Treatment for a patient with acute patella dislocation involves both conservative management and, in some cases, surgical intervention. Here's a summary of the treatment approach and indications for surgery:
Conservative Management: The first step is to perform a reduction, which involves manually realigning the patella back into its proper position, usually by extending the knee. This is often very painful and might need conscious sedation with adequate monitoring in an emergency room.
Following reduction, the knee is typically immobilized in a brace (ideally in 20-30° of flexion as this keeps the patella in the trochlea groove and avoids an elongated healing of the medical patellofemoral ligament) for 2-4 weeks. Weight-bearing may be restricted initially. Once the acute phase has passed, physical therapy is initiated to strengthen the surrounding muscles, improve knee stability, and enhance range of motion. Rehabilitation focuses on restoring full function and returning the patient to their pre-injury activities. It includes exercises to improve strength, balance, and flexibility.
Indications for Surgery:
Surgical intervention may be considered in certain cases of acute patella dislocation, especially if there are associated risk factors or complications. Indications for surgery includes recurrent instability despite conservative treatment or if there is a high risk of recurrent dislocations. These risk factors are underlying anatomical abnormalities contributing to patella instability, such as a shallow trochlear groove, a patella which is situated to high (patella Alta) or a misalignment of the bones. Also, if there is substantial damage to the surrounding ligaments (e.g., medial patellofemoral ligament) or tendons, surgical repair or reconstruction may be required.
Surgical Procedures:
The type of surgery performed for acute patella dislocation depends on the specific patient and the underlying factors contributing to the instability. Common surgical procedures include:
Medial Patellofemoral Ligament (MPFL) Reconstruction: This procedure involves reconstructing or repairing the torn MPFL to stabilize the patella and prevent further dislocations. For this usually a hamstring graft is used.
Tibial Tubercle Osteotomy: In cases where there is a misalignment of the bones, a tibial tubercle osteotomy may be performed to realign the extensor mechanism and improve patellar tracking.
Cartilage Repair: If there is associated cartilage damage, surgical techniques such as microfracture, minced cartilage procedures, or osteochondral grafting may be performed to address the cartilage defect.
It's important to note that the treatment approach should be individualized based on the patient's specific condition, severity of injury, functional demands, and response to conservative measures. Consulting with an orthopedic specialist or sports medicine physician is crucial in determining the most appropriate treatment plan for acute patella dislocation.
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