Do your knees buckle all the time? Let's talk about Patellar Instability!

When you run, climb stairs, or even just walk, do you feel like your knee suddenly 'bends', losing control and falling to the ground? Does it feel like your kneecap (patella) is 'slipping' to one side? Many people have this experience. This is what we are talking about today, the instability of the kneecap, or the medical term `Patellar Instability`. Don't worry, this is a very common condition. Let's explain everything in simple terms.

What exactly is patellar instability?

Simply put, this is when your kneecap (patella) moves back and forth from where it should be.

Think of your kneecap as a train. At the end of your thigh bone (femur), there is a special path, a groove, for this train to travel. We call this the ``trochlear groove.'' Normally, when you bend and straighten your knee, this train, called the trochlear groove, moves up and down inside that groove in an orderly manner.

But in someone with `Patellar Instability`, this kneecap doesn't move properly inside that groove. It jumps out of the way. This can sometimes completely pop out (complete dislocation), or it can pop out just a little and then go back in (partial dislocation or subluxation).

We use our knees all day long. Standing, sitting, walking, running, everything requires knees. That's why these kinds of problems are more likely to occur in the knees.

What are the symptoms of this condition?

When the kneecap protrudes out of the socket, your knee may lose control of itself. This means that the knee will 'bend' and be unable to support your weight. Sometimes, you may not be able to straighten your knee or walk.

Let's look at some of the main symptoms that can identify this condition.

Why do my knees buckle like this? What are the causes?

There are several main reasons for this.

• Shallow trochlear groove: Some people are born with a shallow trochlear groove, which makes it easier for the trochlear bone to slip out.
• Loose ligaments: The ligaments around the knee are like ropes that hold the knee together. Some people have a looser ligament by nature. We call them 'double-jointed'. People like that are also more likely to get a knee sprain.
• Accident: If you receive a hard blow to the kneecap while playing sports, falling, or in another accident, it can become dislocated.

Who is at increased risk for this?

Although this condition can occur in anyone, some people are at higher risk.

• Women: Women are more likely to develop this condition because their ligaments are generally a little looser than men's.
• Athletes: This risk is higher for those who play sports that require sudden changes in direction, for example, soccer, basketball, volleyball, and cheerleading .
• Some medical conditions: This problem can also be caused by certain medical conditions that cause loose connective tissue. For example:
• Cerebral palsy
• Down syndrome
• Ehlers-Danlos syndrome

What can happen if left untreated?

Recurrent patellar instability can cause complications such as:

• Frequent knee jerks.
• Limited knee function (inability to run or jump).
• Chronic pain.
• Conditions such as severe knee arthritis.

How do you find this, Doctor?

Even if your kneecap pops out and goes back into place on its own, you should definitely see a doctor for advice. The doctor will first ask you how it happened and what you were doing when it happened. Then he will examine your knee.

• We check the appearance of the knee and see if there is any swelling.
• They touch the area with their hands and check for pain.
• We're looking at the range of motion you can bend and straighten your knee.
• Maybe you can even try walking.

Tests that may be needed

Tests like this can also be done to accurately confirm the condition.

• Knee X-rays: Check for dislocations or other fractures.
• MRI scan: To check for damage to the ligaments inside the knee, such as ACL tears and meniscal tears, or for loose bone fragments.
• CT scan: To see exactly how the knee joint is positioned.

What are the treatments?

Treatment can be divided into two main categories: non-surgical treatment and surgery.

Nonsurgical Treatments

These treatments are often tried first.

• Putting your kneecap back in place: If your kneecap has popped out and won't go back in, see a doctor right away. The doctor will carefully put it back in place. This is called a ``closed reduction''. This can be a little painful, so you may be given painkillers.
• Knee brace: This is worn to immobilize the knee and keep the kneecap in place. You will need to wear this for several weeks. You may also need to use crutches during this time.
• Painkillers: The doctor may recommend painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain.
• Physical therapy: This is the most important thing. Doing exercises that strengthen the muscles around the knee, as directed by a physical therapist, can help keep the knee joint stable.

Surgical Treatments

If your knee pops repeatedly or if physical therapy doesn't help, your doctor may recommend surgery. Most knee surgeries are done arthroscopically, which means that a camera is inserted through a few small incisions. This reduces the recovery time. It can take 6 to 12 months to fully recover from surgery.

Here are some of the main types of surgery.

How to protect yourself from this situation?

Once a knee sprain occurs, the surrounding connective tissue is damaged. This damage increases the likelihood of re-strain.

These exercises strengthen the muscles around the knee. These muscles then hold the kneecap in place. Cycling is also a great exercise to strengthen the knee. Your doctor may advise you to wear a knee brace during certain activities.

When you definitely need to see a doctor

If you have any of the symptoms below, definitely see a doctor.

• If you can't bend or straighten your knees.
• If you can't stand or walk with your weight on your leg.
• If you have severe knee pain or limited mobility that prevents you from performing daily activities.
• If there is unusual redness or swelling in the knee.

If your kneecap feels like it's constantly popping out, don't ignore it. Even if it pops out and then goes back into place, it's best to see a doctor and get it checked out. That way, you can prevent long-term problems.

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