Description

Patellar Instability is a specialty for Dr. Jeremy Rush’s orthopedic practice in San Antonio.

Tell me about the first patellar instability you remember seeing.

Chronic instability up to dislocation

It is a very heterogeneous group

Patella dislocation and patella subluxation

And patella instability

Addressing the first-time dislocator

Be super aggressive with the rehab

Step one: reduce the dislocation

Brace them for a week but then get them moving

Try to get started in PT within one week

See them back about 6 weeks and then again at 3 months

At 6 weeks with effusion makes you think there is a loose body.

Ability to do straight leg raises

Apprehension with manual pressure

Instability vs dislocation.

Dislocation = all the way out – 95% are lateral

• Usually traumatic events
• Some are from anatomic risk factors

Subluxation is partially out of the groove

Instability is a chronic form of Subluxation

First timer tips

Get them to relax

Move them into extension

Calm them and even cover the dislocation if needed

Maybe get them up and it could self-reduce

Top patient complaints/ indicators of patellar instability

Knee feels unstable or it is slipping

Or my knee just hurts

Buckling

Recurrent effusion

Anterior knee pain

Start with rehab

Target

Positive patellar apprehension

J-Sign

Predisposed to instability

Patella alta

Women are at higher risk due to q-angle hyperlaxity

Rotational abnormalities

On exam

J-sign

Apprehension

Lateral pressure

MRI on chronic instability

MPFL damage

If the injury is unclear then I get an MRI to rule out any sort of cartilage or loose body.  

A huge effusion indicates a loose body.

Contact:

Dr. Jeremy Rush – IG @satxsportsmedicine

Jeremy – @jhjacksonlat

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