{"id":14328,"date":"2023-01-31T19:25:35","date_gmt":"2023-01-31T18:25:35","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=clinical_pattern&#038;p=14328"},"modified":"2024-03-04T12:01:23","modified_gmt":"2024-03-04T11:01:23","slug":"patellar-instability","status":"publish","type":"clinical_pattern","link":"https:\/\/www.physiotutors.com\/clinical-patterns\/patellar-instability\/","title":{"rendered":"Patellar Instability"},"featured_media":14326,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"tracking_tag":[2197],"class_list":["post-14328","clinical_pattern","type-clinical_pattern","status-publish","has-post-thumbnail","hentry","tracking_tag-knee"],"acf":{"free_access":"unfree","app_link":"https:\/\/app.physiotutors.com\/add-ons\/95c79307-e00d-4d48-bc86-0b3b2b5d8fd7","sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":14326,"background_image_alt_text":"Patellar Instability"},"heading":"Patellar Instability","subheading":"Knee","content_editor":"","button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null,"label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Body Chart","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Background Information","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"History & Physical Examination","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"References","button_internal_link":null,"button_anchor":"section-number-8","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"","button_style":"button-link-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null},"button_description":""},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Body Chart<\/h2>"},"column_right":{"content_editor":"<img class=\"alignnone wp-image-14329 size-full\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/01\/Body-Charts-CP-App.jpg\" alt=\"Patellar instability pain diagram\" width=\"2080\" height=\"2080\" \/>\r\n<ul>\r\n \t<li>Pain behind or around the patella<\/li>\r\n<\/ul>"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Background Information<\/h2>"},"column_right":{"content_editor":"<h3>Patient Profile<\/h3>\r\n<ul>\r\n \t<li><span style=\"font-weight: 400;\">Adolescent patients <\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Peak age between 10 and 20 years<\/span><\/li>\r\n \t<li>Trauma in history or recurrent subluxations<\/li>\r\n<\/ul>\r\n<h3>Pathophysiology<\/h3>\r\n<span style=\"font-weight: 400;\">Patellar dislocations occur most frequently during sports but in some cases can occur atraumatically. In a traumatic event, the knee is mostly flexed and subject to a valgus force or receives an anterior or medial blow to the knee. Atraumatic dislocations occur mostly in individuals who have diminished quadriceps strength and neuromuscular control and may present with anatomical abnormalities such as trochlear dysplasia, shallow and short trochlear groove, pes planus, a large tibial tuberosity-trochlear groove distance, increased ligamentous laxity, amplified patellar tilt, valgus limb alignment and rotational abnormalities of the tibia and femur.<\/span>\r\n<h3>Course<\/h3>\r\n<span style=\"font-weight: 400;\">Patients who sustained a patellar dislocation are at increased risk of sustaining a second dislocation. The 5-year recurrence-free estimate for a sports-related dislocation is 53% versus 76% for atraumatic dislocations.<\/span>"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">History &amp; Physical Examination<\/h2>"},"column_right":{"content_editor":"<h3>History<\/h3>\r\nUsually traumatic history \u2013 T<span style=\"font-weight: 400;\">he knee is mostly flexed and subject to a valgus force or receives an anterior or medial blow to the knee.<\/span> <span style=\"font-weight: 400;\">The patient will most likely tell you about the knee giving way and a \u201cpopping\u201d sensation or sound that may be followed by swelling and possibly hemarthrosis. The patella may reduce spontaneously.<\/span>\u00a0Atraumatic dislocations mostly occur in young individuals who have reduced quadriceps strength and control.\u00a0<span style=\"font-weight: 400;\">Movements requiring minimal force usually lie at the base of their instability symptoms and subluxations or dislocations occur often without trauma.