The knee is the largest joint in the body and consists of the lower end of femur (thigh bone) bone, which rotates on the upper end of the tibia (shin bone), and the patella (knee cap), which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability.
In a healthy knee the patella sits in the femur trochlear groove on the end of the femur.
The way these two bones move against each other is affected by a number of factors. Any injury or deviations from normality in any one of these factors can lead to problems with the way the patella articulates with the femoral trochlea and can result in pain and instability of the knee.
Patellofemoral malalignment can cause pain at the front of the knee (anterior knee pain), which can lead to patellofemoral arthritis. In its more severe forms it can cause the patella to dislocate.
The medial patellofemoral ligament (MPFL) attaches to the inner side of the patella and the inner side of the end of the femur. It is the primary medial stabiliser of the patella. The role of this rope like ligament is to prevent the knee from lateral dislocation (dislocating to the outer side of the knee) and subluxation, which is a partial dislocation of the joint. With any lateral movement of the patella the MPFL can be injured or torn. After a patella has dislocated once, the MPFL is often ruptured or stretched and is less reliable in preventing the patella dislocating in the future.
Patella dislocation is typically caused by a direct blow to the knee or a sudden twist of the leg. It occurs when the patella slips out of its normal position in the patellofemoral groove and generally causes intense pain when it occurs along with swelling of the knee.
Patella dislocation is a common injury mainly in young females with joint hyper flexibility, as well as young athletes.
It used to be a difficult problem to manage, however, there have been many surgical and non-surgical advancements in techniques to treat this condition.
Classification of patellar dislocation:
Traumatic and recurrent patellar dislocations
These two conditions are related and represent the majority of dislocations. A traumatic dislocation will become recurrent in 15-45% of cases. This occurs more in females with a ratio of 2:1.
Common Causes of Patella Dislocation:
Signs and Symptoms of Patella Dislocation:
It is common that there is intra-articular damage resulting from patella dislocation. A physical examination can reveal instability of the knee but the best current method of identifying patella malalignment and dislocation is by using both plain radiograph and MRI scans in order to reach the appropriate diagnosis.
MRI scan is very useful especially in the presence of recent dislocation. Many pathological findings can be diagnosed via MRI scan such as: