What are the treatment options available for patellar malalignment and patellar entrapment?
Non-surgical treatment may include physical therapy to strengthen the areas that have an effect on knee pain such as hip rotation, quadriceps, and hamstring exercises. A brace to realign the patella may also ease pain. NSAIDs (non-steroidal anti-inflammatories) can help alleviate pain and swelling during flare ups. If patellar mobility is limited, PT may be used to help increase kneecap motion.
Proximal or distal realignment surgery may be required for patellar malalignment. Proximal re-alignment surgery involves either lengthening structures that limit the movement on the outside of the patella or shortening ligaments on the inside of the patella.
Distal re-alignment surgery involves moving the tibial tubercle (the insertion site of the patellar tendon on the tibia) toward the inner side of the knee. This re-alignment procedure is very effective in restoring normal knee mechanics. This procedure can decrease kneecap joint forces and restore stability. The quadricep angle, known as the Q-angle, is the measurement of the knee between the quadriceps muscles and the patellar tendon. Distal re-alignment surgery restores the Q-angle to a more normal value. The angle is commonly different between women and men, which is another factor of why patellar malalignment occurs more often in women.
In cases of patellar entrapment, arthroscopy or open surgery may be necessary to remove scar tissue and to increase patellar mobility. Soft tissue release may also be used to restore normal patellofemoral mechanics.
After surgery, you will be required to rest, and then the use of crutches will be necessary for 1-2 weeks. Physical therapy is typically needed for 2-3 months after such procedures.