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