Q. My daughter is 17 and has problems with her right knee. She does not remember hurting it, but her kneecap keeps popping out of place. It always pops back in itself, but she says it hurts when it happens. She is afraid to play sports or dance. She did physical therapy for a month which helped at the time but the symptoms returned soon after she stopped. We are both frustrated and wonder what to do.
A. Kneecap problems are very common, particularly in teenage women who are tall and knock kneed. The kneecap lies in a groove in the femur that acts as a channel for the kneecap to glide freely. Because of some patients’ anatomy, the kneecap tilts, possibly leading to pain and popping. In the worst case, this misalignment can cause the kneecap to pop out of the groove totally (sublux or dislocate). Weak quad muscles or an imbalance in quad muscle strength can cause the symptoms to worsen. I recommend you see an orthopedic surgeon to confirm the diagnosis and establish a treatment plan. Physical therapy is usually the mainstay of treatment aimed at strengthening the quadriceps muscles and restoring the muscle balance so the kneecap can track better in its groove, especially the VMO inner quad muscle. One month of physical therapy is usually not enough time to correct a problem of this magnitude. When the therapy is finished, your daughter will need to maintain her exercise and conditioning program indefinitely to prevent recurrence of the symptoms. Surgeries for this condition can be complicated and are not always successful, so I recommend your daughter work hard with nonsurgical options.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net.