Knee Joint Pain and Discomfort – Unstable Cartilage

The patella, commonly referred to as the kneecap, is situated at the front of the knee within the quadriceps muscle group. During flexion or extension of the leg, the patella shifts upward or downward. At the distal end of the femur, closer to the knee joint, there is a V-shaped groove known as the trochlear groove. Under normal conditions, the patella glides smoothly within this groove, ensuring knee stability. However, if the groove is irregular, too shallow, or if muscular dysfunctions are present, disruptions in the patellofemoral tracking may occur, leading to partial or complete displacement of the patella.

Key indicators of patellar instability encompass: – direct trauma to the patella in the lateral knee region; – knee joint locking during motion; – anterior knee discomfort exacerbated by physical exertion; – discomfort while seated; – reduced joint mobility; – accompanying auditory phenomena such as crepitus, clicking, or jumping sensations; – localized swelling. During the physical examination, the clinician conducts a comprehensive assessment to establish a diagnosis and identify potential dysfunctions in the patellofemoral joint. It is essential to evaluate whether lateral subluxations occur and whether the patella is properly stabilized. Diagnostic imaging, including X-rays, MRI, or ultrasound, is necessary to confirm the diagnosis. Additionally, it is crucial to rule out alternative pain sources, such as cartilage degeneration or ligamentous injuries.

When patellar dislocation occurs, meaning the complete displacement of the patella from its groove, the first step is repositioning. While this sometimes happens spontaneously, in certain cases manual reduction is required. Such dislocations often result in damage to the posterior surface of the patella and the distal end of the femur, potentially causing additional pain and joint inflammation. In these instances, arthroscopic treatment is frequently recommended. In most cases of patellar instability, after diagnosing muscular imbalance in the knee region, it is necessary to relax overstretched muscles and strengthen weakened ones. The most commonly affected structures are the quadriceps femoris, the hamstrings, and the iliotibial band. Strengthening primarily targets the medial head of the quadriceps femoris, which plays a crucial role in patellar stability. Exercises aim to restore proper biomechanics in the patellofemoral joint. Cycling is often recommended as part of therapy. In some cases, a brace is used to stabilize and center the patella. The goal is to return to normal activity within 1 to 3 months. Chronic knee instability may require surgical intervention. Depending on the issue, the patella is stabilized in its correct track or tissues that disrupt its movement are released.