Explore expert tips for managing an unstable kneecap with Meri Sehat. Discover strategies for stability and improved knee health.

Unstable Kneecap

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

An unstable kneecap, also referred to as patellar instability, is a medical condition where the kneecap (patella) dislocates or moves out of its normal position within the groove at the end of the thigh bone. 
&nbsp;

Apparently, 50-77 out of 100,000 Americans are diagnosed with some degree of unstable kneecap<a href="#accordion">[1]</a>. It is generally more common among younger individuals, especially adolescents and young adults who are active in sports or physical activities. Nearly 2/3 of the cases occur in young, active patients under the age of 20<a href="#accordion">[2]</a>. 
&nbsp;

The condition can manifest as one of the following types: 
&nbsp;

<ul>
	<li>Patellar Dislocation</li>
</ul>

This is when the kneecap completely moves out of the trochlear groove and requires manual reduction to return it to its normal position. It can occur spontaneously or as a result of specific movements or traumas. 
&nbsp;

<ul>
	<li>Subluxation</li>
</ul>

Also known as chronic patellar instability, this occurs when the kneecap partially moves out of its groove. 
&nbsp;

Signs and Symptoms

These include:

<ul>
	<li>Sudden pain and discomfort in the knee when active </li>
	<li>A feeling of the knee &quot;giving way&rdquo; </li>
	<li>An audible &quot;popping&quot; sound during movement</li>
	<li>Pain that can be sharp or dull, often localized around the front of the knee</li>
	<li>Swelling and tenderness around the knee</li>
	<li>Difficulty walking with a sense of instability or the feeling that the knee is not properly supporting the individual&rsquo;s weight </li>
</ul>

It&#39;s important to note that the severity of symptoms can vary among individuals, and not everyone with an unstable kneecap will experience all of these symptoms.

&nbsp;

Causes

There are a few reasons why an individual experiences an unstable kneecap: 
&nbsp;

<ul>
	<li>Muscle Weakness: If the muscles around the knee, especially the quadriceps at the front of the thigh, are weak, they may not provide enough support to keep the kneecap in its groove.</li>
	<li>Malalignment Of Bones: If the bones are aligned in a way that doesn&#39;t properly guide the kneecap, it can become unstable.</li>
	<li>Injury Or Trauma: A sudden injury or trauma to the knee, like a fall or a sports injury, can damage the structures that hold the kneecap in place, making it more likely to move around.</li>
	<li>Loose Ligaments: Ligaments are tough bands of tissue that hold bones together. If the ligaments around the knee are too loose, they may not keep the kneecap securely in its position.</li>
	<li>Shallow Groove: The groove in which the kneecap sits can be too shallow or misshapen. This can cause the kneecap to slip out of place more easily.</li>
	<li>Overuse Or Repetitive Movements: Activities that involve a lot of bending and straightening of the knee, like running or jumping, can sometimes lead to kneecap instability over time. 
	&nbsp;</li>
</ul>

Diagnosis

The healthcare provider may ask about the patient&rsquo;s medical history and the symptoms they&rsquo;re experiencing.

They may also conduct a physical examination, asking the individual to walk around, bending or straightening their knee<a href="#accordion">[3]</a>. They may also take measurements and feel the area around the kneecap. It helps assess:

<ul>
	<li>The knee&#39;s range of motion and any limitations</li>
	<li>Muscle<a href="https://merisehat.pk/article/why-strength-training-is-a-miracle-fitness-routine"> strength</a>, particularly in the quadriceps and hip muscles</li>
	<li>Joint stability, including how the kneecap shifts during various knee movements</li>
	<li>Tenderness, swelling, and signs of inflammation around the knee joint</li>
</ul>

Sometimes, specific clinical tests, such as the apprehension test, are performed. This test involves gently pushing the kneecap to simulate instability and observing the individual&rsquo;s reaction.

