Dislocation of the patella: treatment and surgery

Dislocation of patella

Under the dislocation it is customary to understand the deformation of the shape of articular joints. This damage is marked by sharp pain.

Dislocation of the patella is the most common knee injury that occurs in children and adults.

Among women, such a pathology is observed more often, since it is associated with anatomical features of the structure of the hip and patella joint.

Symptoms

In acute traumatic displacement in the knee, the patient complains of severe and sharp pain and swelling in the patella. The victim can not move the joint, because any attempts to move with the foot cause intense pain.

With a dislocation, the knee is shifted to the side and increases in volume. Changes in the structure of the knee joint can be felt and determine which direction the displacement occurred. This can be done by an experienced technician during visual inspection.

In some cases, the patella may become in place itself, i. E. there is spontaneous repositioning. The victim still feels discomfort in the joint.

Anatomy and mechanism of dislocation

In front of the knee joint is a rounded bone - a patella. This bone is the largest and located in the thickness of the tendon.

From the inside, the patella is covered with cartilage, supported by ligaments and tendons. They perform a protective function, protect muscles and ligaments from various damages, prevent lateral displacements.

Tendons of the quadriceps femoris attach to the upper surface of the patella with a rounded edge.

Each is attached to the surface of the sesamoid bone and forms a knee joint as a result.

When bending the leg, the patella must be in the central part in the middle of the condyles of the thigh. This situation characterizes the normal condition of the patella.

In case of a fall and stroke, the quadriceps muscle is contracted. Dislocation of the lateral part of the patella appears with an unbent leg. In the bent position of the dislocation it is practically impossible, since the patella closely adjoins the intercondylar joints.

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Predisposing factors

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In most cases, the dislocation of the patella is obtained by athletes, but also occurs among people who lead an active lifestyle. To provoke the appearance of a dislocation can various reasons, the most common are:

• Various knee injuries;
• Osteoarthritis of the knee joint;
• High location of the patella;
• Postponed operations on the kneecap;
• Dysplasia of condyles;
• Abnormal structure of the patella;
• Defects of the shape of the feet.

About the congenital physiological anomalies a person may not know until the moment when the patella is injured. The risk of injury is increased with a shallow nasolar hollow.

Types of dislocation

In traumatological practice, depending on the origin of the injury, congenital and traumatic species are distinguished.

Congenital dislocation of patellais rare among diseases of the musculoskeletal system. The main cause of physiological pathology is the underdevelopment of soft tissues that form the joint.

Acquired or traumatic dislocationappears as a result of an indirect injury. It can be a fall, a strong blow to the knee and other reasons.

Traumatic injury of the patella can be repeated 1-2 times a year. In this case, they speak of a habitual dislocation of the patella.

Depending on how long the damage has occurred,acuteandolddislocation.

Taking into account the direction of displacement, it is distinguished: lateral, vertical, rotational dislocations.

Lateral dislocationappears after falling on the straightened leg or when it strikes the lateral surface of the patella.

Vertical dislocationoccurs rarely and is characterized by the displacement of the patella horizontally with entry into the joint gap.

Rotational dislocationIn contrast to the vertical view, the patella turns vertically around its axis.

Diagnostics

With timely access to the doctor, the acute form of the dislocation can be easily treated and does not go into the old.

If a defect in the calyx is found, it is important to determine the causes that caused this pathology.

Initially, the orthopedist will inspect the damaged area, and then assign a checkup.

X-ray examination is carried out in two projections. Usually two radiographs of each knee are compared. The study is carried out in a standing position in two projections. If necessary, perform X-ray diffraction of the axial projection at different angles.

A more informative and accurate method is computed tomography. This method allows you to determine the slope, but not in the projection distortion.

To confirm the diagnosis and prescribe the right treatment use the method of magnetic resonance imaging.

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Using it, you can determine the exact location and extent of damage to the entire area around the patella.

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This method is not prescribed in the presence of metal structures, a large number of tattoos, etc.

The final diagnosis is made by a traumatologist or orthopedist, given the examination, the clinical course and the results of the studies.

Treatment and operation

In the treatment of dislocation of the patella of the acute form, a conservative method is used that includes several steps.

To reduce pain and swelling of the skin, the affected area is affected by cold. To do this, use cold compresses.

Next, anesthesia is carried out using a solution of novocaine.