\u00a0<\/span>\r\n<ul>\r\n \t<li>Local<\/li>\r\n \t<li>Intense<\/li>\r\n \t<li>Swelling<\/li>\r\n \t<li>Feeling of instability\/giving way<\/li>\r\n<\/ul>\r\n<h3>Physical Examination<\/h3>\r\n<strong>Inspection\r\n<\/strong>\r\n\r\n<span style=\"font-weight: 400;\">In case the patella is still dislocated, it will be most likely displaced laterally.\u00a0<\/span>Misalignment: <span style=\"font-weight: 400;\">trochlear dysplasia, an increased Q-angle, patella alta, increased tibial tuberosity-trochlear groove distance, knee valgus and torsional abnormalities<\/span>\r\n\r\n<strong>Functional Assessment\r\n<\/strong>Squatting;\u00a0r<span style=\"font-weight: 400;\">ange of motion and lower extremity strength<\/span>\r\n\r\n<strong>Active Examination\r\n<\/strong>J-Sign can be indicative of patellar maltracking. Inability to move and load the knee with signs of apprehension\r\n\r\n<strong>Passive Examination\r\n<\/strong><span style=\"font-weight: 400;\">Pain and swelling often impede a passive assessment. Tenderness at the medial epicondyle of the femur and medial patella, and apprehension during lateral displacement of the patella. The lateral femoral epicondyle may be tender from collision with the patella during dislocation and\/or reduction. Tenderness over the origin of the medial patellofemoral ligament may be indicative of a ligamentous disruption. An increased lateral glide of the patella (2 or 3 quadrants of the patellar width) accompanied by <a href=\"https:\/\/www.physiotutors.com\/wiki\/patellar-apprehension-test\/\" target=\"_blank\" rel=\"noopener\">apprehension<\/a> can give an idea about ligamentous laxity or rupture. A positive <a href=\"https:\/\/youtu.be\/pRqnODPqxFs?t=54\" target=\"_blank\" rel=\"noopener\">patellar grind test<\/a> may be suggestive of a chondral injury. Lateral tilting of the patella may suggest a tight lateral retinaculum.<\/span>\r\n\r\nhttps:\/\/youtu.be\/IKhEElT8jvQ?t=95\r\n<h3>Differential Diagnosis<\/h3>\r\n<ol>\r\n \t<li><span style=\"font-weight: 400;\">Fracture of the patella, femur or tibia<\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Rupture of the cruciate or collateral ligaments<\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Osteochondral loose bodies or lesions of the patella or trochlea<\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Meniscal tear<\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Patellofemoral syndrome<\/span><\/li>\r\n \t<li><span style=\"font-weight: 400;\">Medial synovial plica<\/span><\/li>\r\n<\/ol>"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Treatment<\/h2>"},"column_right":{"content_editor":"<h3><strong>Strategy<\/strong><\/h3>\r\nPatient education, progression of weight bearing, analgesics, active exercises for hip and knee muscles\r\n<h3><strong>Interventions<\/strong><\/h3>\r\nPassive: Brace\/Tape, NSAIDs help in the acute stage, Patient education\r\n\r\n[embed]https:\/\/youtu.be\/WfjAZkH1NDY[\/embed]\r\n\r\nActive: Address biomechanics of the lower limb, strengthening of quadriceps, hip abductor strengthening, hamstrings and gastrocnemius, proprioception\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=9E0uMkNyxVE&amp;t=60s\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=17Ih7bky-_Y&amp;t=4s"}},{"acf_fc_layout":"cta-big","heading":"Download the new Physiotutors App","subheading":"PHYSIOTUTORS APP","content_editor":"Are you ready for a learning revolution?\r\n\r\nExperience the Physiotutors content you love in our new app.","form_toggle":false,"form":"92","number_of_buttons":"one","button_1":{"button_1_button_type":"internal_link","button_1_button_label":"DOWNLOAD NOW","button_1_button_style":"button-two","button_1_button_internal_link":16662,"button_1_button_anchor":"","button_1_button_url":"http:\/\/study.physiotutors.com\/course\/running-rehab\/","button_1_button_file":null},"button_2":{"button_2_button_type":"internal_link","button_2_button_label":"","button_2_button_style":"button-one : 1","button_2_button_internal_link":null,"button_2_button_anchor":"","button_2_button_url":"","button_2_button_file":null},"image":17728,"image_alt_text":"","overlay":false},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">References<\/h2>"},"column_right":{"content_editor":"<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Seitlinger G, Ladenhauf HN, Wierer G. What is the chance that a patella dislocation will happen a second time: update on the natural history of a first time patella dislocation in the adolescent. Curr Opin Pediatr. 