Patellar Subluxation: Insights on Surgery and Rehabilitation - Orthopedics

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Patellar lateral subluxation, often referred to as patellar instability, occurs when the patella (kneecap) partially dislocates from its normal position in the femoral groove during knee movement. This condition can arise from both congenital factors, such as anatomical abnormalities that predispose an individual to instability, and acquired factors, such as injuries sustained during sports or physical activities. In your case, the history of sports injuries, particularly the meniscus tear and subsequent knee swelling, may have contributed to the development of patellar instability, even if the underlying predisposition was present from birth.

To differentiate between congenital and acquired causes of patellar lateral subluxation, a thorough clinical evaluation is essential. This includes a detailed history of knee injuries, physical examinations, and imaging studies such as X-rays and MRIs. Congenital factors might include a shallow femoral groove, abnormal alignment of the lower extremity, or ligamentous laxity, while acquired factors often relate to trauma or repetitive stress injuries that disrupt the normal mechanics of the knee.

Regarding your recent surgery for patellar lateral subluxation, the patellar elevation procedure (patellar tendon elevation) aims to stabilize the patella and improve its tracking during knee movement. Post-operative rehabilitation is crucial for recovery and involves a structured program tailored to your specific needs. While strengthening the quadriceps is a primary focus, other rehabilitation exercises can also be beneficial.

1. Range of Motion Exercises: Gentle range of motion exercises should be initiated as soon as tolerated to prevent stiffness. This can include heel slides, where you slide your heel towards your buttocks while lying down, and straight leg raises once you have adequate control.

2. Strengthening Exercises: In addition to quadriceps strengthening, consider incorporating exercises for the hamstrings and hip muscles. Isometric exercises, where you contract the muscles without moving the joint, can be beneficial initially. As you progress, you can include closed-chain exercises like wall sits or mini squats, which are safer for the knee.

3. Balance and Proprioception Training: Incorporating balance exercises can help improve stability and prevent future injuries. Simple exercises like standing on one leg or using a balance board can be effective.

4. Stretching: Gentle stretching of the quadriceps, hamstrings, and calf muscles can help maintain flexibility and prevent tightness, which can contribute to instability.

5. Functional Training: As you progress, functional exercises that mimic daily activities or sports-specific movements can be introduced to prepare your knee for return to activity.

It is normal to experience some discomfort or a feeling of resistance when performing exercises, especially in the early stages of recovery. This can be due to swelling, pain, or the healing process of the tissues involved. However, if you experience significant pain, instability, or worsening symptoms, it is essential to consult your orthopedic surgeon or physical therapist for further evaluation and guidance.

In summary, patellar lateral subluxation can arise from both congenital and acquired factors, and your history of sports injuries may have contributed to your current condition. Post-operative rehabilitation is vital for recovery, focusing on strengthening, range of motion, balance, and functional training. Always communicate with your healthcare provider regarding your symptoms and progress to ensure a safe and effective recovery.