutches for either partial or nonweightbearing. Rehabilitation requires vastus medialis obliquus strengthening.

X-ray may reveal evidence of osteochondral damage to the articular surface of the patella and femur as well as any predisposing anatomical abnormalities, such as patella alta. Arthroscopy may be required to remove a loose osteochondral fragment.

Surgery is indicated if a properly managed conservative program fails. Arthroscopic lateral release and medial plication may be appropriate for a patient with recurrent patellar subluxation. Following surgery, an intensive rehabilitation program is vital.

This is basically the on going problems with my knee — I had a cortisone shot put in on Wednesday, hurt like hell, need I mind you.

If this doesn’t work — and so far, its a no go. I will have to have arthroscopic surgery. Finally, hopefully something will come of this. All the physical therapy done, and the years suffering and hurting. I’m ready to get this done and over with. So come Thanksgiving/Christmas I’m pretty much going to have a bum leg, but in the end it’ll be worth it.


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