Additional tests that may be recommended include imaging studies like X-rays and specialized MRI sequences to provide insights into the causes and severity of the instability and eliminate other possible reasons for the pain. 
&nbsp;

Treatment

The treatment and management of an unstable kneecap depend on the severity of the condition, the underlying causes, and the individual&#39;s specific situation.

The goal of treatment is to stabilize the kneecap, reduce pain, improve joint function, and prevent future episodes of instability. Non-operative treatment is usually attempted for 3 to 6 months. If that fails, surgical options are considered.

If the kneecap has completely dislocated, the first step is to return the kneecap to its proper place through a process called reduction. The doctor will apply gentle force to push it back into its groove. It may be uncomfortable and require pain medicine, but there&rsquo;s no need for anesthesia<a href="#accordion">[1]</a>.

&nbsp;

<h5>Conservative Treatment</h5>

&nbsp;These measures are effective only in mild-moderate cases of patellar instability.

<ol>
	<li>Physical Therapy: A physical therapist can design a customized exercise program to strengthen the muscles around the knee. Cycling is usually recommended.</li>
	<li>Bracing Or Taping: Specialized braces or taping techniques can provide external support to the knee, helping to keep the kneecap aligned during movement. 
	&nbsp;</li>
</ol>

<h5>Medications</h5>

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended to alleviate pain and reduce inflammation. 

&nbsp;

<h5>Lifestyle Modification</h5>

These include learning and practicing proper techniques for sports and physical activities to minimize the risk of instability.

<ol>
	<li>Activity Modification: Avoid activities that provoke instability, such as sudden changes in direction or high-impact movements. Rest is encouraged to reduce the swelling and allow for natural healing to occur.</li>
	<li>Strengthening Exercises: Continue to perform prescribed exercises even after the pain subsides to maintain muscle strength and joint stability.</li>
	<li>Weight Management: Maintaining a healthy weight reduces stress on the knee joint and can help prevent further episodes of instability</li>
</ol>

&nbsp;

<h5>Surgical Treatment</h5>

Surgical intervention is necessary for cases of severe or recurrent patellar instability.

<ol>
	<li>Arthroscopic Surgery: Minimally invasive procedures can address underlying issues, such as repairing damaged ligaments, realigning bones, or removing damaged tissue.</li>
	<li>Reconstruction: If ligaments are severely damaged, reconstruction procedures like medial patellofemoral ligament reconstruction may involve using tissue grafts to reinforce the ligaments and stabilize the kneecap.</li>
	<li>Knee Osteotomy: Compared to the arthroscopic procedure, this is an open surgical procedure that requires a larger incision and a longer recovery period.</li>
	<li>Knee Replacement: This is essential in the case of recurrent dislocations or severe arthritis. 
	&nbsp;</li>
</ol>

Ongoing care with the healthcare provider is important after treatment to monitor the patient&rsquo;s progress and address any new symptoms or concerns.

&nbsp;

Untreated or poorly managed patellar instability can lead to several potential complications. These complications can affect both the knee joint and an individual&#39;s overall quality of life.

<ul>
	<li>Recurrent Dislocations Or Subluxations: Each episode of instability can cause further damage to the surrounding structures, including cartilage and other soft tissues, leading to more pain and dysfunction.</li>
	<li>Muscle Imbalances: Chronic instability can lead to muscle imbalances around the knee joint, as certain muscles might become weaker while others become overworked. Muscle imbalances can contribute to joint instability and further complications.</li>
	<li>Decreased Quality of Life: Persistent pain, limitations in physical activities, and the psychological impact of living with an unstable joint can all contribute to a decreased quality of life. The fear of unstable kneecap episodes also causes individuals to avoid physical activities and sports, impacting their overall fitness and lifestyle.</li>
	<li>Osteoarthritis: Over time, the cumulative effects of instability-related damage can increase the risk of developing <a href="https://merisehat.pk/article/alternative-treatments-for-osteoarthritis">osteoarthritis</a>. Nearly 50% of people with patellar dislocation develop post-traumatic osteoarthritis 5-15 years after injury.</li>
	<li>Secondary Knee Conditions: Compensation mechanisms to protect the unstable knee joint can lead to changes in gait and movement patterns. These changes may contribute to the development of secondary knee conditions in other areas of the joint. 
	&nbsp;</li>
</ul>

