Patellar Instability is a specialty for Dr. Jeremy Rush’s orthopedic practice in San Antonio.

Chronic instability up to dislocation

It is a very heterogeneous group

Patella dislocation and patella subluxation

And patella instability

Addressing the first-time dislocator

Be super aggressive with the rehab

Step one: reduce the dislocation

Brace them for a week but then get them moving

Try to get started in PT within one week

See them back about 6 weeks and then again at 3 months

At 6 weeks with effusion makes you think there is a loose body.

Ability to do straight leg raises

Apprehension with manual pressure

Dislocation = all the way out – 95% are lateral

• Usually traumatic events
  
• Some are from anatomic risk factors
  

Subluxation is partially out of the groove

Instability is a chronic form of Subluxation

Get them to relax

Move them into extension

Calm them and even cover the dislocation if needed

Maybe get them up and it could self-reduce

Knee feels unstable or it is slipping

Or my knee just hurts

Buckling

Recurrent effusion

Anterior knee pain

Start with rehab

Target

Positive patellar apprehension

J-Sign

Patella alta

Women are at higher risk due to q-angle hyperlaxity

Rotational abnormalities

J-sign

Apprehension

Lateral pressure

MRI on chronic instability

MPFL damage

If the injury is unclear then I get an MRI to rule out any sort of cartilage or loose body.  

A huge effusion indicates a loose body.

Dr. Jeremy Rush – IG @satxsportsmedicine

Jeremy – @jhjacksonlat

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

Donate and get some swag (like Patreon but for the school)

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second year free, and support the podcast.

Marc Pro – Use “THESMB” to recover better.