Patella instability.

Hi all, sorry for the lateness of this post.

I would like to discuss one patient that I was seeing on my musculo placement. She presented with a recurrent history of bilateral patella dislocation, with the last incident occurring 3 years previous. The first patella dislocation she experienced was when she was 12 years old. The patient was a self employed cleaner, and consequently performed repetitive bending with her job. She also participated in martial arts, and was keen to continue with this, although was concerned about her knees.

On examination both patellae had an obvious medial tilt in the resting standing posture, and the patella lateral glide apprehension test was positive (and marked). The patient was extremely tight in the lateral structures, especially the ITB, with glut med weakness. VMO activation was extremely poor bilaterally. Crepitus was noted on patella compression. Bilateral proprioception was also decreased, and the patient complained of instability with single leg squat combined with internal rotation.

Perceived single leg squat stability improved with external medial glide applied to the patella. Initial treatment consisted of STM and heat applied to the lateral structures in an attempt to loosen these, VMO retraining +++, HEP for ITB stretching, and taping for medial glide and tilt initially to the right (worse) knee. At the next session the patient stated that the knee felt much improved.

Subsequent treatments continued with glut med and VMO retraining, and bilateral knee taping. The patient felt much more assured of her knee stability, and was more confident with her work as a result. The lateral structures also felt considerably looser.

As this was such a chronic condition I felt the short term improvements were worthwhile, and encouraging. Any other suggestions?

Dale.