Patellar Dislocation
En Español (Spanish Version)

Definition
A patellar dislocation occurs when the kneecap slides out of place. The patella is the bone more commonly known the kneecap. It fits securely in a V-shaped groove in front of the knee so that the patella can move up and down when the leg is bent or straightened.

Patellar dislocation is very common. Treatment includes nonsurgical manipulation of the patella, immobilization, medications, and physical therapy. In some cases, surgery may be required to repair damage caused by the dislocation.

The Kneecap

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Causes
Trauma or abnormal movement at the knee causes patellar dislocation. Examples include:

  • A direct blow to the knee or from injury, such as a fall
  • Tension that applies force from side-to-side on the patella
  • Sudden twisting motions
Risk Factors
Factors that may increase your chance of patellar dislocation include:

  • Shallow V-shaped groove on front of your knee.
  • Knock knees—knees angled inward and touching when the legs are straight
  • Flat feet—fallen arches in the feet
  • Excess pronation of the feet—inward roll of the feet when walking or running
Other factors that can create instability in the patella include:

  • Weak thigh muscles
  • A patella that sits too high on the thigh bone
  • Weakened and stretched ligaments from a previous patellar dislocations
Symptoms
Patellar dislocation may cause:

  • Extreme pain and swelling at the knee
  • Buckling under your own weight
  • Stiffness
  • Abnormal appearance of the knee
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. This will include a thorough exam of your patella to check for tenderness and swelling. If possible, your doctor will have you walk. Your doctor may be able to make the diagnosis based on your symptoms.

Imaging tests like CT Scan or x-rays may be done to see if there is any damage to other structures around the knee.

Treatment
If your patella did not return to the V-shaped groove on its own, your doctor will manipulate it back into place.

Your knee will be immobilized in a brace for stability and support. You may need the brace for up to 4 weeks. Your activities will be limited until your knee is stable again.

Medication
Medications will be given to help reduce swelling and reduce pain.

Physical Therapy
Physical therapy may be recommended to:

  • Stretch and condition the quadriceps and hamstring muscles
  • Maintain muscle strength, flexibility, and endurance
  • Improve balance and range of motion
Improving leg strength may help prevent future dislocations.

Electrical Stimulation
Electrical stimulation treatments may be used to send gentle electrical pulses through the skin into local tissue. These may include:

  • Electrical muscle stimulation (EMS)—to help rehabilitate muscles
  • Transcutaneous electrical nerve stimulation (TENS)—to help manage pain
Surgery
Surgery may be needed for recurrent patellar dislocation or dislocations with severe injuries to soft tissue. It may also be needed for those who don’t recover with standard medical therapy. Surgical procedures include:

  • Arthroscopic repair of damaged cartilage, or to realign ligaments or tendons that stabilize the patella
  • Reconstruction of medial patellofemoral ligament to help with stability and prevent recurrent dislocations
Prevention
To help reduce your chance of patellar dislocation, keep quadriceps and hamstring muscles strong with strengthening and stretching exercises.




RESOURCES:
Family Doctor—American Academy of Family Physicians

Ortho Info—American Academy of Orthopaedic Surgeons

CANADIAN RESOURCES:
Canadian Association of General Surgeons

Canadian Orthopaedic Foundation

References:
Acute patellar dislocation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 26, 2012. Accessed November 5, 2013.

Panni AS, Vasso M, et al. Acute patellar dislocation: What to do? Knee Surg Sports Traumatol Arthrosc. 2013;21(2):275-278.

Unstable kneecap. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00350. Updated August 2007. Accessed November 5, 2013.

8/4/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for conservative management of lateral patellar dislocations and instability in children and young adults aged 8-25 years. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2014 Mar 18.

Last Reviewed December 2014



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