When Knee Dislocations Persist: Exploring Surgical and Non-Surgical Solutions

Experiencing repeated dislocations of the patella is a challenging and often painful ordeal, especially for athletes who rely heavily on their physical capabilities. Fortunately, there are various approaches to address this issue. Depending on the severity and frequency of the dislocation, individuals have a range of treatments to consider, from physical therapy and specialized braces to more intensive surgical procedures.

Understanding Patellar Dislocation

A patellar dislocation occurs when the kneecap, or patella, slips out of its groove on the front of the femur. This is often the result of an acute injury or a sudden change in direction during intense physical activity. While the first dislocation may only require non-surgical interventions, repeated occurrences often necessitate a different approach.

Physical Therapy

• Strengthening Exercises: Physical therapy is an initial step in treating recurrent patellar dislocation. It focuses on strengthening the quadriceps and surrounding muscles, which can help stabilize the kneecap and prevent future dislocations.
• Range of Motion Exercises: Therapists often include exercises that improve the knee’s range of motion, thus preventing stiffness and aiding in a quicker recovery.
• Customized Programs: Each individual may require a tailored program that addresses specific weaknesses or imbalances that contribute to the dislocation.

Patellar Stabilization Braces

• Supportive Gear: Patellar stabilization braces provide support and help keep the kneecap aligned. They are particularly useful during sports activities when the risk of dislocation is heightened.
• Variety of Designs: There are numerous designs available, each offering different levels of support, and these braces are typically lightweight and comfortable for active wear.

Surgical Options

When non-surgical treatments do not yield desired results, surgery may become a necessary consideration, especially after multiple dislocations.

• Medial Patellofemoral Ligament Reconstruction (MPFL): This common procedure involves repairing or reconstructing the ligament on the inside of the knee to restore stability. It often includes the use of a graft sourced from the patient’s own body or a donor.
• Osteotomy: In cases where alignment of the extensor mechanism is significantly off, a more complex surgery called an osteotomy might be performed. This involves cutting and realigning bones to ensure the patella tracks properly.
• Bony Realignment Procedures: Occasionally, bony procedures are necessary for patients whose kneecap groove is too shallow, allowing the kneecap to slide out of place easily.

Understanding the Decision for Surgery

Electing to undergo surgery is a serious decision that must consider multiple factors, including the frequency of dislocations, the patient’s level of pain and discomfort, and the impact on their lifestyle and sports participation. A thorough assessment by an orthopedic surgeon will help determine the most suitable option.

Recovery and Rehabilitation

• Post-Surgical Rehab: Rehabilitation following surgery is crucial for regaining strength and mobility. It’s a gradual process that involves guided physical therapy to ensure optimal recovery.
• Time Frame: Recovery time varies depending on the type of surgery, but patients can generally expect a period ranging from a few months to a year before fully resuming sports activities.
• Ongoing Management: Even after recovery, ongoing management and adherence to strengthening exercises are vital in preventing future dislocations.

Other Considerations

While surgery and physical therapy are prominent methods of dealing with patellar dislocations, alternative therapies such as regenerative medicine approaches can sometimes offer relief. These may include the use of platelet-rich plasma or stem cell therapies to promote healing and reduce inflammation.

Conclusion

Dealing with recurrent patellar dislocations requires a combination of patience, persistence, and professional medical guidance. By employing a structured treatment plan that may involve both non-surgical and surgical options, individuals can return to their active lifestyles with enhanced function and reduced risk of future injury. Each case is unique, and collaboration with orthopedic specialists is key to tailoring a solution that aligns with personal health goals and athletic ambitions.

Dr. David Guyer discusses effective strategies for athletes dealing with chronic patellar dislocations, including physical therapy, stabilization braces, and surgical options.