arthritis in the knee

3D illustration of Patella – Part of Human Skeleton.

By Dr. Carol Frey

Kneecap pain affects around 10 percent of active adolescent girls. Kids with this problem will usually complain of pain while running, walking stairs, or performing other activities that involve weight bearing with a bent, or flexed, knee.

Most of the time the pain is in the middle of the kneecap. New research indicates that patellofemoral pain may be a product of hip weakness and poor control of the thighbone (femur) during weight-bearing activities such as sports.

It’s fairly easy to identify poor mechanics in a young athlete. Just have your daughter try jumping on a single leg. See for yourself. The knee may cave inward, like a knock knee position. The girl should be able to stick the landing and hold that position for a few seconds.

Physical therapy can make big improvements in the poor mechanics. At the West Coast Center for Orthopedic Surgery and Sports Medicine we recommend that the athlete with this type of kneecap pain do stretches and strengthen hip and the core muscles. A single leg squat is a simple test of lower extremity mechanics, hip strength, and injury risk.

Patella (kneecap) dislocations and subluxation (an incomplete dislocation) are also known as instability of the kneecap. There are two ways this injury occurs. One way is direct trauma to the kneecap, causing it to displace. Another way is indirect trauma associated with sudden slowing or stopping with a twist or change in position.

A complete dislocation will occur when the kneecap comes completely out of the joint. Usually it will go back into place by itself when the athlete straightens the knee. If the kneecap remains dislocated, the knee should be splinted, ice applied, and only a doctor should attempt to put the kneecap back in place. Athletes with subluxation (incomplete dislocation) may complain of their knee feeling as if it may give away.

Factors that may put an athlete at risk for kneecap problems are loose ligaments, flat feet, internally rotated hips, knock knees, or quadriceps weakness.

Recurrent dislocations and subluxation can be a big problem. Corrective surgery is considered if a rehab program has failed and full strength has been achieved in the quadriceps muscles. With knee pain in front, the problem is usually from overuse or doing too much activity too soon. In other words, the frequency, duration, or intensity of workouts may have increased too rapidly. This may cause muscles to fatigue and lose their protective power and allow repetitive microtrauma to occur. That in turn can lead to structural injury.

Whenever you feel pain in your kneecap, it’s probably best to see a doctor to make sure you are getting the right diagnosis. At the West Coast Center for Orthopedic Surgery and Sports Medicine we see these kind of injuries almost every day. The good news: We know how to treat them, and we know how to get you back on track.

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