After that, the traumatologist carefully adjusts the injured patella in a closed way (finger pressing on the cup) to avoid damage to the cartilage.

After removal of the plaster bandage, a control X-ray examination is performed to determine the accuracy of the correction and to reveal the bone-cartilaginous bodies formed during trauma.

If the dislocation has passed into an old stage and has a prescription more than three weeks, then resort to surgical treatment. Given the degree of injury, the doctor chooses a method of eliminating the damage to the knee cap.

There are the following methods of surgical treatment:

• Arthroscopic stitch of the knee joint according to Yamomoto;
• Operation Heineke-Vredene;
• Operation Campbell;
• Arthroscopic plastic.

Surgical treatment is based on a thorough examination of the damaged area, sanation, and also suturing the fibrous capsule.

After the operation, the patient is given a plaster bandage to immobilize the knee joint. After 2-3 months, mobility returns.

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Dislocation of patella

Dislocation of patellaconstitute, % of the total number of dislocations.

The probability of dislocation of the patella increases with a small kneecap, poorly developed external condyle of the hip, violation of the relationship between the axis of the quadriceps muscle and its own ligaments patella.

Usually, until the time of injury, these anatomical features are not manifested and remain unnoticed. There are lateral, vertical and torsional dislocations of the patella.

Regardless of the type of dislocation, it is accompanied by severe pain syndrome, painfulness and restriction of movements in the knee joint, palpation determined by the patellar bias. Treatment consists in the patellar fixation and fixation with a plaster bandage.

Dislocation of patellaconstitute, % of the total number of dislocations. The patella is a small round flat bone located on the front surface of the knee joint.

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On top of the patella are attached the tendons of all four heads of the quadriceps femoris muscle.

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Fibers of tendons cover the patella from all sides and form a patellar patch in the region of its lower pole.

The patella is in a small cavity, held in place by the tendons of the quadriceps muscle and supporting ligaments (external and internal). A certain role in limiting the mobility of the patella is played by the condyles of the femur.

Predisposing factors

The probability of a patellar dislocation increases with a small kneecap, a poorly developed external condyle of the hip, violation of the relationship between the axis of the quadriceps muscle and its own patellar ligaments. Usually, until the time of injury, these anatomical features are not manifested and remain unnoticed.

Classification of patella dislocation

Traumatology distinguishes acquired (traumatic) and congenital dislocations of the patella.

Depending on the prescription of the injury, a sharp and chronic dislocation of the patella is isolated. If the dislocation occurs repeatedly, they talk about the habitual dislocation.

In the direction of displacement are distinguished:

• lateral dislocations of the patella (external and internal);
• torsional (rotational) dislocations, in which the patella turns around its vertical axis;
• vertical dislocations, in which the patella turns around its horizontal axis and wedges into the joint gap between the tibia and femur.

Most often there is an external, less often - internal dislocation of the patella. Torsion and vertical dislocations of the patella are extremely rare.

As a rule, the cause of the patellar dislocation is a direct trauma (a fall on the knee joint, a lateral blow to the patellar region), combined with a contraction of the quadriceps muscle.

The lateral dislocation of the patella usually occurs with an unbent leg. When bending at the knee joint lateral dislocation is almost impossible, since the knee is tightly pressed to the intercondylar surface of the femur.

In rare cases, with a bent shank, a vertical dislocation of the patella is possible.

Symptoms of patella dislocation

Sharp traumatic dislocation of the patella is accompanied by sharp pain. The knee joint is slightly bent, enlarged in volume, expanded in the transverse direction (with lateral dislocations).

Active movements are impossible, passive painful and sharply limited. Palpator determines the direction and degree of patellar bias.

When fully dislocated, the patella is located outside of the lateral condyle of the thigh, with the incomplete - located above the lateral condyle.

Sometimes the traumatic dislocation of the patella sets in independently.

After self-healing dislocation of the patella, there is a slight or moderate swelling in the knee joint area. Possible hemarthrosis (accumulation of blood in the knee joint).

Diagnosis of patella dislocation

The diagnosis of a patellar dislocation is made by a traumatologist on the basis of a characteristic history, clinical picture and radiographic data.

The comparative radiographs of both patellae, drawn in the tangential direction of the x-rays from the front and from the top to the bottom or from the bottom upwards, are most informative.

