Managing Patella Dislocations with Chiropractic
What you need to know
FAQ about the Patella
How Chiropractic Can help
01
What muscles do chiropractors test for ?
What muscles do chiropractors test for ?
Testing the strength of the muscle is important because the vastus medialis oblique (VMO) serves to control patellar tracking through varying degrees of knee motion and prevents the occurrence of anterior knee pain . In patellar instability, it is critical to maintain the dynamic balance of the quadriceps to limit the dominance of the lateral structures
03
What is the treatment that Chiropractors can do for Patella Dislocation
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Patients should initially be immobilised for 2–3 weeks, to control pain; immobilisation in some 20° flexion approximates the two extremities of the torn medial wing.
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Knee braces are used to stabilise the patella as soon as pain allows;
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weight-bearing is authorised as soon as possible, depending on pain;
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early mobilisation is important to maintain joint cartilage trophicity ; closed-chain exercises and passive mobilisation are then initiated
02
What diagnostic imaging do you need?
Xray : Radiography should comprise an AP weight-bearing view in extension, Merchant view (weight-bearing in 45° flexion), also known as a femoropatellar axial view, and lateral view in 30° flexion.
CT SCAN: CT assesses osseous risk factors: patellofemoral malalignment, osteochondral defects, patellar tilt and lateral subluxation, elevated TT-TG distance and trochlear dysplasia
MRI SCAN: MRI is more specific in precisely determining involved structures and thus guiding treatment decision-making. It assesses the patellofemoral joint cartilage surfaces and also the medial patellar stabilizing structures (medial retinaculum, MPFL and VMO)
IF there is a patella dislocation, the MRI shows hemarthrosis, bone oedema of the medial patellar facet and lateral femoral condyle (osteochondral lesions of the medial patellar facet and the anterolateral part of the lateral femoral condyle. Concave deformity of the inferomedial patella, due to impaction, is a specific sign of lateral patellar dislocation.
04
What is the goal of rehabilitation with Patellar Dysfunction?
Rehabilitation following inaugural traumatic patellar dislocation seeks to restore normal range of knee motion (full flexion and extension) and to reinforce the quadriceps to restore dynamic patellar balance.
The medialis vastus was for some years a target for reinforcement, insufficiency being thought to contribute to lateral dislocation,
FAQ about Patellar Dislocations
Extra FAQS
01
Chiropractic or Surgery for Patella Dysfunction?
Management in adults with patellofemoral instability is still controversial.
About one-third of patients treated conservatively have activity limitations 6 months to 3 years following the patellar dislocation, even in the absence of re-dislocation.
Surgical treatment is associated with a low rate of recidivism and good outcomes and levels of sport participation.
However, whether surgery is associated with better outcomes than conservative management remains unclear.
Patients with recurrent patellar dislocations have a six-fold increased risk of persistent patellar instability if treated with active rehabilitation alone, compared to MPFL-R in combination with active rehabilitation, even in the absence of significant anatomical risk factors
03
What predisposes you to re dislocation of the patellar
Recurrent patellofemoral instability is common, especially among the active and young population. Its aetiogenesis is multifactorial.
Several pathoanatomical factors which predispose to instability have been described, such as patella alta, dysplasia, mal-alignment syndromes, and leg axis deformities
02
What are the chances of Re Dislocation of the Patellar?
. Traditionally, management of patients following primary patellar dislocation has been non-operative, characterized by a short period of immobilisation followed by movement based medicine and gradual return to activities
Recurrent patellar instability has previously been reported in up to 60% of patients following non-operative management
04
What is the incidence of Patellar dislocation?
Mean annual incidence of patellar dislocation varies with age group: it is between 5.8 and 7.0 per 100,000 person-years in the general population, but 29 per 100,000 in 10–17 year-olds
Patella dislocation
What you need to know
What is Patellar dysfunction Acute traumatic patellar dislocation is the second most frequent cause of traumatic hemarthrosis of the knee, after anterior cruciate ligament tear, and accounts for 3% of all traumatic knee lesions The patellofemoral joint is complex; stability depends on osteoarticular conformation and static and dynamic stabilisation structures. Any change in anatomy, such as extensor apparatus alignment defect, patellofemoral dysplasia or trauma, can induce patellar instability. The peripatellar soft tissue and particularly the medial patellofemoral ligament (MPFL) and vastus medialis obliquus (VMO) muscle contribute significantly to joint stability The MPFL provides 50–80% of the mechanisms counteracting lateral patellar glide Mean annual incidence of patellar dislocation varies with age group: it is between 5.8 and 7.0 per 100,000 person-years in the general population, but 29 per 100,000 in 10–17 year-olds
What causes Patella Problems
Signs and Risks of Patella Problems The typical mechanism underlying patellar dislocation is a movement of the knee in flexion and valgus without direct contact, accounting for 93% of traumatic patellar dislocations . Most patients report a sensation of slippage, intense pain and secondary effusion, often suggestive of knee sprain. True traumatic dislocation, caused by direct tangential shock dislocating the patella laterally, also occurs. almost all patients with traumatic patellar dislocation show hemarthrosis, MPFL lesion and medial patellar wing fracture. Osteochondral fracture occurs in 25% of traumatic patellar dislocations Recurrence risk is increased 6-fold in case of history of ipsi- or contralateral patellar dislocation
How to Prevent Patella Problems
PREDISPOSING FACTORS Trochlear dysplasia : On an xray , we look for the following signs: Crossing sign, supra trochlear spur, double contour, trochlear projection, trochlear depth Isolated high patella or “patella alta” may be found in recurrent patellar dislocation and may be the cause of recurrence The secondary predisposing factors are described as follows: • elevated Q angle with tibial tubercle lateralization and genu valgum • elevated femoral anteversion with compensatory lateral tibial torsion • vastus medialis hypoplasia; • ligament hyperlaxity with genu recurvatum; • patellar dysplasia:
Return To Play Advice with Patella Dislocations
When can you return to playing sport after patella dysfunction? The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability Core strength is also crucial as it plays an important role in the stability of the lower limb. Indeed, if the trunk is not stable during cutting manoeuvres, the loads applied to the knee are in valgus, thus generating a situation where the patellofemoral joint is at risk of dislocation To avoid re-injury, the stability of the lower limb must be mastered at the end of the rehabilitation programme. Cutting manoeuvres, change of direction, and running on uneven ground are the three activities perceived to be the greatest risk factors for patellar dislocation The athlete should be prepared for the specific loads and demands to be experienced in their specific sport, including: cutting manoeuvres and pivoting exercises, performed for most of the team sports; (2) plyometric and landing strategies, emphasized in any sports with jumps; (3) one-leg stability, particularly exercised for martial arts; and (4) proprioception, side stability, and landing capacities, which are stressed with skiers
