‘Bone Joint and Nerve Clinic’ was started in the year 2018 by one of the Best Orthopaedic Surgeons in Patna, Dr. Neeraj kumar.

To establish the centre of excellence in Orthopaedics Dr. Neeraj kumar focused on its specialities by providing a safe & secure environment and performed the duties with utmost competency through utilising effective and innovative clinical practices with profound academic research.

PATELLA INSTABILITY

PATELLA INSTABILITY

Pathophysiology

  • Mechanism
    • non contact twisting injury to extended and externally rotated. Osteochonral fracture happens while patellar relocation.
    • Direct blow due to collision on the side of knee

Anatomy

  • Static stabilizers
    • MPFL ( Medial patella femoral ligament)
    • Patellar boney confirmity
  • Dynamic stabilizer
    • vastus medialis

Epidemiology

  • Risk factors
    • Marfans syndrome
    • Ehlers-Danlos syndrome
    • external tibial torsion
    • Femoral antiversion increased
    • Genu valgum
    • Increased Q angle
    • patella alta
    • Trochlear dysplasia
    • Lateral femoral condylar hypoplasia
    • Excessive lateral patellar tilt
    • Dysplastic vastus medialis obliques
    • Tight lateral structure(ITB, Vastus lateralis)

Classification

  • Acute more due to direct injury
  • Chronic recurrent dislocation
  • Habitual occurs whenever patient bends his knee

Clinical features

  • Symptoms and signs
    • Anterior knee pain
    • Instability
  • Examination
    • knee effusion in acute case due to haemarthrosis
    • Tenderness over MPFL
    • Increased lateral translation of patella more than 2 quadrants
    • Patellar Apprehension sign positive
    • Increased Q angle
    • J sign

Imaging

  • X- ray
    • antero posterior
    • lateral view
    • merchants view
  • CT scan
    • TT-TG distance > 20mm abnormal
  • MRI
    • MPFL tear

Treatment (Adult)

  • Pain killers, physiotherapy, activity modification and bracing
    • 1st time dislocation without bony avulsion or osteochondral fracture
  • Operative
    • Arthroscopic debridement or repair
    • MPFL repair with or without graft
    • Lateral reticular or ITB release
    • Fulkerson osteotomy
    • Distalization of tibial tubercle
    • Trochleoplasty

Complication

  • Recurrent dislocation
  • Patella femoral arthritis
  • medial patellar dislocation
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