Therapy
As a rule, treatment of patellar lateralization is only considered when complaints arise that lead to restrictions in the patient’s everyday life. The treatment usually begins with a simple, conservative therapy, whereby the imbalances in the muscle-ligament apparatus of the knee are to be corrected by physiotherapy. The aim of the regularly performed exercises accompanied by a professional physiotherapist is to balance or correct the imbalances in the thigh musculature through muscle strengthening, muscle stretching and coordination exercises.
The main focus here is on strengthening the vastus medialis muscle (the medial part of the quadriceps muscle), stretching the ischiocrural muscles and the iliotibal tract, and improving coordination of movements in the knee joint. In many cases, this can already achieve centering of the patella and better gliding in the gliding channel. Support can also be provided by wearing knee bandages or expertly applying tapes that can compensate for instability of the patella or the collateral ligaments of the knee joint.
The short-term administration of pain and anti-inflammatory drugs (e.g. ibuprofen, diclofenac) can also relieve the symptoms. However, if the conservative therapy measures are unsuccessful or if there is already massive cartilage damage to the patella, in some cases only surgical treatment can lead to symptom relief. Various surgical methods are available, either minimally invasive arthroscopic surgery or open surgery: Possible are gathers of the medial knee joint capsule parts (medial retinaculum), splits of the lateral knee joint capsule parts (lateral retinaculum), plastic surgery of the medial collateral ligament (MFPL reconstruction), bony injury of the patellar ligament (loosening of the ligamentum patellae attachment at the tibia and displacement of the attachment further medially).
There are various exercises to counteract patellal lateralization. The exercises are mainly aimed at training the medial vastus muscle. This thigh muscle is responsible for stretching in the knee joint and for guiding the patella.
By strengthening the thigh muscles, the risk of patella dislocation can be reduced. Typical exercises for the thigh are leg press or deep knee bends. Exercises with the Theraband are also useful to strengthen the external rotators.
For this purpose, the Theraband should be stretched around the knee joints and the legs should be moved apart while the hip is bent. Kinesio-Tapes are often used for patellar lateralizations and luxations of the patella. The tension of the tape strengthens the stability in the knee joint and promotes blood circulation.
It thus promotes the healing of injured ligaments or muscle structures. A fast healing and strengthening of the thigh muscle leads to a strengthening of the patellar ligament and prevents dislocation. A knee joint bandage can help with patellar lateralization and prevent luxation of the patella.
Bandages relieve the knee joint and ease pain. Through compression, they also have an activating effect and thus promote the regeneration of the tendons and ligaments as well as mobility. A bandage leads to increased stability in the knee joint and helps to keep the kneecap in its anatomical splint.
In the case of patellal lateralization, the kneecap is displaced outwards. This increases the risk of dislocation. Insoles can help stabilize the knee joint and support gait dynamics.
Insoles are often used for bow legs or knock-knees. In knock-knees, patellal lateralization can occur, so the use of insoles could help here. However, if the cause of patella lateralization is congenital bone dysplasia or ligament lesions, insoles are of little help.