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Patellar Instability is a specialty for Dr. Jeremy Rush's orthopedic practice in San Antonio.
Tell me about the first patellar instability you remember seeing.
Chronic instability up to dislocation
It is a very heterogeneous group
Patella dislocation and patella subluxation
And patella instability
Addressing the first-time dislocator
Be super aggressive with the rehab
Step one: reduce the dislocation
Brace them for a week but then get them moving
Try to get started in PT within one week
See them back about 6 weeks and then again at 3 months
At 6 weeks with effusion makes you think there is a loose body.
Ability to do straight leg raises
Apprehension with manual pressure
Instability vs dislocation.
Dislocation = all the way out – 95% are lateral
- Usually traumatic events
- Some are from anatomic risk factors
Subluxation is partially out of the groove
Instability is a chronic form of Subluxation
First timer tips
Get them to relax
Move them into extension
Calm them and even cover the dislocation if needed
Maybe get them up and it could self-reduce
Top patient complaints/ indicators of patellar instability
Knee feels unstable or it is slipping
Or my knee just hurts
Buckling
Recurrent effusion
Anterior knee pain
Start with rehab
Target
Positive patellar apprehension
J-Sign
Predisposed to instability
Patella alta
Women are at higher risk due to q-angle hyperlaxity
Rotational abnormalities
On exam
J-sign
Apprehension
Lateral pressure
MRI on chronic instability
MPFL damage
If the injury is unclear then I get an MRI to rule out any sort of cartilage or loose body.
A huge effusion indicates a loose body.
Contact:
Dr. Jeremy Rush – IG @satxsportsmedicine
Jeremy – @jhjacksonlat
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