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  Medical Topics: 

  • Anterior Cruciate

  •        Ligament 
  • Articular cartilage

  •           Injury 
  •      Meniscus

  •        Patella

  • Degenerative Joint

  •          Disease 

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    1.  Anatomy and Function:   The patella is a small, flat, round  
            bone that articulates with the femur in front of the knee  
            joint. The undersurface has articular cartilage on it to allow 
            it to glide smoothly over the femoral groove (trochlea) as the  
            knee is flexed. The quadriceps muscle uses the the patella as  
            a fulcrum to increase its power when extending the knee. 
    2.  Injury:  The patella is commonly injured when its position in  
            the femoral trochlea is not in the center. This condition is  
            called patella malalignment or subluxation. These problems  
            typically become painful in young, active patients as the  
            uneven stress on their articular cartilage causes softening  
            (chondromalacia) of the tissue. Left untreated, this  
            abnormal wear can lead to gradual deterioration of the  
            articular cartilage under the patella. Further, a severely  
            malaligned patella is at risk for a patella dislocation, which  
            can inflict permanent cartilage damage as well. 


                  Normal                   Subluxation              Dislocation 

    3.  Treatment:  The goal of treatment in painful patella  
            malalignment is to improve the balance and position of the  
            patella tracking mechanism.  This is divided into 3 phases of  
             a)  Isometric quadriceps strengthening, patella-stabilizer  
                  brace and anti-inflammatory medication for 8 weeks. 
             b)  Phase "a" plus intra- articular injection of cortisone for  
                  4 weeks. 
             c)  Surgery:  Mild cases of subluxation as determined by  
                  exam and X-ray are treated by arthroscopic  
                  repositioning of the patella and smoothing of the  
                  articular surface. More severe degrees of malalignment  
                  require major open surgery such as illustrated here: 

            Soft Tissue Surgery                    Plus Bone Transfer 

                  Surgical treatment of the damaged articular surface  
            under the patella has been enhanced by a new technique  
            known as coblation. The process involves the use of  
            high-frequency sound waves to remove damaged cartilage  
            particles from the surface and smooth the remaining  

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