Rehab, Exercise, and Sports Therapy Podcast (REST)
Sep 20, 2026 · 37 min · 13 segments
In Episode 26 of the Rehab, Exercise, and Sports Therapy (REST) podcast sponsored by University Orthopedics and produced by Practice Marketing and Communications, we…
Nick LemmeGuest
Dan BienHost
I wanted to touch base with you a little bit on this because I feel like it's a pretty complicated injury because you have kind of two ends of the spectrum.
chronic patellar instability patients who may have underlying issues, whether it's connective tissue disorders, anatomical issues with a dysplastic trochlea, that kind of thing.
So one of the things I wanted to touch base with you about just to get the medical surgical side is tell us a little bit about your algorithm when you are presented with one of these patients.
What goes into your screening evaluation process the first time you meet them? And what kind of information are you hoping to kind of tease out or extract?
I think the thing with lateral patellar instability, out of everything that we probably treat as sports medicine surgeons, it's probably one of the most complicated.
I think a lot of people treat it, but may not fully understand it because I think there's a lot of different factors and that contribute to how we make decisions on treatment.
And even as, you know, people who are experts in this field, we don't fully understand who is, you know, when a procedure like a soft tissue procedure, like an MPFL reconstruction is okay versus adding something else.
And it's something that, you know, we're fleshing out as there's more and more research.
Um, so I think most people's algorithms have probably changed over the last couple of years.
And I think it's kind of a, um, you know, you could ask three orthopedic surgeons how they would treat a patient and you may get two or three different answers.
Um, but for me, I think, you know, I have someone that comes in and they say they had a patellar dislocation, um, First thing I want to talk to them about is the mechanism, right? Because that tells us how much energy was required for this patellar to dislocate.
So was it like a motorcycle accident or a non-contact twisting injury, which is probably the most common, or was it like atraumatic? And a lot of times...
people it can be difficult because they say like my knee dislocated right so because they don't sometimes most of the time the patellar dislocates and then they extend their knee and it reduces so they don't even see it dislocated so you can be fooled and whenever anytime someone says my knee dislocated you have to ask more questions and and dive in on that obviously because a true knee dislocation is very different than a patellar dislocation so mechanism is very important The next thing I ask is the number and the frequency of events.
Obviously, a first-time patellar instability patient we're going to treat very differently than someone who's had 10 or 15 dislocations.
The other thing is, was there hemoarthrosis? So big effusion suggests that it's a true traumatic first-time dislocation.
Someone that doesn't have an effusion, but they say, I think my kneecap dislocated.
I wanted to touch base with you a little bit on this because I feel like it's a pretty complicated injury because you have kind of two ends of the spectrum.
chronic patellar instability patients who may have underlying issues, whether it's connective tissue disorders, anatomical issues with a dysplastic trochlea, that kind of thing.
So one of the things I wanted to touch base with you about just to get the medical surgical side is tell us a little bit about your algorithm when you are presented with one of these patients.
What goes into your screening evaluation process the first time you meet them? And what kind of information are you hoping to kind of tease out or extract?
I think the thing with lateral patellar instability, out of everything that we probably treat as sports medicine surgeons, it's probably one of the most complicated.
I think a lot of people treat it, but may not fully understand it because I think there's a lot of different factors and that contribute to how we make decisions on treatment.
And even as, you know, people who are experts in this field, we don't fully understand who is, you know, when a procedure like a soft tissue procedure, like an MPFL reconstruction is okay versus adding something else.
And it's something that, you know, we're fleshing out as there's more and more research.
Um, so I think most people's algorithms have probably changed over the last couple of years.
And I think it's kind of a, um, you know, you could ask three orthopedic surgeons how they would treat a patient and you may get two or three different answers.
Um, but for me, I think, you know, I have someone that comes in and they say they had a patellar dislocation, um, First thing I want to talk to them about is the mechanism, right? Because that tells us how much energy was required for this patellar to dislocate.
So was it like a motorcycle accident or a non-contact twisting injury, which is probably the most common, or was it like atraumatic? And a lot of times...
people it can be difficult because they say like my knee dislocated right so because they don't sometimes most of the time the patellar dislocates and then they extend their knee and it reduces so they don't even see it dislocated so you can be fooled and whenever anytime someone says my knee dislocated you have to ask more questions and and dive in on that obviously because a true knee dislocation is very different than a patellar dislocation so mechanism is very important The next thing I ask is the number and the frequency of events.
Obviously, a first-time patellar instability patient we're going to treat very differently than someone who's had 10 or 15 dislocations.
The other thing is, was there hemoarthrosis? So big effusion suggests that it's a true traumatic first-time dislocation.
Someone that doesn't have an effusion, but they say, I think my kneecap dislocated.
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