Patella dislocation - from bracing to racing

Patella (knee cap) dislocation in young athletes can have devastating effect. WE have recently beed treating a 23 year old male who first dislocated his knee when playing football as a 14 year old. This was relocated in A&E. He had some physio but never regained full trust in his knee and hence didn't return back to sport.

He managed day to day until this year when he slipped coming down stairs and once again dislocated his patella. He was put in a brace for 1 month and unfortunately when he came to see us he had extreme quadriceps and glut wasting. On isokinetic testing (gold standard strength testing) his non-affected quadriceps were 70% stronger than his dislocating side.

So what did we do?

With any patella dislocation you have to stop the knee from rolling in during functional activity as this puts the patella into a vulnerable position.

The problems we found were:

1. reduced ankle bend

reduced ankle dorsiflexion

2. significant glut weakness - causing the knee to roll in

3. significant quadriceps weakness (isokinetic testing)

Treatment:

we have now increased the quads strength by 50%. This has been achieved by:

1. 30 degree knee extensions (patient unable to do one at initial assessment)

2. Glut activation exercises

3. single leg press (starting with 5KG now at 80KG)

4. Star excursion balance (to improve balance and control)