The basis for diagnosing the habitual dislocation are repeated patellar displacements that occur without pronounced traumatic effects.

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The habitual and chronic dislocations of the patella may be an indication for MRI of the knee joint.

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When solving the question of the expediency of the operation, diagnostic arthroscopy of the knee joint is performed.

Treatment of patella dislocation

Sharp dislocation of the patella is usually treated conservatively. Produce a dislocation direction under local anesthesia.

The limb is bent in the hip joint (to ease the tension of the quadriceps tendons) and unbend at the knee joint.

Then gently move the patella to eliminate the dislocation and impose a plaster bandage.

At an acute dislocation of the patella, immobilization is shown for 4-6 weeks. Massage and physiotherapy are carried out under the supervision of a physiotherapist, without removing the linget.

Full load on the leg is allowed a month after the injury.

Surgical treatment of acute patellar dislocation is performed when bone-cartilage bodies are identified and the probability of repeated dislocations due to changes in the knee joint is high.

The old and habitual dislocations of the patella are an indication for surgical treatment. After the operation, immobilization is shown for a period of 4-6 weeks.

The full volume of movements in the knee joint is allowed after 8-10 weeks.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/patellar-dislocation

Dislocation of patella

A knee cap or patella can be a source of pain in the knee joint.

The joint between the femur and the patella calls patello-femoral. If the anatomy of the patello-femoral joint is not changed, in order for a patellar dislocation to occur, a very large force is required.

However, if there is an anomaly in the patello-femoral joint, the probability of patella dislocations increases dramatically.

As a result of improper functioning of the patello-femoral joint, there is an increased wear of the patella and femur cartilage, and subchondral fractures may also form.

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A painful condition in which there is a loss of cartilage in the joint is called arthrosis of the patello-femoral joint.

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Problems in the patello-femoral joint can be present in people of different ages. This article will help you understand what problems can arise in the patello-femoral joint, and how they can be solved.

The patella is an oval bone with two articular surfaces separated by a vertical crest.

The patella is located on the front surface of the knee joint. The patella moves in the intercondylar groove of the femur. The joint, formed by the patella and the femur bone in medicine, is called patello-femoral.

With the tension of the 4th head of the thigh muscle, its tendon pulls the patella, the latter in turn for its own patellar band and tibia, thereby unbending the knee.

The surface of the patella, facing the femur, is covered with a smooth and slippery cartilage which is called articular. This cartilage allows you to slide the patella relative to the femur in the intercondylar sulcus.

Lateral and medial head 4-th chapter of a muscle of the thigh, patello-femoral and patelo-tibia ligaments also attach to the patella and help control its position in the intercondylar furrow.

The friendly action of the muscles and ligaments keeps the patella from dislocation.

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One of the most common causes of pain in the patello-femoral joint is a violation of the patellar motion in the intercondylar sulcus.

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The head of the quadriceps and ligaments help center the patella in the intercondylar fissure of the femur during movements.

For various reasons, an imbalance in muscle traction is possible, as a result of which one of the heads pulls the patella more than the other.

This, in turn, causes a large patellar pressure on the articular cartilage of the intercondylar sulcus on one side compared to the other. Constant overpressure causes damage to the articular cartilage.

Another cause of problems in the patello-femoral joint is the anomaly of the structure.

In medicine, this condition is called valgus deformity of the knee joint.

In cases where the angle increases, the vector of traction of muscles and ligaments affecting the patella changes, so when moving the patella tends to dislocate outward from the furrow.

In this case, the cartilage in the outer part of the intercondylar groove of the femur undergoes more pressure when moving. If this effect occurs for a long time, first softening starts, and then the cartilage is destroyed. This phenomenon is called the patella chondromalacia.

Finally, the dislocation of the patella can occur if one of the walls of the intercondylar sulcus, often external, is less developed than the inner one, or the depth of the intercondylar sulcus is not sufficient to retain the patella from dislocation. In these cases, the patella also tends to dislocate from the joint. With repeated dislocations, there is a rapid degeneration of the cartilage of the femur and patella and causes the patient a persistent severe pain syndrome. It should be noted that dislocations and subluxations tend to relapse, as the surrounding patella-supporting ligaments are stretched or damaged, and the condyles of the hip are abraded.

