Patellar dysplasia is a malformation that results in asymmetry of the kneecap and can be congenital or acquired. Congenital dysplasia of the patella is often a symptom of a malformation syndrome, while acquired forms result from accidents. Therapy consists primarily of physical therapy and the administration of analgesics.
What is patellar dysplasia?
The patella is also known as the kneecap. It is a flat, disc-shaped, triangular bone in front of the knee joint. The patella is involved in the articular surfaces of the knee joint and performs the function of a sesamoid bone in the tendon of the adjacent muscle. The main function of the patella is lacing the knee joint and lever arm extension of the quadriceps femoris muscle. In medicine, a dysplasia is the malformation or malformation of tissues or organs. In this context, patellar dysplasia corresponds to a malformation of the bony patella. Non-developments are not malformations in the strict sense. Underdevelopments or overdevelopments of the patella, however, may well be called patellar dysplasia. The malformation of the patella can be the result of a hereditary disease, but may also be acquired through accidents in the course of life. In the narrower definition, we only talk about patellar dysplasia when the kneecap has an asymmetrical shape.
Causes
The causes of patellar dysplasia range from genetic mutations to processes of the patellar tissue after trauma. Thus, a distinction can be made between congenital and acquired causes in the context of patellar dysplasia. For example, dysplasia of the patella can occur in the context of various malformation syndromes and is then in most cases due to genetic mutations. Such mutations may have a hereditary basis and thus be passed on, for example, in autosomal dominant or autosomal recessive inheritance. If the malformation of the patella occurs as part of a syndrome, it is merely a symptom of a superordinate phenomenon. However, the dysplasia may also be acquired and thus correspond, for example, to a complication following surgery or injury to the patella. Depending on the particular cause, the deformity sometimes manifests itself in clinically different symptoms.
Symptoms, complaints, and signs
The symptoms of patellar dysplasia depend greatly on the cause of the deformity. Common to dyplasias of the patella in the narrow definition is an asymmetry that causes abrasion of the cartilage layer due to loading. Even in infancy, a pronounced patella dysplasia can thus cause considerable pain. However, a discreet malformation of the patella can also remain asymptomatic for decades and thus does not cause any complaints. Most of those affected initially complain exclusively of load-dependent pain. Later, the pain may also occur in relaxation situations. Progressive patellar dysplasia is also noticeable in crunching noises during weight-bearing and bruising on the skin. How quickly patellar dysplasia progresses and how severe the pain is as it progresses depends on the cause. Genetically determined dysplasias, for example, may be characterized by rapid progression in individual cases. The degree of stress also plays a role in progression.
Diagnosis and disease progression
Dysplasia of the patella can be imaged by radiographic imaging and undoubtedly diagnosed in this way. Finding the cause is somewhat more difficult. The medical history can provide the physician with initial indications of past accidents involving patellar injury or genetic hereditary disorders. A specialist can detect pronounced dysplasia of the patella with the naked eye. Nevertheless, radiographic imaging is relevant to the diagnosis because it makes it easier to assess the extent of the dysplasia. In many cases, dysplasia of the patella is not diagnosed until it is in an advanced stage because it does not necessarily cause symptoms until then. The typical symptoms of load-dependent pain and crunching sounds in the knees are reason for the physician to perform imaging. The prognosis for patients with patellar dysplasia depends on the cause. By and large, any asymmetry of the patella is largely irreversible.However, accidental patellar dysplasia is often diagnosed earlier than genetic dysplasia and thus can be blocked more easily.
Complications
Due to patellar dysplasia, patients primarily suffer from severe pain. These occur thereby particularly with loads and with the movement, so that the patients are strongly limited in their everyday life. This results in restricted movement and a general reduction in the ability to bear weight. The knees are often swollen and covered with bruises. Even without weight-bearing, patellar dysplasia can lead to significant pain, so that many patients also suffer from psychological complaints or depression. Furthermore, the pain of this disease can also occur at night and thus lead to sleep problems or irritability of the affected person. The quality of life of the patient is thus considerably limited and reduced. Even in children, this disease can already occur and thus possibly also significantly restrict the development. A causal treatment of patellar dysplasia is not possible. Those affected are thus dependent on various therapies and on taking painkillers in their lives to alleviate these symptoms. Life expectancy is not reduced by the disease. However, the disease can limit the patient’s life so that they can no longer participate in sports activities.
When should you see a doctor?
