Patients’ experiences of living with patellar instability before and after surgery: a qualitative interview study

Abstract

ObjectivesTo explore the experience of living with patellar instability before and after surgery.DesignQualitative individual semistructured interviews of patients with patellar instability using a four-step thematic cross-case analysis strategy (systematic text condensation).SettingTwo orthopaedic units within two large Hospitals in Norway.ParticipantsA convenience sample of 15 participants, aged between 16 and 32 years, who had undergone surgery for patellar instability within the last 6–12 months.ResultsParticipants offered rich and detailed descriptions of the impact and lived experience of patellar instability, including fear of new dislocations, increased awareness of the knee and adaptations to avoidance behaviour in everyday life both before and after surgery. The four major themes that emerged from the data were: (1) fear of patella dislocations governs everyday life activities, (2) adaptation to avoidance behaviour, (3) feeling different, misunderstood and stigmatised affects self-esteem and (4) feeling stronger, but still not fully confident in the knee after surgery.ConclusionsThese findings offer insight into the experience of living with patellar instability. Patients reported that the instability had major impacts on their everyday life, affecting ability to participate in social life and physical activities both before and after surgery. This may imply that an increased attention towards cognitive interventions may be useful in the management of patellar instability.Trial registration numberNCT05119088.

Rehabilitation after surgery for patellar instability

“…Recurrent lateral patellar dislocations represent a painful ordeal with a profound impact on patients' lives [ 26 , 57 ]. The disorder is associated with a substantial reduction in knee function [ 9 , 27 , 61 ], persistent pain [ 3 , 61 ], kinesiophobia [ 53 ], activity limitations [ 4 , 26 , 38 , 57 , 58 , 61 ] and diminished health‐related quality‐of‐life [ 4 , 6 , 28 , 38 , 47 , 61 ]. Moreover, recurrent dislocations frequently result in early osteoarthritic changes in the patellofemoral joint, leaving patients dealing with both knee instability and pain [ 2 , 22 ].…”

“…This finding underlines the developmental perspective of the condition, which makes it more of a chronic disease than merely recurrent episodes of ‘knee incidents’. Consequently, increased apprehension in simple tasks of daily life and increased awareness of the knee are often more pronounced in patients with PI compared to other knee conditions [ 26 ].…”

“…Although surgery provides a structurally more stable patella, some patients continue to grapple with postoperative pain [ 2 , 56 ], impaired knee function [ 9 , 20 , 41 , 50 , 52 ], psychological distress and persistent avoidance behaviour [ 26 , 29 , 39 , 57 ].…”

“…Hence, prehabilitation is important to facilitate the best possible outcome and to provide a peaceful knee—no joint effusion, full range of motion (ROM) (active/passive) and optimised quadriceps function—before surgery. Typical impairments after recurrent patellar dislocation include quadriceps strength deficits, anterior knee pain, altered movement patterns, reduced balance and proprioceptive control and lack of confidence in the knee [ 4 , 26 , 38 , 61 ]. Prehabilitation should, therefore, include education and information, lower extremity muscle strengthening, balance and neuromuscular training to prepare patients for postoperative rehabilitation and improve the course of treatment in accordance with prehabilitation programmes for other knee injuries [ 12 , 21 , 65 ].…”

The Tibial Tuberosity–Trochlear Groove Distance Can either Increase or Decrease during Adolescent Growth

“…Recurrent lateral patella dislocation (RLPD) causes significant pain and discomfort, reduces physical activity level and quality of life, and leads to avoidance behavior, social isolation, and lower self-esteem [1]. The condition commonly affects skeletally immature patients [2], affecting girls more often than boys [3,4].…”