People who have a patella located too high relative to the femur are also at risk. In this part of the femur, the intercondylar sulcus is not expressed, so even a slight impact on the patella causes a dislocation.

Complications of patellar dislocation can be considered subchondral fractures.

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A subchondral fracture occurs when the patella jumps over the femoral condyle during a dislocation, at which moment a piece of bone or cartilage may split off from the femur or patella. A fragment of bone or cartilage remains in the cavity of the knee joint and causes blockade.

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Dislocation of the patella is often found in women from 20 to 30 years and in men under 40 years. Most often the dislocation of the patella spontaneously corrected when the knee is unbent. If the dislocation is not eliminated and the patient is taken to the hospital, the elimination of the dislocation does not cause any difficulties.

Provided that the patient is the first case of dislocation, he is most likely to say that he felt like "the knee flew to the side" or "dislocated." The patient also notes a noticeable deformity of the joint and swelling around the kneecap.

During the examination, the doctor should always detect damage to the articular cartilage of the patella and the femur, which often accompany the dislocation of the patella.

If articular cartilage or bone is damaged, when the contents of the joint are aspirated, droplets of fat will appear in the blood.

Dislocation of the patella occurs in most cases in the lateral (external) side. In this case, the medial stabilizers of the patella are damaged.

Accurate palpation with your fingertips in the joint area allows you to determine the location of the lesion.

Usually, the soft tissues become wilted along the medial edge of the patella.

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In this area, the medial patello-femoral ligament (MPFL) and the medial broad thigh muscle are attached to the patella.

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With dislocations, these structures are more likely to burst. Also, with palpation and load on the patella, its increased mobility is determined, more to the outside.

The patient is usually delivered to the hospital with a dislocated dislocation. Dislocation spontaneously recuperates at the prehospital stage with extension of the leg.

When the patient is admitted to the hospital, the radiograph of the joint is performed.

On radiographs, it is possible to identify concomitant subchondral lesions, rarely if dislocation was not was removed earlier, the pictures show the dislocation of the patella from the intercondylar groove of the femoral bones.

Patients with habitual dislocation most often talk about several dislocations in the past. Previous dislocations in the patient were accompanied by acute pain, edema and hemarthrosis.

Some stress tests cause the patient to feel "anxious" or "afraid" that the patella will dislocate during the study.

X-ray examination is one of the most important in the diagnosis of diseases and injuries of the patello-femoral joint. In some cases, MRI is used to diagnose damage to the patello-femoral joint.

The advantage of this method is great information and painlessness.

Recent advances allow doctors to see articular cartilage and determine whether it is damaged or not. It is important that this study does not require the introduction of dyes into the joint.

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In some cases, arthroscopy can be used to establish a definitive diagnosis.

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Arthroscopy is an operation that involves placing a small optical device inside the joint, allowing the surgeon to see the structures inside the joint directly.

The arthroscope allows the doctor to see the condition of the articular cartilage on the inner surface of the patella.

The vast majority of problems in the patello-femoral joint are diagnosed without resorting to surgery, and arthroscopy is commonly used to treat problems identified by other survey methods.

Some of them experience vague pain in the knee joint, sometimes around or along the inner edge of the patella.

As a rule, people who have problems in the field of patello-femoral joint experience pain when walking down the stairs.

Finding a patient in a sitting position for a long time with a bent knee joint, for example in a car or movie theater, can also cause pain. Often a patient can hear a crunch when moving in the knee. If the cartilage is significantly worn out, inflammation in the joint can occur and even accumulate fluid.

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If conservative treatment does not improve your condition, surgical treatment may be offered. There are various methods to diagnose and successfully treat problems associated with patella. In some, especially complex cases, their combination may be required.

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Arthroscopy is one of the most effective ways to treat diseases and knee joint injuries.

Examining directly the articular surface of the patella and femur, the surgeon can evaluate the localization and degree of wear of the cartilage.

The doctor can also observe how the patella moves in the femoral bone cut with movements in the knee joint and assess the degree of patellar dislocation (subluxation).

If the patellar articular cartilage is damaged, the doctor with the help of a special tool can treat the damaged areas of the cartilage, smooth out the roughness of the cartilage, which can reduce pain.

Arthroscopy is performed through the minimally possible puncture of the skin, thus achieving an excellent cosmetic effect.

