Dr. Barden is only 1 of 2 Dr. Fulkerson Fellows in the state of Georgia. Dr. Fulkerson has a long history as a pioneer in the field of patellofemoral instability, with the Fulkerson Procedure named after his innovative strategy for treating unstable knee caps.

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Patellofemoral instability refers to a condition where there is abnormal movement or tracking of the patella (kneecap) in relation to the femur (thigh bone). This instability can lead to symptoms such as pain, swelling, and a feeling of the knee “giving way.” Here’s a medical explanation of patellofemoral instability:

1. Anatomy: The patella is a small bone located in front of the knee joint. It sits in a groove at the end of the femur called the trochlear groove. Several structures, including ligaments, tendons, and muscles, help stabilize the patella and ensure proper movement.
2. Causes: Patellofemoral instability can result from various factors, including:
   • Structural abnormalities: Anatomical variations in the shape of the patella or femur can affect how the patella tracks during knee movement.
   • Muscle imbalance: Weakness or tightness in the muscles around the knee, such as the quadriceps and hamstrings, can impact patellar stability.
   • Ligament damage: Injuries to the medial patellofemoral ligament (MPFL) or other supporting ligaments can lead to instability.
   • Trauma: Direct trauma to the knee or repetitive stress injuries can contribute to patellofemoral instability.
3. Pathophysiology: In a healthy knee, the patella moves smoothly within the trochlear groove during activities like walking, running, and bending the knee. However, in patellofemoral instability:
   • The patella may dislocate partially or completely out of the groove, causing sudden pain and instability.
   • Subluxation refers to temporary displacement of the patella, while dislocation involves complete displacement that requires manual reduction.
   • Chronic instability can lead to cartilage damage, recurrent dislocations, and functional limitations.
4. Symptoms: Patients with patellofemoral instability may experience:
   • Pain around the kneecap, especially during physical activity or when climbing stairs.
   • Swelling and tenderness in the knee joint.
   • Sensation of the knee “giving way” or feeling unstable, especially during movements that stress the patellofemoral joint.
   • Audible or palpable clicking, popping, or grinding sensations in the knee.
5. Diagnosis: Orthopedic evaluation, including a physical examination, imaging studies such as X-rays and MRI, and possibly dynamic tests like the apprehension test, helps diagnose patellofemoral instability and assess its severity.
6. Treatment: Management of patellofemoral instability depends on factors like the underlying cause, severity of symptoms, and patient’s activity level. Treatment options may include:
   • Physical therapy to strengthen muscles, improve flexibility, and enhance patellar tracking.
   • Bracing or taping techniques to support the patella and reduce instability.
   • Orthopedic interventions such as surgical repair of ligaments, realignment procedures (e.g., tibial tubercle osteotomy), or patellar stabilization surgery for recurrent dislocations.
   • Activity modification, pain management, and lifestyle adjustments to prevent exacerbation of symptoms.

Overall, patellofemoral instability is a complex orthopedic condition that requires comprehensive evaluation and tailored treatment to address the underlying causes and improve knee function and stability.