What is a Patella Dislocation?

Patellar subluxation is a partial dislocation of the kneecap (patella). It’s also known as patellar instability or kneecap instability. The kneecap is a small protective bone that attaches near the bottom of your thigh bone (femur)

Dr. Jas Chahal, MD, MSc., FRCSC, Orthopaedic Surgeon, discusses The Facts You Need to Know About a Patella Dislocation Knee Injury

 

Dr. Grant Lum, MD, CCFP, Dip Sports Med, discusses What is Patellar Instability of the Knee and How Is It Treated?

Quiz: Do You Understand Articular Cartilage Damage & PRP?

Test your knowledge by answering the following questions:

Questions
True
False
1

An articular cartilage injury can heal on its own.

Explanation:
Once damaged, articular cartilage will not heal on its own.
2

Symptoms of articular cartilage injury includes pain around or under the knee cap.

Explanation:
Symptoms of articular cartilage injury includes pain around or under the knee cap, swelling, and limitations in daily function or sports. The pain may worsen when climbing stairs or straightening the knee.
3

Treatment options depend on the patient and the cartilage injury.

Explanation:
There are patient-specific treatment factors such as age, activity level, function and expectations. There are cartilage-defect specific factors such as the size of the cartilage lesion, where it’s located and whether or not it occurs in combination with other problems in the knee joint.
4

Cortisone is not a treatment option for an articular cartilage injury.

Explanation:
Treatments for articular cartilage injury of the knee includes cortisone or hyaluronic acid or platelet-rich plasma injections, bracing and physiotherapy.
5

Surgical treatments include microfracturing with a special pick.

Explanation:
Surgical treatments include microfracturing with a special pick and De novo, which uses donor cartilage to repair the knee. Orthopedic surgeons in some parts of the world perform a process called autologous chondrocyte transplantation.
(Answer all questions to activate)

Audrey Spielmann, MD FRCP(C), discusses MRI Scans for Knee Injuries and When They Are Important.

Treatment Options For Knee Pain Associated to Articular Cartilage Damage

When doctors contact patients with articular cartilage problems in the knee, usually what they hear about is swelling in the knee, pain, and limitations in function, and that can be in simple everyday activities, or it can be limitations in more advanced activities like sports and work-related function.

Each situation is unique and that’s important to remember, and a lot of what patients have to tell their physician relates to where they’re coming from in terms of their physiological age, their chronological age, their lifestyle, and what their expectations are, and where they want to return.

The treatment options for cartilage problems in the knee depends on various aspects. There’s patient specific factors that we talked about such as age, activity level, function, expectations, and there is actual cartilage defect specific factors that we consider; for example, how big is the cartilage lesion, where is the cartilage lesion location, and does the cartilage lesion occur by itself or in combination with other problems in the knee joint; for example, ligament problems, meniscus problems, and the overall alignment of the entire extremity.

You have to remember what happens in the knee is often a direct result of what happens both above and below. So above we have the hip, the pelvis, and the core muscles, and below we have the foot, and the ankle. So overall you have to consider the overall patient in terms of anatomy, in terms of a cartilage lesion, and in terms of where they’re coming from as an individual.

For the young patient with a lesion in the cartilage that limited to one area, and the rest of their knee is in relatively good shape, there’s actually a lot of options, and the options range anywhere from non-operative treatment that can include injections, such as cortisone, hyaluronic acid, and maybe even platelet rich plasma, all the way to more advanced option, such as unloader braces and physical therapy.

From the surgical side, you have micro fracture, you have other newer treatments like De Novo, which is an allograft or cartilage where donors who have passed away have donated their cartilage so recipients with the appropriate pathology can be treated.

Other alternatives include receiving other types of transplants or cartilage transplants, and in certain parts of the world you can be treated with your own cartilage cells where the cartilage is biopsied, it’s grown in the lab and re-implanted into your knee, and that procedure is called autologous chondrocyte transplantation.

We don’t have that in Canada, but in the United States and Europe it’s widely available. If you’re an individual who has cartilage disease either spread out through the entire knee or a very advanced disease that’s very large and involved both sides of the joint, focal cartilage treatments, such as the ones I’ve talked about may not be appropriate for you. In your situation, you may be better managed with injections.

Once again, in the various types we’ve talked about: braces, physical therapy, and more invasive surgical alternatives, and these include things, such as an osteotomy of your knee, a partial knee replacement, or even a total knee replacement. So ultimately decide what treatment is best for you, and where you fall into the spectrum of cartilage pathology, you need to be evaluated by your local orthopedic surgeon.

If you think what we’ve talked about today applies to you, please contact your primary care physician for a referral to the appropriate specialist or orthopedic Surgeon .

Presenter: Dr. Jas Chahal, Orthopaedic Surgeon, Toronto, ON

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