During arthroscopy, it is possible to eliminate the consequences of a patella dislocation. Often with repeated dislocations, pieces of cartilage are broken into the joint cavity.

In patients with habitual dislocation, the patella is in a state of subluxation in the lateral direction. During arthroscopic surgery, it is possible to perform a lateral release.

The essence of the operation is the dissection of the ligaments along the outer edge of the patella, thereby the patella is displaced from the state of subluxation to the normal position to the center of the furrow of the femur, and the load on the cartilage decreases.

Also, during arthroscopy, the tissue along the inner edge of the patella can be tightened, to perform a capsuloraphy (Yamamoto operation).

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Performing a lateral release and Yamamoto operation allows you to balance the traction of the quadriceps muscle and thereby evenly distribute the pressure on the patella cartilage.

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In some cases, a strong patellar dislocation, lateral release, and Yamamoto's operation may not be enough.

In addition to the lateral release, an operation can be performed, the purpose of which is to strengthen the ligament apparatus located along the inner edge of the patella (MPFL).

There are various operations that achieve this goal.

With some of them, a transplant is formed, which is attached to one side of the patella, and on the other to the femur. Due to this operation, the patella during movements in the knee joint is not able to move to the position of dislocation or subluxation.

Arthroscopic surgery is usually performed under spinal anesthesia. In the hospital you will need to spend one or two nights.

In our clinic, we widely apply arthroscopy and other minimally invasive methods of treating the pathology of the knee joint.

The operations are performed on state-of-the-art medical equipment using high-quality and proven consumables and implants from major world manufacturers.

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However, the result of the operation depends not only on the equipment and quality of the implants, but also on the skill and experience of the surgeon. The specialists of our clinic have extensive experience in the treatment of injuries and diseases of this localization for many years.

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Dislocation of the patella: treatment, symptoms and first aid

Traumatic damage in the form of a patellar dislocation occurs relatively infrequently, according to statistics only in, % of cases of all traumatic injuries.

Nevertheless, the trauma poses a lot of problems: both to the treating doctor and the patient, as it causes difficulties in treatment and rehabilitation, as well as a high risk of re-development.

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Structure

The patella is a small bone, which belongs to the class of sesamoid.

Sesamoid ossicles are the accreted and degenerate parts of the ligamentous apparatus that are located near the joint.

So, for example, there are sesamoid bones of the foot, located next to numerous small ones. The patella is the largest bone of the generation of sesamoid.

It is located at the front joint.

It is a flat bone that has two surfaces: articular or internal, facing the the outer surface of the articular capsule of the knee joint, it is covered with hyaline cartilaginous tissue, and outdoor. Bone formation is triangular in shape, facing upward.

The patella is fixed with the help of ligaments and tendons. From the top to the patella are attached the tendons of the quadriceps muscle of the thigh: the straight and intermediate, lateral and medial broad muscles of the thigh. From below, it is connected to the tibia by a direct ligament. Education is flexible, performs the following functions:

1. Protective: protects the capsule of the joint and serves as a shield;
2. Block: it does not allow re-bending to the knee joint;
3. Stabilizing: supports the shape of the knee joint.

To the outer surface of the cup is prednadkolennikovaya bag, due to which there is movement. The nadnadkolennikovaya bag is located under the connection with the quadriceps femoris muscle, and under the apex and a direct ligament there is a podnakolennikovaya bag.

Varieties

Dislocation of the patella is divided into:

• Congenital dislocation. Diagnosed in children in the first 3 years of life, the occurrence is 3 times more common in the male population. Pathology is characterized by a "breakdown" in intrauterine development in the period of embryogenesis, accompanied by a violation of neuromuscular development and is often combined with deforming in the condyles of the femur. At the child the first complaints arise in preschool and younger school age;
• Acquired or traumatic. It occurs as a result of the impact of the traumatic factor on the joint with a force exceeding the compensatory capacity of the ligament apparatus;
• A habitual dislocation of the patella. The frequency of occurrence in humans 2 or more times a year.

It flows according to the type of acute or chronic process. The aged is typical for the usual pathology. Depending on the mechanism at which a traumatization occurred, the disease is divided into types:

1. Vertical. There is a horizontal migration of the sesamoid bone and its entry into the interarticular gap with the capsule breaking through;
2. Rotary. Injury results in the rotation of the calyx of the knee around its axis;
3. Side. The impact force occurs on the side of the calyx, or when the leg is dropped in the extended position. It is also divided into:
   • Lateral dislocation;
   • Medial dislocation.

