The Patella (Kneecap)
The Patella, or kneecap, is one of three bones, along with the Tibia (shin bone) and Femur (thigh bone), that make up the knee joint. All of these bones are covered with a layer of cartilage at points where their surfaces come into contact. Furthermore, the Patella is wrapped up inside a tendon. This tendon connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee joint.
The Patella is important functionally because it increases the leverage of the knee joint. From a mechanical perspective, the patella allows for an increase of about 30% in strength of extension (kicking) of the leg at the knee joint.
Problems associated with the Patella
There are several common problems associated with the Patella that can cause problems and pain in the knee:
- Chondromalacia Patellae (Runner’s Knee) – the most common disorder is known as chondromalacia patellae. Chondromalacia occurs because of irritation of the articular cartilage on the undersurface of the kneecap.
- Prepatellar Bursitis (Housemaid’s Knee) – is a condition of swelling and inflammation over the front of the knee. This is commonly seen in patients who kneel for extended periods, such as carpet layers and gardeners.
- Patellar Subluxation/Dislocation – also called an unstable kneecap, patients who experience this painful knee condition have a patella that does not track evenly within its groove on the femur.
- Patellar Tendon Tendonits – an injury that affects the tendon connecting your kneecap (patella) to your shinbone. Patellar tendinitis is most common in athletes whose sports involve frequent jumping.
Treatment of these various kneecap conditions depends on the diagnosis; however there are some general guidelines that can be followed.
- Rest – allowing the injured knee to allow time for inflammation to subside is very important. Cross-training will allow you to keep in shape. When you do return to activity, do so gradually.
- Physical Therapy – very important to balance the strength of the muscles around the knee joint. Most importantly, the quad and hamstring muscle groups should be flexible and balanced.
- Bracing – bracing helps stabilize the injury and restrict motion of the joint so it can heal.
- Ice the Injury – apply ice to the knee to cool down inflammation in stimulate blood flow to the area. Be careful not to ice too much!
- Anti-Inflammatory Medications – they may help with inflammation and will also help alleviate some of the pain associated with patella conditions.
- Arthroscopic Surgery – seldom needed because of a kneecap problem, arthroscopy is a treatment option if the problem is not getting any better with conservative treatment.
Surgical options vary depending on your age, and the degree of the injury (whether it’s isolated in one compartment or uncompartmental). Options include:
- Arthroscopically-assisted realignment procedures
- Knee scope
- Isolated patellar femoral replacements
- ACIL Autologous Chondrocyte Implantation (cartilage transplant/grafting)