Putting the Kneecap in Its PlaceWhen the kneecap is out of whack, doctors call the condition patellar malalignment. (The patella is the kneecap.) Patellar malalignment often goes undiagnosed. The author suggests that, when it is diagnosed, doctors are sometimes too quick to use surgery as the first treatment.
There are two kinds of symptoms related to patella problems, slipping and pain. Patients who feel the patella slip, or even dislocate, usually have mechanical problems with their knee. Patellar pain, on the other hand, isn't fully understood by doctors. Many patients with patellar malalignment don't feel any pain. Others do. Factors such as an injury or overuse seem to trigger the pain. Other disorders may cause the pain, such as nerve or blood vessel problems or inflammation of the patellar tendon. And some conditions can cause patellar pain even when the patella is correctly lined up.
The author discusses a number of ways to identify patellar malalignment. Foot problems, tightness of the muscles around the kneecap, and pain in certain knee positions can all suggest patellar malalignment. Most cases of patellar malalignment don't require fancy testing or surgery. The pain usually goes away with conservative treatments including ice, rest, anti-inflammatory drugs, and physical therapy. Stretching and strengthening exercises have proven helpful as a way to keep the kneecap in better alignment. Knee braces or taping the kneecap may also help center the kneecap, easing pain. In some cases, abnormal foot positions cause the problems in the knee. Orthotics to better align the feet may help in these cases.
When their patients end up needing surgery, doctors have several ways to help. Most types of surgical procedures for this problem are used to improve the alignment of the patella.
Ronald P. Grelsamer, MD. Patellar Malalignment. In The Journal of Bone and Joint Surgery. November 2000. Vol. 82-A. No. 11. Pp. 1639-1651.
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