The patella (Latin: shell; kneecap) is a triangular, flat bone disk that is in front of the knee joint and plays a key role in its function. The kneecap is embedded in the tendon of the large thigh muscle (Quadriceps femoris muscle) and takes on the function of a placeholder between the tendon and the knee joint as well as that of a pulley, so that the extension of the lever arm leads to an optimal transmission of tensile force from the thigh muscle to the lower leg.
To keep the patella in its central position in front of the knee joint, it is turned towards the middle of the body (after medial) and to the side (laterally) stabilized by lateral ligaments and guided by the surrounding muscles in their bony gliding groove of the thigh. If, however, there are slight instabilities in the ligament-muscle apparatus that secures it, this can lead to the kneecap leaving its actual sliding channel and shifting to the side.
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This so-called patellar lateralization leads to the fact that, on the one hand, the transmission of tensile force is impaired and, on the other hand, there is increased contact pressure of the patella on the sliding channel, which leads to excessive and uneven loading of the knees. There is increased abrasion of the articular cartilage on the back of the kneecap, especially on the outer surface, which in the course of a painful cartilage disease (Chondropathia patellae) or even to complete, partial cartilage wear (patellar arthrosis).
The reason for the positional deviation of the patella from its plain bearing is usually a fault in one of the systems that stabilize it.
One possible cause can be a bony malposition of the kneecap or the sliding channel, so that, for example, deviations in shape impede physiological sliding.
On the other hand, the reason for patellar lateralization can be instability in the collateral ligaments - especially the medial collateral ligament - so that the kneecap can no longer guide the kneecap adequately and it shifts to the side. This can be the case, for example, after injuries or trauma, but it is also due to congenital ligament instability.
$config[ads_text2] not foundThe third possible cause is an imbalance in the muscles surrounding the kneecap. Do the outer muscles of the thigh predominate and the inner thigh muscles (Vastus medialis muscle) relatively weaker, the patella tends to be increasingly pushed or pulled to the side against the outer part of the plain bearing.
The misalignment of the kneecap or the too far lateral sliding of the patella in the sliding channel is only noticed in most cases when there is already cartilage damage. Occasionally, however, especially during sporting activities such as running, cycling and swimming, an unstable feeling in the area of the kneecap can occur, as if it were "jumping out" at any moment.
If the articular cartilage of the patella is damaged or completely destroyed by the incorrect loading, localized knee pain occurs, which is usually felt during movement in the knee joint in the front of the knee, directly behind the kneecap or in its immediate vicinity. These pains are provoked in particular by walking downhill and down stairs as well as when getting up from a sitting position (so-called “theater knee”).
Read more on the subject at: Pain behind the kneecap
The painful cartilage damage can be accompanied by a general irritation of the knee joint, which manifests itself in the form of knee swelling and effusion.
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The knee joint is one of the joints with the greatest stress.
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In many cases, patellar lateralization can already be diagnosed through a physical examination. While lying down, lateralization can be detected by observing the patellar movement during passive and active movements in the knee joint (transition from the extended to the flexed knee), and clinical tests can also provide an indication of collateral ligament instabilities, muscle shortening or imbalance, deviations in the mobility of the patella from their slide bearing as well as existing knop damage (e.g. Zohlen sign). In some cases, compression pain may even be noticed when pressure is applied to the kneecap.
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In addition, imaging can facilitate or support the diagnosis, whereby various methods can be used. The method of choice is a simple x-ray of the knee joint, in which the centering of the patella can be precisely assessed, as well as x-rays in 30 °, 60 ° and 90 ° functional positions. In addition, sonography enables targeted examination for pathologies or changes in the tendon of the quadriceps muscle, while magnetic resonance imaging enables a detailed assessment of the ligament and cartilage structures.
Read more on the subject at: MRI of the knee
A treatment of the patellar lateralization is usually only considered when symptoms arise that lead to the patient being restricted in everyday life.
It usually begins with a simple, conservative therapy, whereby the causal disparities in the muscle-ligament apparatus of the knee are to be remedied by physiotherapy. The aim of the regularly performed exercises in the company of a professional physiotherapist is to compensate or correct the imbalances in the thigh muscles through muscle strengthening, muscle stretching and coordination exercises. The main focus here is on strengthening the vastus medialis muscle (the medial part of the quadriceps muscle), stretching the ischiocrural muscles and the iliotibal tract and improving the coordination of motion sequences in the knee joint. In many cases, centering the patella and better sliding in the slide channel can be achieved in this way.
Wearing knee braces or the professional application of tapes, which can compensate for instability of the kneecap or the lateral ligaments of the knee joint, can also have a supportive effect. In addition, the short-term administration of pain relievers and anti-inflammatory agents (e.g. ibuprofen, diclofenac) can ease the symptoms.
However, if conservative therapeutic measures are unsuccessful or if there is already massive cartilage damage to the patella, in some cases only surgical treatment can lead to symptom relief. Various surgical methods are available, which are either minimally invasive, arthroscopic or open surgery:
$config[ads_text1] not foundGathers of the medial knee joint capsule parts are possible (medial retinaculum), Splits of the lateral knee joint capsule parts (lateral retinaculum), a plastic of the medial collateral ligament (MFPL reconstruction), a bony injury to the kneecap ligament (loosening of the Ligamentum patellae-Set on the shin and move the attachment further medially).
There are various exercises to counteract patellar lateralization. The main aim of the exercises is to train the vastus medialis muscle. This thigh muscle is responsible for stretching the knee joint and guiding the kneecap. Strengthening the thigh muscles can reduce the risk of patellar dislocation. Typical exercises for the thigh are leg presses or deep squats. In addition, exercises with the Theraband are useful to strengthen the external rotators. To do this, the Theraband should be stretched around the knee joints and the legs should be moved apart with the hips bent.
Kinesio tapes are often used for patellar lateralizations and dislocations of the kneecap. The tension of the tape strengthens the stability in the knee joint and promotes blood circulation. It thus promotes healing in injured ligaments or muscle structures. Rapid healing and strengthening of the thigh muscle leads to a strengthening of the patellar ligament and prevents dislocation.
Read more on the subject at: Kinesio tape
A knee brace can help with patellar lateralization and prevent dislocation of the kneecap. Bandages relieve the knee joint and relieve pain. They also have an activating effect through compression and thus promote the regeneration of tendons and ligaments as well as mobility. A bandage leads to increased stability in the knee joint and helps to keep the kneecap in its anatomical splint.
Patellar lateralization results in an outward displacement of the kneecap. This increases the risk of a dislocation. Insoles can help stabilize the knee joint and support gait dynamics. Insoles are often used for bow or knock knees. Patellar lateralization can occur with knock knees, so the use of insoles could help. However, if the cause of the patellar lateralization is congenital bone dysplasia or ligament lesions, insoles are of little help.
Read more on the subject at: Knock knees
