With all the talk about taking a knee in the news lately, it’s timely to explore exactly how the kneecap works and the immense value the kneecap adds to our mobility and daily life. As well it’s useful to review the hardships that can occur when one has problems with their kneecaps – often referred to as having an ‘unstable kneecap.
How The Kneecap Works
The kneecap is what connects muscles in the front of the thigh to the shinbone (tibia). When you straighten or bend your leg, the kneecap is correspondingly pulled up or down. The thighbone (femur) has a V-shaped notch – known as the femoral groove – at one end to accommodate this moving kneecap. In a healthy knee, the kneecap fits properly into this groove. But should the groove be too shallow or uneven, the kneecap can slide off, resulting in a partial or complete dislocation. This can happen over time, or suddenly – for example, a serious fall could also pop the kneecap out of place and should be of particular concern for the elderly.
Is There Something Wrong With My Kneecap?
Here are some symptoms that may lead you to suspect kneecap challenges:
- Your knees buckle and can’t support your weight or without significant pain
- Pain the front of the knee that increases with physical activity
- Pain when sitting
- Stiffness, creaking or cracking sounds from the knee
- Swelling around the knee
Diagnosis and Examination
Like many injuries, diagnosing an unstable kneecap can take time and requires patience from both the patient and their medical team. During a physical examination, you may be asked to walk around or to strength and bend your knee. The doctor may then carefully feel around your kneecap, and take measurements to determine if the bones are out of alignment or perhaps if the thigh muscles have atrophied or become weak.
The next step in the process would be to conduct x-rays or MRI scans to see how the kneecap is fitting into the groove. Before immediately assuming a kneecap issue, it’s important to rule out other possible reasons for this pain, such as a tear in the ligaments of the knee or in your knee cartilage.
Treatment and Surgical Options
The first step to return the kneecap to proper function is called ‘reduction’. This is the act of getting the kneecap back into its groove. Sometimes reduction happens spontaneously and without external effort; other times your doctor will have to gently force the kneecap back into place.
What happens in a dislocation, is that it often damages the underside of the kneecap and the end of the thighbone – this leads to additional pain and can lead to arthritis. Arthroscopic surgery can correct this condition; your medical team will meet with you to consult you on the various pros and cons of this procedure.
In a partially dislocated kneecap, your doctor may recommend additional non-surgical treatments such as physical therapy exercise and braces. Cycling is often recommended as part of the physical therapy; the goal is to return you to your normal activities within 30 to 90 days.
However, should the kneecap condition be chronic, where the knee continues to be unstable even after attempts at treatment, surgery to realign and tighten tendons to keep the kneecap on track or to release tissues that pull the kneecap off track, may be necessary.
