Kneecap - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Kneecap

General points for problems with the Kneecap

Many people even in the younger years get kneecap problems. Noises in the joint are often not harmless. The cause: the kneecap (latin:patella) is a disc-shaped bone, which lies in the tendon of the four-headed thigh muscle.

The patella moves upwards and downwards during bending and stretching like on a slide bearing. During for example stretching, the patella lies noiseless and painless a distance from approximately 8-10cm over the thigh bone. Due to different reasons, a distorted course between the kneecap and the anterior side of the thigh can occur, which can lead to a painful damaging of the joint cartilage. Apart from that, frequent joint noises behind the patella occur which are not harmless. The cartilage gets ever thinner due to abrasion and the bony surfaces rub together in the final stage. Fragments of cartilage produced by this abrasion, irritate the joint mucous membrane and lead to the formation of joint fluid which is too thin, meaning the lubrication function in the joint is lost.

Treatment of problems with the kneecap

Firstly the abrasion situation must be stopped in order to reproduce smooth upper surfaces. In less serious cases, a combinations therapy consisting of physical methods and injection therapy is undertaken. Through insole supplies, which can be developed with walk analysis, the pressure load on the kneecap is attempted to be changed and with this, an improvement in pain with reduction of friction is brought about. In further developed cases, a careful, very sparing smoothening of the cartilage or even a cartilage transplantation comes into question.

The central rebuilding of the patella leads to an even distribution of pressure. Therefore, there are different operative methods e.g. the changing of the course of the kneecap through soft tissue procedures with replacement operations of the overstretched, non-functioning kneecap retaining ligaments, or the bony transfer operation of the kneecap tendon. Afterwards, the central rebuilding of the patella leads to an even distribution of pressure - newly formed cartilage tissue can permanently exist in these circumstances.

Inability to work

With light professional activity the inability to work is 1 to 2 weeks. In order not to strain the kneecap during bending, crutches are needed for between 2 and 6 weeks depending on the localisation of the precise cartilage damage. Extremely important with this intervention is the rehabilitation, because the exact localisation of the cartilage damage deems it necessary to undertake completely different rehabilitation concepts.

Sports activity after the treatment

The rehabilitation after kneecap intervention often takes very long. Particularly in this area great experience in the rehabilitations process is necessary.

The exact localisation of the cartilage damage is necessary for the rehabilitations process, in order to develop a useful medium-term programme plan. Depending on the quality of the replacement cartilage tissue, the quality of the operative intervention, and the quality of the cartilage transplantation, it can take 6-12 months in order to fully participate in sport.