Patella instability explain in detail etiology signs and symptoms and

Patella instability explain in detail etiology signs and symptoms and investigations and evaluation treatment rehab surgeries explain in detail with appropriate illustrative diagrams and images

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"patellar instability" AND treatment

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patellar instability etiology classification signs symptoms investigations treatment surgery 2024

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patellar instability etiology classification signs symptoms investigations treatment surgery rehab

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Here is a comprehensive, illustrated review of patellar instability covering all the major areas you requested. Here is a brief summary of what was covered:

What Was Covered

Etiology

The major anatomical risk factors (the "Dejour quartet") are: trochlear dysplasia (most important - present in 85% of recurrent dislocations), patella alta, elevated TT-TG distance (>20 mm), and increased patellar tilt. These combine with soft tissue deficiency (especially MPFL rupture), lower-limb malalignment (Q-angle, femoral anteversion, genu valgum, tibial torsion), trauma, and ligamentous laxity syndromes.

Signs & Symptoms

Giving way, anterior knee pain, hemarthrosis, patellar apprehension, crepitation, and in acute dislocations - visible deformity. Key exam findings: positive Fairbank's apprehension test, J-sign (maltracking), medial retinaculum tenderness.

Investigations

X-ray: Merchant view (sulcus angle, congruence angle, tilt); lateral (patella alta, crossing sign of trochlear dysplasia)
CT: TT-TG distance measurement (key surgical planning tool)
MRI: MPFL integrity, osteochondral injury, cartilage assessment, Dejour V3.0 grading

Treatment & Rehab

Non-operative for first-time dislocations (brace + rehab emphasizing VMO, closed-chain exercises, hip strengthening). Surgery for recurrent instability or high-risk first-timers.

Surgeries

Ranging from MPFL reconstruction (gold standard, low risk/high reward) to tibial tubercle osteotomies (Elmslie-Trillat, Fulkerson AMZ), trochleoplasty for severe trochlear dysplasia, and osteotomies for malalignment - each with specific indications guided by the patient's unique anatomical risk factor profile.

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