Weak at the Knees?

May 4, 2017| Health and Wellbeing /

Every year around 8000 Australians experience their first patella dislocation, with many going on to suffer repeat dislocations. Goodness Me explores why our knees take a knocking and why surgery is often the best solution for a dislocated patella.

Patella (kneecap) instability occurs in several guises: sometimes patients will feel that their knee is unstable, or just feel like the kneecap is not quite sitting right. For many, the first sign of a problem is a complete patella dislocation, where the kneecap shifts substantially — generally to the outer (lateral) side of the leg.

shutterstock_186348863.jpg

Most commonly, people experience their first dislocation in their teenage years, usually during sport or dancing, with women far more likely to dislocate a patella than men.

According to Epworth orthopaedic surgeon Dr Jonathan Robin, the most common cause of patella instability is abnormal development of the femur groove, known as the trochlear groove.

“Where the patella is meant to move with the end of the femur, most often we will find that the trochlear groove is either flat, or even convex. This is called trochlea dysplasia. When a person experiences multiple dislocations, an MRI is best to see whether there is an issue with the trochlear groove that is causing the dislocations and if we can fix that surgically.”

Surgery involves beveling out the groove and recreating a more natural groove for the patella to move in, then re-fixing the cartilage to stabilise the patella joint. Being open surgery, generally a two-night hospital stay is required, with subsequent recovery time at home.

The next most common cause of patella instability is ‘patella alta’ — or a high-riding kneecap. Here, the kneecap tends to be late in finding the trochlear groove during bending of the knee, causing the patella to dislocate.

Patella alta is corrected through a combination of open and keyhole-assisted surgery, where the surgeon detaches the patella tendon and moves the kneecap towards the foot by up to 8mm, then screws it back into place.

“Many patients will have both trochlea dysplasia and patella alta, which can be addressed with corrective surgery at the same time,” Jonathan says.

When you have experienced a patella  dislocation, Jonathan says it is also very common to have damaged or ruined the medial patella femoral ligament (MPFL).

To correct this, surgeons most commonly use a part of the hamstring tendon to replace the damaged ligament, which is known as an MPFL reconstruction. Jonathan says doctors often opt for a reconstruction rather than a direct repair of the native ligament, as trying to get the ligament back to its normal length and tension is difficult — sometimes even impossible — once the patella has dislocated.

The recovery period after knee surgery usually involves six or more sessions of weekly physiotherapy and then a slow return to normal activity. Most people can return to sport or dancing within six months post surgery, depending on the complexity of the procedure. In the most severe cases, a return to sport is sometimes not possible.

Patella instability is a highly correctable problem, says Jonathan, and better to address early through surgery.

“We no longer accept that we have to stop activities altogether following a patella dislocation or repeated dislocations. Whether you are an active sportsperson or a dancer, you don’t want to stop your favourite activity, so most people choose to get it fixed early,” Jonathan says.

We no longer accept that we have to stop activities altogether following a patella dislocation or repeated dislocations. Whether you are an active sportsperson or a dancer, you don’t want to stop your favourite activity, so most people choose to get it fixed early
— Dr Jonathon Robin, Orthopaedic Surgeon, Epworth HealthCare

Ignoring patella instability can potentially cause problems down the track, adds Jonathan, such as arthritis — which may develop after repeated injuries from dislocations and the altered way in which the patella moves on the trochlea.

“The first port of call if you have previously dislocated your patella is to visit your GP. In an acute setting, a patella can often be relocated by straightening the leg. If you are unable to relocate it, you should go straight to your nearest hospital emergency department for assistance and investigation,” he says.



Epworth

Join the conversation on The Village



June 17, 2019| Health and Wellbeing/

When Period Pain Strikes Again

We caught up with Dr Kent Kuswanto, Epworth obstetrician and gynaecologist to talk all things periods.

June 13, 2019| Our Community/

Team Recipes - Super Moist Gluten Free Banana Bread

Recipes brought to you by the Epworth team. You can’t stop at one slice and you’ll never know it’s gluten free! Slice & serve warm.

June 11, 2019| Our Community/

First Birthday for Epworth Cousins

It’s been a year since we’ve been following sisters Alex and Jane’s bubs - Charlotte and Lola. It’s been a year since they both gave birth to their daughters, one at Epworth Freemasons and the other at Epworth Geelong. Let’s find out how life has changed since then.

June 4, 2019| Health and Wellbeing/

Ovarian Cysts

An ovarian cyst is a fluid filled sac or pouch which forms on the ovary. Ovarian cysts, in most cases are harmless and resolve on their own. If the cyst is cancerous, it requires medical intervention. Ovarian cysts are common in women of childbearing age.

May 21, 2019| Health and Wellbeing/

Catering for Someone with a Food Allergy

With 1 in 10 infants now developing a food allergy, being conscious of what you are buying and how you prepare food is more important than ever.