If visual abnormalities of the skeletal system in the area of the knee are observed in a newborn child, a medical evaluation of the existing changes should be performed. Normally, a birth occurs that is attended by obstetricians in both the inpatient and home settings. Immediately after the delivery, the midwives, nurses as well as attending physicians perform the initial examinations of the child. In these cases, the relatives do not have to take any further steps to investigate the cause of the visual peculiarities. If the malformation of the patella only becomes apparent in the course of life, there is a need for action. In case of disturbances of locomotion, restrictions of the mobility of the knee joint as well as a low physical resilience, a physician is needed. Pain, low muscle strength, swelling as well as disturbances of the blood circulation have to be examined and treated. If there is a noise in the area of the knee during locomotion, this is an alarming sign. A visit to the doctor should be made to prevent further damage. If there are no complaints despite the recognizable malformation of the patella, a check-up visit to a doctor is recommended. The functions of the knee are checked and documented. Follow-up visits to a physician are only necessary in these cases if changes become apparent or complaints develop during the course of life.
Treatment and therapy
Therapy for patellar dysplasia is not possible on a causative basis. Neither genetic causes nor trauma to the patella can be reversed to revise the symptom of asymmetry. Symptomatic treatments are available for patients with dysplasia of the patella. In individual cases, treatment options depend on the present progression of cartilage damage. Destroyed cartilage cannot be rebuilt. However, if dysplasia of the patella is diagnosed early enough, the progression of cartilage damage may be limited. Therapy therefore focuses on measures that help preserve the cartilage that is still present. For example, the affected knee should be protected from excessive stress. In this context, physiotherapy can teach the patient strategies for reducing stress. Under physiotherapeutic care, the patient also builds up muscles that are located around the knees and can thus have a cushioning and stabilizing effect on the kneecap. Conservative therapy with analgesics can relieve the patient’s pain. In extreme cases, surgical replacement of the affected patella takes place at a later stage in order to preserve the patient’s ability to walk. Physical therapy is also essential after such surgery.
Outlook and prognosis
The prognosis for patellar dysplasia should be assessed according to individual circumstances. However, a cure cannot be assumed.In the case of a congenital disorder, recovery is not possible because, for legal reasons, the genetic material of the human being may not be altered by medical professionals. Treatment depends on the individual manifestation of the malformation syndrome. Normally, the patient’s development and growth process is continuously accompanied by physiotherapy. In this way, the affected person learns already at the beginning of his or her life how an optimal load should be applied to the body. Although a complete cure cannot be expected, a considerable alleviation of existing complaints can nevertheless take place. At the same time, it can be achieved that serious subsequent disorders are avoided. Recovery is also unlikely in the case of acquired patellar dysplasia. If the cartilage in the area of the knee has been damaged or completely destroyed, it cannot be restored. Long-term therapy is also necessary so that a change in the physical load capacity can be learned. The aim of the therapy is to minimize the pain and still allow the patient to lead an optimal everyday life. In particularly severe cases, surgical intervention is performed. This decision is independent of the cause and is based on the existing damage. If the operation proceeds without further complications, physiotherapeutic care can be started afterwards.
Prevention
Knee patella dysplasia cannot be fully prevented. Some acquired patellar dysplasias are the result of misalignment or poor posture. This type of dysplasia can be prevented with exercise.
Aftercare
In many cases of patella dysplasia, affected individuals have no special or only limited measures of aftercare available. Therefore, patients should seek medical attention at the first symptoms or signs of the condition to avoid further complications or other medical conditions. Since it is a genetic disease, it cannot be completely cured. If there is a desire to have children, genetic testing and counseling is recommended to prevent recurrence of patellar dysplasia. Most affected individuals rely on the measures of physical therapy or physiotherapy. In this regard, the affected person can also perform many of the exercises in his or her own home and thus increase the mobility of the body. Likewise, most of those affected are dependent on the help and support of their own family in everyday life. It is not uncommon for psychological support to be necessary to prevent depression or other psychological upsets. Regular visits to a doctor are also very useful to check the condition of the complaints. Whether it comes through the patella dysplasia to a reduced life expectancy of the affected person, can not be universally predicted in this case.
Here’s what you can do yourself
With patellar dysplasia, the knee and the affected leg should not be subjected to heavy loads. Sports activities should be tailored to the needs of the affected person so that the organism is not further damaged. Together with the doctor or a physiotherapist, exercises and training sessions can be worked out that are performed daily on the patient’s own initiative and responsibility. This serves to support an optimal supply of the muscles, tendons and nerve fibers. In addition, the demands of the bones and joints can be supported in the best possible way. Carrying and lifting heavy objects should be avoided. One-sided movements as well as incorrect postures should also be avoided. To ensure that the skeletal system is not subjected to further overexertion, attention should be paid to the patient’s own weight. Excess weight or a strong increase in weight have a negative influence on the health of the person affected. A body weight according to the BMI guidelines is recommended. To cognitively cope with pain or other discomfort, the use of relaxation techniques can lead to relief. Through methods such as meditation or yoga, an inner tension is reduced and at the same time the well-being is strengthened. For the promotion of one’s own health, an optimal diet is advisable. The absorbed nutrients via fresh food or liquids cause a regeneration and strengthen the body’s own defense system.
