The patella (kneecap) is a bone in the front of the knee joint that helps improve the performance of quadriceps muscle on the top of the thigh. There is a groove in the end of the femur (thigh bone) where the patella resides. If your patella moves out of its groove and then snaps quickly back into place, a subluxation has occurred. If the patella moves out of its groove and stays out of place, a complete patella dislocation has occurred.
If you have suffered a patella dislocation, then you may understand how painful this condition may be. A dislocated patella can cause loss of knee range of motion, swelling around the knee, or loss of strength in the muscles that support the knee. It can limit your ability to walk, run, or function normally in your day-to-day activities.
After you dislocate your patella, you doctor will reduce the dislocation. This means that the kneecap will be manually pushed back into the groove at the end of your thigh bone. You may be referred to physical therapy for treatment for dislocated patella. There you may work to regain normal knee mobility and function and to decrease knee pain.
While physical therapy for a dislocated patella may be successful, occasionally the patella continues to dislocate. This may be caused by tightness in the structures on the outside part of the kneecap or by weakness in the muscles that support the knee. This frequent dislocation can cause a great deal of pain and limit normal recreational, athletic, or work activity.
Surgery for a Dislocated Patella
If you have suffered from a recurring dislocation of the patella or if you have suffered a severe dislocation, surgery may be an option for you. The surgical procedure most often performed for a dislocated patella is a lateral release surgery. During this surgery, the tight tissue on the outside, or lateral, part of the knee is cut and lengthened. This allows the patella to sit properly in its groove.
Physical Therapy After Lateral Release Surgery
After a lateral release surgery, you may be referred to physical therapy. Your therapy will most likely begin with an initial evaluation where measurements of range of motion, strength, and swelling will be taken. Your doctor may require that you wear a knee brace, and your physical therapist may check to see that you are wearing it properly.
The initial goals of physical therapy after lateral release are to improve mobility and strength, progress walking with crutches to walking with no device, and to control pain and swelling. This is accomplished by common treatment techniques that may include:
The focus of your exercises during the initial phase is to improve function of the muscles on the top and bottom of your thigh and to improve basic hip muscle function.
Minimal protection phase
At about four to five weeks after surgery, you should be able to tolerate more stress and force through the knee. You will probably no longer require crutches for walking, and your pain and swelling level should be at a minimum. At this point, your doctor may also have you discontinue use of the knee brace. It is always best to check with your doctor and physical therapist to be sure when you should stop using the brace. You may still need to use the brace for athletic or vigorous activity.
Exercises to restore normal strength and mobility are the main focus in this phase. Advanced hip strengthening exercises may be started to help you return to normal walking and running. Approximately eight weeks after surgery walking should be normal and you should be able to tolerate light jogging. Again, be sure to work closely with your surgeon and physical therapist to be sure you are ready to jog and run.
Return to normal function
The return to function phase should focus on exercises that place maximal stress on the knee to ensure that the patella and supporting structures can tolerate the loads that you may encounter during your normal activities. If you are returning to sports, plyometric drills can help you prepare to tolerate running, starting and stopping, and jumping.
If you are suffering from episodes of patella dislocations or subluxations, your doctor may recommend a lateral release surgery to help keep the patella in place. Physical therapy after surgery is essential to ensure a safe return to your normal activity and function.