Also, depending on the damage to the skin can be an open or closed dislocation.

First aid: what to do

If a patellar dislocation is suspected, you must:

1. Call the SMP team to transport the victim to a specialized medical institution;
2. Immobilize the lower affected limb in the straightened position, to prevent the progression of the disease and prevent more traumatization;
3. Apply ice or a piece of frozen meat, pre-wrapped with a cloth. This will reduce swelling and inflammation, due to vasospasm due to exposure to cold;
4. If possible, anesthetize with intramuscular injection of an analgesic: Ketanov, Dexalgin, Spasmalgon, and others. Oral administration has a less pronounced effect.

Which doctor should I go to

Pathology is in the full competence of a trauma doctor. Thus, the injured patient is delivered to a 24-hour emergency room.

In case of a chronic or habitual dislocation of the calyx of the knee joint, the patient is observed by a trauma doctor in a polyclinic.

With frequent relapses of a habitual dislocation, the patient can independently fix the cup, although it is better to consult a doctor anyway!

Symptoms and signs

With a congenital dislocation of the patella, the lesion is often one-sided. The calyx, when viewed, is shifted to the bow. On a direct x-ray image, the patella is reduced in size, compared to the healthy side, its lateral position is noted.

The calyx is running (changing its position) with flexion and extension: more often with full extension in the knee, it returns to its normal position, and when folded, it shifts. Gradually, with the growth of the child, clinical manifestations worsen: blocks in the joint are formed, while movements are impossible and the child falls when walking.

Pain is associated, due to regular traumatization of the ligamentous and articular component, bursitis develops, with damage to the blood vessels - hemorrhages in the knee joint cavity. In acute dislocation, the following symptoms are observed:

• The sharp pain is sharp, because of what movements are impossible;
• Visible deformation of the left or right knee;
• Due to edema and inflammation there is a significant increase in joint volume, local hyperthermia and skin hyperemia;
• Absence of pulsation of arteries below the knee (a bad diagnostic sign, since it indirectly indicates damage to the arterial vessel, with the prolongation of therapy, irreversible ischemic changes of the shin are possible);
• Paresthesia or hyposthesis of the shin: numbness, fever or cold, itching (an indication of the destruction of peripheral nerve plexuses).

Clinical features of habitual dislocation, usually indicate a subacute course of the disease:

1. Discomfort when walking;
2. Drawing combat feelings;
3. Knee deformation;
4. Slight increase in volume, due to edema.

Treatment

Treatment for a dislocation of the patella is carried out by a trauma doctor. Depending on the type of fracture and its severity, tactics of reference are chosen: conservative or operational.

Conservative treatment consists in adjusting the calyx. Then fixation is made before healing by gypsum.

If necessary, a puncture of the joint is first performed to drain the accumulated effusion or blood, if the vascular component is damaged.

Operation

If the patient is ineffective, surgery is recommended.

It is carried out with the help of arthroscopic method: using optical endoscopic equipment. The most common operation is capsuloraphy.

In principle, capsulorrhaphy consists in fixing the upper part of the patella with the seams of Yamomoto to the capsule of the knee joint.

This operation is effective for the therapy of habitual dislocation, since it stabilizes patellar movements and the influence of the quadriceps muscle, due to which the distribution of the effect on the cartilaginous component. In some severe cases, additional fixation of the ligamentous apparatus

At home

Then the limb is bent in the hip at a right angle, the knee is completely unbent.

Finger pressing on the patella is replaced with a sesamoid bone, while the patient feels the "chamber".

Then it is recommended to immobilize the limb with a tight bandage of elastic bandage or a rigid orthosis.

Rehabilitation and recovery

Rehabilitation measures are taken after absolutely any kind of patella injury, including after the habitual dislocation of the knee cap. The duration of rehabilitation by time takes from two months to a year, depending on the severity of the lesion. Rehabilitation includes:

1. Massage. It is performed immediately after removal of the dressing, the main task is to improve blood circulation, increase reserve regenerative capacity, restore and prevent muscle contractures.

