knee goes out of place easily

[natalie]

Hello.

I would like to see if marathon running/jogging is a sport I can do on a regular basis with this particular knee problem:
The knee has what look like spokes that fit in grooves.
My "spokes" are not "sharp" enough to fit well in thier grooves, so my knee can go out of place easily. Any recommendations for joggers w/this problem? As I think more, it should be just fine, for one race, since there is no twisting involved. What about long term damage to knees if I become a daily runner?


prolific

[Gene Zeitler DC MS ART]

Hi Natalie,

Sorry for the delay in my response, I just returned from vacation.

I’m not quite sure I know what you are talking about when you describe “spokes” and “grooves,” but I think I know what you are saying. I believe you are talking about a patellar dislocation. On the distal end of the thigh bone (femur) there are two condyles or what you could describe as two half wheel like structures which allow the femur to roll and glide on the tibia (lower leg bone) when you straighten and bend your leg. These two condyles form a groove (intercondylar groove) in which the patella (knee cap) sits and glides when you straighten and bend your leg. The patella can track laterally (to the outside of the knee) over the lateral femoral condyle and dislocate. Certain factors predispose people to spontaneous patellar dislocations. They include:

· A shallow intercondylar groove
· A knee that collapses inward
· Tight structures on the outside of the knee
· Loose structures on the inside of the knee
· A high riding patella
· Hypermobility
· Excessive pronation (flat feet)
· Increase knee angle (Q angle-angle formed between the femur and tibia)
· Weakness of the VMO (vastus medialis obliquus) a small muscle on the inside of the knee

It is hard for me to make significant recommendations without more of a history and an examination. First, was there any trauma involved? Acute patellar dislocations and ACL ruptures can be confused because they have similar presentations. Second, how often does it occur? Third, does it only happen with rotational motions? Fourth, how do you know that your “spokes” are not “sharp” enough-did you have an x-ray or MRI?

If you had an acute patellar dislocation this would potentially be treated differently than a spontaneous patellar dislocation, which is often treated conservatively (non-surgically). A spontaneous patellar dislocation can often be treated with stretching and strengthening appropriate structures supporting the knee. Sometimes orthotics can be prescribed to correct flat feet and collapsing of the knee. Other things such as a shallow intercondylar groove and a large Q angle cannot be changed since you are born with these limitations.

Without addressing these items, running can cause the patella to dislocate. In addition, long term running can cause premature degeneration of the knee and possibly other complications. My recommendation is to have it checked out so you can get a more accurate diagnosis.

Hope this helps!

Gene Zeitler, DC, MS, ART