Injuries and Conditions : Knee : Patella Malalignment/Dislocation : Treatment : Surgical :
Patella Malalignment surgery
Evaluation of Patient for Surgery
Patients are given a complete physical examination which provides an assessment of the patients overall health.
An examination is given of the range of movement in both the injured and uninjured knee.
Strength and walking (gait) ability is measured and analyzed.
Knee arthrometry is utilized to measure the tightness and stability of the knee.
Expectations for Recovery
A surgically relocated patella, which has been properly rehabilitated, will allow the patient to regain complete strength, stability, and motion of the knee.
Patients that are in good physical condition are likely to recover within four months and will then usually be able to perform at previous levels of athletic intensity.
Patients that are in poorer overall condition will be able to return to previous activity levels, although rehabilitation and physical therapy will tend to be more lengthy and involved.
In all cases, physical therapy is required to restore the muscle strength, flexibility and stability lost during the injury.
Post Operative Recovery
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
Post-op instructions:
After surgery, bracing may be recommended until the patient has regained strength and stability of the knee and he/she can easily extend the leg and do deep knee bends without difficulty.
Close examination of the knee during the subsequent 4-6 weeks is needed to ensure that the knee is correctly healing.
Athletic activities like jogging are usually allowed one month after the procedure. Although often only in a controlled environment such as on a treadmill.
Sport-specific exercises are allowed dependant upon their intensity level and stress placed on the recuperating knee.
Medication and Medical Products
Orthotics An orthotic insert fits inside a shoe and helps position the foot in an anatomically correct position while walking, running, or jumping. Frequently, abnormal foot motion and gait occurs as a result of over-pronation of the foot; most orthotics are used to treat this condition. Over-pronation is a tendency to roll the foot onto the inner edge, loading the inside of the foot and leaving the outer edge almost weightless. A professionally made orthotic insert will exactly contour to the bottom of the foot, and can compensate for over-pronation or other abnormal foot mechanics.
One of two construction methods may be used to create an orthotic; one utilizes a plaster mold of the entire foot to make a moderately rigid insert, the other utilizes a foam impression of the bottom of the foot, creating a more flexible insert. In either case, the finished product must be tilted with small wedges, while other accommodations are made to protect sensitive areas of the foot. The choice of orthotics and design will vary according to the expected use, foot type, and body weight.
Orthotics can be used to treat:
abnormal foot mechanics
patella dislocation or maltracking
patellar tendonitis
general knee pain
ankle instability
Knee Braces Knee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.
Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.
Knee braces can be used to treat:
Pre-operative ACL/PCL ruptures or injuries
Non-surgical ACL/PCL injuries
General knee instability
Pre/post joint replacement with ligament instability
Grade II or III ligament sprains.
Knee: Cold Therapy Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.
Cold therapy can be used to treat:
Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.
Knee Examples include:
Pre-operative ACL/PCL injuries.
Non-surgical ACL/PCL injuries.
General knee pain or swelling.
Soft tissue injuries.
Possible Complications and Risks
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
Loss of extension in the knee is among the most common complications after patella dislocation surgery. Although this complication is not completely preventable, the risk can be minimized if a patient follows a disciplined physical therapy program.
Dislocations may recur during activity if the injury has not completely healed.
Repeated dislocations may cause the knee to become arthritic and unstable.
Injury to the joint is possible if physical therapy becomes overly strenuous for the condition of the knee.
The knee may be subject to arthrofibrosis, the development of a fiber like material that the body sometimes generates in joints after injury or surgery. This condition can limit movement and cause considerable stiffness.