2. Passive movements of the knee joint. Produces physician-physiotherapist, gently passively bends and unbends the knee, rotational movements crusher. This causes unpleasant feelings in the patient, sometimes painful, so sometimes anesthesia is required before the procedure.

3. Physiotherapy. It is carried out by various methods of combining:

• Electrotherapy. Electrophoresis with calcium, local anesthetics, nicotinic acid - thereby improving drainage lymphatic activity, blood circulation, accelerating regeneration processes;
• Thermal applications. Use paraffin or ozocerite, topically apply to the affected area, also improves blood flow, eliminates stagnant phenomena;
• Vibromassage. Allows to achieve deep structures of the knee joint, prevents the development of chronic arthrosis;
• Dorsenvalization. Electric discharges reduce inflammation, pain, help reduce puffiness and other types of physiotherapy.

4. Exercise therapy. After the doctor has developed a leg, the courses of therapeutic gymnastics begin. The patient independently tries to make movements, the complex of exercises for strengthening muscles of an anticnemion and a femur is selected with the minimal loading on a knee.

How much to go in plaster

The duration of the casting depends on the severity and complexity of the medical manipulations, the premorbid background of the patient, his age, concomitant pathology and other factors. On average, walking in a plaster is necessary for a period of at least 6 weeks.

With surgical intervention on the usual dislocation, prolongation is possible up to 8 weeks. If the patient is elderly with signs of osteoporotic and osteochondrosis changes, the gypsum may persist for up to 2 months.

Effects

With timely and correct treatment of patella dislocation, the consequences are most often avoided. With the wrong treatment tactics, or prolongation of therapy, a transition to a chronic stage is possible.

Chronic arthrosis of the knee joint develops, the aggravation of which can occur when minor traumatism, meteorological changes, during cold whitening with a decrease immunity.

It can be accompanied by intra-articular effusion, limitation of amplitude of movements, etc. The most formidable complication is the transition of the acute form into a habitual dislocation. This prolongs treatment and is an indication for prompt intervention.

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Dislocation of the patella: causes, symptoms, treatment and rehabilitation

The dislocation of the patella is an unpleasant pathological condition in which a knee cap is displaced from the person.

Structure of the joint

So, the presented joint is one of the most mobile and loaded in the human body. It includes an oval bone (patella), which covers the muscles and ligaments, protecting them from damage.

Its balance is ensured by the ligaments of the quadriceps muscle of the thigh, its own ligament, and also by other muscles.

A patellar patch, as well as the bone itself, plays an important role in limb movement. These joint elements provide the quadriceps muscle with sufficient force to bend the leg. Any injury to this part of the knee is fraught with serious complications, as well as restriction of human mobility.

Types of pathology

The dislocation of the patella can be classified as follows:

1. Congenital. This type of pathology is extremely rare. The main cause of this condition is considered insufficient development of tissues, of which the joint was built.
2. Traumatic, or acquired. In this case, the damage results from a fall or direct impact. If the patellar bias occurs more than once a year and is periodic, then a dislocation in this case can be called habitual.

In addition, the pathology is acute and chronic. And you can classify the dislocation in the direction of bone displacement:

• Rotary. The patella moves around its axis.
• Side. It appears as a result of a fall on the unbent shin or stroke.
• Vertical. This type of injury is extremely rare. The bone here shifts in the horizontal plane and enters the joint space.

And still it is possible to divide a pathology on degree of displacement of a bone:

1. Easy. In this case, the patient practically does not feel pain, and the trauma itself can be detected only when examined by a doctor, by accident.
2. Average. Here the gait of the victim is already changing, he can often fall.
3. Heavy. It is characterized by very severe pain, as well as a complete restriction of leg mobility. Muscles of the thigh are tightened, but the person's health is deteriorating.

Causes of the disease

A patellar dislocation can be provoked:

• Direct injury (side impact, sharp turn).
• Defect in the structure of the joint.
• Too much muscle tension.
• Physiological features of the body.
• Inflammatory degenerative knee diseases.
• Operative intervention on the joint.
• Dysplasia of the condyle of the thigh.
• Falling from a height.

In addition, the patellar ligament may not perform its functions well enough. These causes of patella dislocation are quite common. However, they can also be warned.

