Tap the patellar luxation

The treatment of a patellar dislocation usually begins with a conservative attempt before resorting to surgical measures, although in 50% of cases this can already lead to permanent success. Only if the therapy fails or the dislocation reoccurs will surgical therapy be used. The conservative therapy approach here consists of physiotherapy and the application of bandages, orthoses, plaster shells or tapes.

With the help of these measures, an attempt is first made to immobilize and strengthen the patellar muscles (especially the quadriceps muscle). The application of tapes – preferably kinesio-tapes – is aimed at bringing the patella into the correct position or into its guide rail in order to enable smooth movement in the knee joint and to prevent (re)slipping. It is therefore used to easily fix the kneecap in its correct position.

In addition, the application of a kinesio-tape can also reduce pain and inflammation, provided that one of the two previously existed in the context of the patella dislocation or the existing patella malposition. The correct treatment following a patellar dislocation is of great importance, since otherwise consequential damage such as arthrosis can develop very frequently. In addition, there is an increased risk to suffer a new patella dislocation and thus the probability of complications increases.

Initially, one usually tries to perform the treatment conservatively, i.e. without surgery. Under certain circumstances, however, it may be necessary to perform surgery. Factors that speak in favor of surgery Of course, the patient’s wish is always decisive in determining whether or not surgery is ultimately necessary.

Which of the available operations is preferred in an individual case depends on:

The non-response to conservative therapy
Multiple luxations
Very pronounced cartilage damage
Shearing of cartilage-bone fragments (flakes)
Damage to the holding and band apparatus
The age of the patient,
The extent of the injury (instabilities, frequency of dislocations, extent of injury)
And basic anatomical conditions (malpositions)

The goal of all procedures is to restore the normal anatomy of the knee joint. During the operation it is important, on the one hand, to repair the cartilage damage and, on the other, to remove any free bone or cartilage from the joint. These removals can normally be carried out during arthroscopy of the knee as part of the diagnostic procedure.As a rule, soft-tissue surgery is primarily used when it is highly likely to lead to healing, and only in more extreme cases is bony correction methods (which, moreover, may only be used after growth has been completed).

Different surgical procedures can be distinguished: Both methods can be combined with the so-called “lateral release” if necessary. This is characterized by the fact that the ligament structures on the outside of the patella are cut through, which reduces the tendency of the patella to protrude outwards. However, there are many other possibilities to surgically treat a patella luxation.

After the operation, however, the treatment phase is not yet complete. Depending on which procedure is chosen, the patient must still relieve the knee joint for a certain period of time and then undergo regular physiotherapy to ensure the correct position of the patella in the long term.

The insall surgery, for example, is a very common operation.
Here, the inner capsule apparatus is sutured tightly and the ligament is gathered on the inside, which ultimately pulls the kneecap more towards the inside of the joint, making it much more difficult to luxate outwards.
MPFL reconstruction often occurs when the holding device is damaged. In this procedure, the triangular ligament between the inner side of the patella and the thigh (the Medial Patello-Femoral Ligament = MPFL) is replaced by a tendon previously obtained from the lower leg. This results in high stability.
One bony measure, for example, is tuberosity dislocation (surgery according to Elmslie-Trilat).
In this procedure, the point where the kneecap tendon attaches to the lower leg is moved further inwards. As a result, the patella is located further inwards in its glide path and can no longer dislocate so easily.

The follow-up treatment after a reconstruction operation for a patella dislocation consists of 4 phases:

The first phase begins during the hospital stay and includes the first week of post-operative treatment. Pain medication, cryotherapy, passive and active-assisted physiotherapy using a movement splint and lymph drainage are used.
Only 2-3 days after the operation, the knee remains immobile by means of a splint, after which the above-mentioned therapy and a partial weight-bearing of approx. 25 kg begin. After the first week, the same therapy measures are continued outside the hospital and physiotherapy is intensified. The partial weight-bearing is increased to half the body weight.
This is followed by phase 2 for a further two weeks, during which active physiotherapy with full range of motion as required, as well as strength and stretching exercises are performed and full weight bearing with an orthosis is aimed for.
The subsequent phase 3 includes a further increase in load and training intensity for 4 weeks, as well as a full load without an orthosis.
In phase 4, i.e. about 3 months after the operation, sports-specific training can be resumed without restriction (ball and contact sports, however, only after 9-12 months).