Rehabilitation for a post-traumatic patella dislocation in a patient with hip dysplasia – a challenging combination for a physiotherapist

• Main Author: Oana-Ruxandra STÎNCEL
• Format: Article
• Language: English
• Published: University of Oradea Publishing House 2021-06-01
• Series: Romanian Journal of Physical Therapy
• Subjects: patella dislocation; hip dysplasia; hyperlaxity; knee injury; hip injury
• Online Access: http://revrokineto.uoradea.ro/27_46/1.revrokineto_27_46_Stincel.pdf

Introduction: Hip dysplasia is a well-known cause of hip pain and dysfunction characterized by an increased mechanical load on the hip joint and soft tissues in this region. A common sign of atraumatic hip dysplasia is hyperlaxity caused by repetitive micro traumatic activities, genetic predisposition, or benign hypermobility syndrome. Patellar dislocation is a traumatic disruption of the patella from the femoral trochlear which can result in patellar instability, pain, recurrent dislocations, damage to the medial patellofemoral ligament, and patellofemoral osteoarthritis. Case presentation: A 30-year-old male patient presents to our clinic with a history of patellar dislocation of the right knee after a traumatic event, a direct lateral blow by a car. After conducting a brief examination, we could observe that the patient revealed a painless dislocating hip issue on the right side, the peculiarity in the patient's medical history representing the justification of the study. The association between both pathologies limited exercise applicability of the rehabilitation protocol and, in order to follow the protocol's progressive stages, we adapted some of the weight-bearing exercises. The patient was asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) at the baseline of the first evaluation, and also after 1 and 2 months after beginning the rehabilitation program. Results: After following The Gundersen Health System Rehabilitation Program and knee-hip targeted exercises to increase posterolateral hip musculature we obtained significant improvements in patient-reported outcomes (quality of life and pain) and functional performance (functionality, sports and recreational activities). Conclusion: Our case highlights the importance of a thorough examination and proper rehabilitation program approach to ensure full recovery. Thus, we can appreciate that a rehabilitation program which addresses the patients' hip dysplasia could cause a considerable decrease in patella dislocation prevalence or recurrence. Using specific instruments as KOOS and HOOS questionnaires to assess patients' opinion about their social, physical, and associated problems helps us provide a better and more concise approach to conducting the rehabilitation program.