Common risk factors associated with an unstable kneecap include: 
&nbsp;

<ul>
	<li>Underlying Conditions</li>
</ul>

<ol>
	<li>Previous dislocations or subluxations</li>
	<li>Knee injuries, such as ligament tears or fractures</li>
	<li>Ehlers-Danlos syndrome</li>
	<li>Cerebral palsy</li>
	<li>Down syndrome 
	&nbsp;</li>
</ol>

<ul>
	<li>Age And Gender </li>
</ul>

<ol>
	<li>Growth spurts, increased physical activity, and joint development in adolescents and young adults</li>
	<li>Increased pelvic width in females 
	&nbsp;</li>
</ol>

<ul>
	<li>Stress from being overweight</li>
	<li>Genetics </li>
</ul>

&nbsp;

In certain conditions, it&rsquo;s possible to prevent the condition. 
&nbsp;

<ul>
	<li>
	<h5>Strengthening Exercises</h5>
	</li>
</ul>

Work with a physical therapist to develop a customized exercise program that focuses on strengthening the quadriceps, hip abductors, and other muscles around the knee joint. Strong muscles provide better support for the kneecap and improve joint stability.

Incorporate balance and proprioception exercises. These exercises help improve the sense of joint position and control, enhancing overall stability.

Consult with a healthcare professional about using braces or taping techniques that provide external support to the knee joint, helping to prevent excessive movement.

&nbsp;

<ul>
	<li>
	<h5>Employing Proper Technique</h5>
	</li>
</ul>

Practice proper techniques for jumping, landing, pivoting, and changing direction when participating in sports or physical activities. Engaging in activities with the correct form can reduce the stress on the knee joint.

<h5>&nbsp;</h5>

<ul>
	<li>
	<h5>Gradual Training Progression</h5>
	</li>
</ul>

Gradually increase the intensity and duration of physical activities to give the muscles and joints time to adapt and become stronger.

&nbsp;

<ul>
	<li>
	<h5>Lifestyle Changes</h5>
	</li>
</ul>

These include:

<ol>
	<li>Maintaining a healthy weight reduces stress on the knee joint, which can help prevent instability episodes.</li>
	<li>Choose appropriate footwear with proper cushioning and support. Ensure that sports equipment, such as running shoes or athletic cleats, provides good shock absorption.</li>
	<li>Always warm up before physical activities and include dynamic stretches to prepare the muscles and joints for movement. 
	&nbsp;</li>
</ol>

Regular physical activity and a healthy lifestyle can help improve muscle strength, joint health, and overall well-being. 
&nbsp;

Key Points

<ul>
	<li>Patellar instability, commonly known as an unstable kneecap, refers to a condition where the kneecap (patella) moves out of its normal position within the knee joint, leading to pain, discomfort, and a feeling of instability.</li>
	<li>Patellar instability can manifest as dislocations (complete movement out of place) or subluxations (partial movement out of place) of the kneecap.</li>
	<li>Various factors contribute to unstable kneecap, including anatomical abnormalities (shallow groove or high-riding patella), ligament laxity, and trauma.</li>
	<li>Common symptoms include sudden pain, a sensation of the kneecap shifting, a feeling of the knee &quot;giving way,&quot; limited range of motion, and visible deformity during dislocation.</li>
	<li>Diagnosis involves a combination of medical history, physical examination, and imaging studies to assess the extent of instability and rule out other conditions.</li>
	<li>Conservative methods of treatment include physical therapy, bracing, and activity modification.</li>
	<li>Surgical interventions may be needed for severe or recurrent instability and can involve realigning bones, repairing ligaments, or reconstructive procedures.</li>
</ul>