Symptomatology of pathology

Before starting treatment, it is necessary to understand how pathology manifests itself. So, if a man has a dislocation of the patella, the symptoms are as follows:

1. In the injured area there is a strong and sharp pain.
2. The knee cap is deformed.
3. An obvious patellar shift to the side or up and down.
4. A person can not bend or unbend a knee, lean on his leg.
5. Unpleasant feelings are gradually amplified.
6. The appearance of edema in the affected area.
7. Redness of the skin.
8. Sensation of instability of the joint.
9. Increased temperature in the area of ​​the affected joint.

If one or more of the symptoms presented are present, the doctor should be contacted immediately. Otherwise, the patient can expect serious complications. Also, do not patch the patella yourself, because you can make it even worse.

Diagnostic features

Naturally, the patient needs to undergo a thorough differential examination. The point is that it is necessary to distinguish the dislocation and fracture of the patella, and also to exclude other pathologies. Diagnosis involves the use of such methods:

• External examination of the patient, palpation of the injured knee, and fixation of complaints.
• Radiography. And it is necessary to make a comparative picture of both joints. X-rays are made in several projections.
• MRI. The procedure allows you to get the maximum clinical picture, which will give an opportunity to prescribe effective therapy.
• Arthroscopy. This procedure is both diagnostic and therapeutic at the same time. It is used for research if other methods have proved to be of little informative.

Based on the information received, a traumatologist or orthopedist will describe the scheme of treatment and rehabilitation of the patient.

Conservative treatment of dislocation

Immediately after getting injured, a cold should be applied to the damaged area. This will calm down internal bleeding (if any), relieve swelling and reduce pain syndrome. Naturally, the limb is better to immobilize and call a doctor or go to the emergency room.

Further actions of doctors are as follows:

1. The injured part of the leg should be anesthetized. In this case, an injection method is used, since it provides a quick effect.
2. The patella should be carefully adjusted so as not to damage the cartilage and not increase the risk of complications.
3. On the foot you need to impose a fixative bandage or gypsum. The duration of its application is 6 weeks.
4. Through gypsum, the joint should be heated with UHF.
5. After the bandage is removed, the specialist makes a control X-ray study.
6. Next follows the period of restoration of the functionality of the joint.

Operative intervention

If the patient has a patellar fracture, or if conservative therapy is ineffective, surgery is applied.

The surgeon makes a puncture of the joint, removing the accumulated liquid inside it.

After the intervention, the patient will have to undergo another course of recovery, the duration of which is at least 9 weeks.

There are such types of surgery:

1. Open plastic of the medial ligament.
2. Arthroscopy.
3. Transposition of the distal attachment of the ligament.

Early and correct operation can eliminate hemarthrosis, damaged parts of the cartilaginous tissue, sew and fix the joint capsule.

It should be noted that if a dislocation is accompanied by a rupture of ligaments, then it is impossible to sew them.

The expediency and necessity of carrying out the surgical intervention is determined by the doctor.

Rehabilitation after trauma

The recovery process must be performed under the close supervision of the orthopedist. Rehabilitation includes the feasible load on the damaged joint, strengthening muscles, massage, as well as physiotherapy procedures.

The patient is selected individual complex of physical exercises, which will restore the amplitude of movements and functionality of the knee in full.

Naturally, do not overload the articulation too much, especially during the postoperative period. For muscle training, flexion and extension exercises are used.

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In this case, the angle should not be large.

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During rehabilitation of the knee joint, the patient can use special fixing bandages, which will not allow the cup to move again.

Prevention of pathology and possible complications

To dislocation of the patella did not occur, it is required to observe such preventive measures:

• Every day you need to perform simple physical exercises that will help strengthen the muscles and ligaments that hold the knee cap.
• It is better to avoid sudden movements and a heavy load on the joint.
• With genetic predisposition or deformity of the joint, it is better to give up dancing, skiing, jumping.

If a patellar dislocation is diagnosed in a person, treatment must be performed without fail. Otherwise, complications are possible.

For example, the patient begins to develop arthrosis of the knee joint. In addition, the dislocation can become habitual. That is, the patella will shift even from a slight physical exertion.

In this case, the therapy becomes somewhat more complicated.

Another complication of the pathology is dystrophy of ligaments and cartilaginous tissue. The patient has weakness in the muscles, which almost does not allow you to move your foot.

A source: http://.ru/article/284992/vyivih-nadkolennika-prichinyi-simptomyi-lechenie-i-reabilitatsiya