2018 Feb;30(1):65-70. doi: 10.1097\/MOP.0000000000000568. PMID: 29176355. https:\/\/pubmed.ncbi.nlm.nih.gov\/29176355\/<\/span><\/li>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Petri M, Ettinger M, Stuebig T, Brand S, Krettek C, Jagodzinski M, Omar M. Current Concepts for Patellar Dislocation. Arch Trauma Res. 2015 Sep 1;4(3):e29301. doi: 10.5812\/atr.29301. PMID: 26566512; PMCID: PMC4636822. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/26566512\/<\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hiemstra LA, Kerslake S, Lafave M, Heard SM, Buchko GM. Introduction of a classification system for patients with patellofemoral instability (WARPS and STAID). Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2776-82. doi: 10.1007\/s00167-013-2477-0. Epub 2013 Mar 28. PMID: 23536205. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/23536205\/<\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Johnson DS, Turner PG. Management of the first-time lateral patellar dislocation. Knee. 2019 Dec;26(6):1161-1165. doi: 10.1016\/j.knee.2019.10.015. Epub 2019 Nov 11. PMID: 31727430. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/31727430\/<\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Baryeh K, Getachew F. Patella dislocation: an overview. Br J Hosp Med (Lond). 2021 Aug 2;82(8):1-10. doi: 10.12968\/hmed.2020.0429. Epub 2021 Aug 4. PMID: 34431342. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/34431342\/<\/span><\/li>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">M\u00e9n\u00e9trey J, Putman S, Gard S. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2320-6. doi: 10.1007\/s00167-014-3172-5. Epub 2014 Jul 22. PMID: 25047793; PMCID: PMC4169614. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/25047793\/<\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, Bedi A. An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am. 2016 Mar 2;98(5):417-27. doi: 10.2106\/JBJS.O.00354. Erratum in: J Bone Joint Surg Am. 2016 Jun 15;98(12):e54. PMID: 26935465. <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/26935465\/<\/span><\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Martin RK, Leland DP, Krych AJ, Dahm DL. Treatment of First-time Patellar Dislocations and Evaluation of Risk Factors for Recurrent Patellar Instability. Sports Med Arthrosc Rev. 2019 Dec;27(4):130-135. doi: 10.1097\/JSA.0000000000000239. PMID: 31688530.\u00a0 <\/span><span style=\"font-weight: 400;\">https:\/\/pubmed.ncbi.nlm.nih.gov\/31688530\/<\/span><\/li>\r\n \t<li style=\"font-weight: 400;\" aria-level=\"1\">Ling DI, Brady JM, Arendt E, Tompkins M, Agel J, Askenberger M, Balcarek P, Parikh S, Shubin Stein BE. Development of a Multivariable Model Based on Individual Risk Factors for Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am. 2021 Apr 7;103(7):586-592. doi: 10.2106\/JBJS.20.00020. PMID: 33787553. https:\/\/pubmed.ncbi.nlm.nih.gov\/33787553\/<\/li>\r\n<\/ul>"}}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patellar Instability - Physiotutors<\/title>\n<meta name=\"description\" content=\"Learn about the diagnosis, prognosis and treatment of Patellar Instability in our Clinical Pattern for Physiotutors Members\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.physiotutors.com\/clinical-patterns\/patellar-instability\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patellar Instability - Physiotutors\" \/>\n<meta property=\"og:description\" content=\"Learn about the diagnosis, prognosis and treatment of Patellar Instability in our Clinical Pattern for Physiotutors Members\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.physiotutors.com\/clinical-patterns\/patellar-instability\/\" \/>\n<meta property=\"og:site_name\" content=\"Physiotutors\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/facebook.com\/physiotutors\" \/>\n<meta property=\"article:modified_time\" content=\"2024-03-04T11:01:23+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/01\/1280x768-4.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1280\" \/>\n\t<meta property=\"og:image:height\" content=\"768\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@physiotutors\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/clinical-patterns\\\/patellar-instability\\\/\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/clinical-patterns\\\/patellar-instability\\\/\",\"name\":\"Patellar Instability - 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