Charles V. Toman, MD - 4/14/2009

Question
hello this is kevin jeffrey, i have been going to physical therapy to center my patella. a few days ago i took a big fall while longboarding. as i fell my knee twisted and i sprained it the next day after it gave out while walking up the stairs. i went to the doctor and she said that the patella is possisioned way to the left. is that a bad thing, surgery or what would be the next step?

Answer
Kevin,

First of all sorry that you are having to deal with this.  It sounds like you may have dislocated or subluxated your patella.  What this means is that it slid out of place probably to the outside.  This usually occurs when your leg is moving from a flexed or bent position to an extended position.  When it slides over you can have significant pain and here a kind of pop sound.  If your knee cap sits laterally or to the outside, this can lead to pain and a sense of instability.  Some people refer to this subluxation as "J" ing of the patella.  This means the patella kind of goes up straight and then kind of veers off to the outside of your knee as your leg comes into full extension.

The first step in treatment for this condition is physical therapy to strengthen your vastus medialis and vastus medialis obliquus.  These muscles are components of the quadriceps muscle on the front of your thigh.  They are situated on the inside part of your thigh and insert near the knee cap.  Their function is to help stabilize and center the knee cap.  if the structures on the outside are tight and the structures on the inside are loose or weak, then your knee cap will pull to the outside.  It's kind of like the reins you would have on a horse.  if you pull on one the horse pulls to that side if you pull on both equally the horse goes straight.  

So if you are pulling to the outside you can try to strengthen your inside muscles with therapy and things like cycling.

If this fails there is a procedure called a proximal patellar realignment which requires a mall incision and serves to loosen the tissues on the outside and advance or tighten up the structures on the inside.  

I would see an Orthopaedic surgeon who specializes in knee or sports medicine to treat this condition.  Most patients are able to stabilize the knee cap with exercises and strengthening.

Hopefully this has been helpful.  Please let me know if you would like me to elaborate on any of these topics in greater detail.