Patellofemoral Instability

– It’s a Knee’d to know basis

Patellofemoral instability is an umbrella term for conditions characterised by the abnormal movement or positioning of the kneecap (patella) in relation to the thigh bone (femur). This instability can lead to subluxation (partial dislocation) or dislocation (complete displacement) of the patella from its normal groove in the femur. This can result in pain, swelling, and functional limitations, and is more common in young, hypermobile females.

Dancers can also be at an increased risk of patellofemoral instability due to a combination of factors. Bendy bodies that are great for dancing can have underlying joint laxity that predisposes them to poor patellar tracking and instability. The functional demands of dancing, including repetitive movements, jumps, and landings, can further exacerbate muscular imbalances around the knee and contribute to instability.

Common Risk Factors for Kneecap Subluxation and Dislocation:

  • Anatomical Variations: Structural abnormalities such as a shallow or malformed groove in the femur (trochlear dysplasia), or a high-riding patella (patellar alta), can predispose individuals to patellar instability. 
  • Muscular Imbalances: Weakness or imbalance in the muscles around the knee, particularly the quadriceps and vastus medialis obliquus (VMO), can lead to poor patellar tracking and instability.
  • Joint Hypermobility: Increased joint laxity, often seen in hypermobile individuals, can make the knee joint more prone to instability.
  • Trauma: A significant blow or force to the knee, especially during jumping sports or dance, can result in acute patellar subluxation or full dislocation.

Physiotherapy for Patellofemoral Instability:

  • Taping and Bracing: Utilising techniques such as patellar taping or bracing can help realign the patella within its groove, providing stability and reducing the risk of dislocation during physical activity. There is good evidence to show that if you feel strong and confident in your knee, you are at a reduced risk of subluxation or dislocation. 
  • Exercise Therapy: Targeted strengthening exercises, particularly for the quadriceps, hamstrings, hip abductors, and core muscles, can improve muscular balance and stability around the knee joint. Additionally, exercises to improve proprioception and neuromuscular control are important for building joint stability and preventing recurrent instability episodes.
  • Activity Modification: Specific advice on return to dance or your usual activity can help with pain management and reducing the incidence of subluxations or dislocations. 
  • Surgical vs. Non-Surgical Management: In cases where more than 3 dislocations occur within 12 months, or if significant structural abnormalities are found, surgical intervention may be warranted. Surgical options can include procedures to realign the patella, repair damaged ligaments, or reconstruct stabilising structures around the knee.

Patellofemoral instability can be a significant challenge for individuals, particularly young dancers, due to its impact on performance and quality of life. However, with individualised physiotherapy intervention, patellofemoral instability can be effectively managed and improved, getting you back to your desired level of activity while reducing the risk of recurrent injury.

~ Elise McMahon

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