Dislocated Kneecap: When Is Surgery Recommended
Surgery can stabilize the knee and lower the risk of the kneecap becoming dislocated again. It is considered after a second kneecap dislocation or if the knee is very unstable.
The doctor will first push the kneecap back into place. Then there are two treatment options:
- Conservative treatment: The kneecap is stabilized for a few weeks using a brace or bandage. Physical therapy is started at the same time, with the goal of strengthening the muscles that support the kneecap.
- Surgery: Doctors operate on the knee to stabilize the kneecap. During the surgery, cartilage or bone injuries may be treated or misalignments might be corrected as well. Physical therapy is started after surgery too.
Peace And Love Protocol
Newer management techniques include the PEACE and LOVE protocol. Immediately after an injury a person should:
- Protect: Restrict movement for 13 days. People should minimize rest as prolonged periods can compromise tissue strength and quality.
- Elevate: Elevate the knee higher than the heart to promote interstitial fluid flow out of tissues.
- Avoid anti-inflammatories: Inhibiting inflammation using medications may negatively affect long-term tissue healing, especially when doctors prescribe higher dosages.
- Compress: Apply external pressure using a bandage or taping.
- Educate: Physical therapists should educate patients on the benefits of an active approach to recovery.
After the first days have passed, soft tissues need LOVE:
- Load: A person should resume exercise as soon as symptoms allow. People can add optimal loads without exacerbating pain to:
- enhance capacity of tendons, muscles, and ligaments
Returning To Activity & Sports After Patellar Dislocation
Most people with patellar dislocations can return to sports after a supervised, stepwise rehabilitation program. A physician should assess strength and balance to determine when it is safe to return to sports. Use of a brace with sports is recommended for individuals following a patellar dislocation.
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How Is A Patella Dislocation Diagnosed
Knowledgeable healthcare providers can usually diagnose a dislocated kneecap by physically examining the knee and asking you questions about the injury. However, theyll order radiographic imaging tests to check for any related injuries, such as torn ligaments, cartilage injury or fractures. With patellar dislocation, it is safe to correct the joint first and take pictures after.
If your dislocated patella corrected itself, you might not realize that it was dislocated. A dislocation that corrects itself is called transient. Afterward, your knee will still be sore and swollen, but it may look like many other more common knee injuries. In this case, imaging tests can show evidence after the fact that there was a dislocation, along with secondary injuries.
What To Do If Your Hip Pops Out Of Place
The body is meant to handle normal wear and tear injuries. Small bruises or sprains are common for everyone, especially athletes. However, once people get into their retirement age, the body is prone to more injuries. One injury that can hurt the hips is a severe dislocation. If the hips suffer from this condition, the hip joint may physically pop out of place. If the hip dislocates, it can be very painful and stressful. What do you do next? Follow this information about what to do if your hip pops out of place.
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Rare And Unusual Knee Instability Causes
Causes of knee instability that occur even less frequently include the following.
- Partial dislocation: If you do something strenuous enough to damage the ligaments, it is likely that you will have damage to the cartilage around the knee bone as well. The patella, or kneecap, can become partially or completely dislocated. A partial dislocation is called a subluxation. Dislocation can occur if the ligaments are damaged and are not holding the kneecap firmly in place as usual.
- Cartilage tears: The cartilage at the ends of the upper and lower leg bones, which meet under the kneecap, can become torn. This often happens along with a ligament sprain.
- Cartilage wear: Cartilage can gradually wear away over time, causing pain and difficulty moving since there is no longer enough cushioning material between the bones.
- Birth deformity: You may have been born with knee structure that makes the joint vulnerable to slipping out of place.
This list does not constitute medical advice and may not accurately represent what you have.
What Are The Different Types Of Surgery
There are many different kinds of surgery to treat an unstable kneecap. The basic types are:
- Surgery on the joint capsule and the ligaments: This involves tightening or replacing parts of the capsule and ligaments that stabilize the kneecap on the inner side of the knee, particularly including the medial patellofemoral ligament . This ligament is usually torn the first time the kneecap is dislocated. Then it can be replaced by part of a tendon taken from the back part of the thigh muscles. This procedure is supposed to ensure that the kneecap doesnt slip out of place so easily outwards .
- Surgery on the bones to correct anatomical misalignments: These procedures can deepen the trochlear groove that the kneecap fits into. It is also possible to move the patellar tendon on the shinbone to the side. The aim of doing this is to keep the kneecap in the middle of the groove when force is put on it. Sometimes the axis of the leg is also corrected by straightening the thigh and lower leg and stabilizing them with a plate.
The techniques that are considered depend on the anatomical form of the knee and leg.
Front view of right knee, with ligaments and thigh muscles
How Can You Prevent From Dislocating A Knee
Attempt to avoid major accidents. Avoid risky activities such as skiing, motorcycle riding, or jumping from high places people who decide to do these high-risk activities should obtain and follow instructions from experts about how to decrease their risks.
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- Description: Dislocation of the knee is a true limb-threatening emergency. This is also a rare injury. Dislocation of the knee is caused by a particularly powerful blow to the knee. The lower leg becomes completely displaced with relation to the upper leg. This displacement stretches and frequently tears not only the ligaments of the knee but also arteries and nerves. Untreated arterial injuries leave the lower leg without a blood supply. In this case, amputation may be required. Nerve injuries, on the other hand, may leave the lower leg viable but without strength or sensation.
- This injury can be due to a motor vehicle accident where the patient’s knee or leg hits the dashboard.
- Symptoms and signs: Knee dislocations are severely painful and produce an obvious deformity of the knee. Many dislocations are reduced or put back into anatomic alignment spontaneously. As this occurs, many will report feeling a dull clunk.
What Should You Do After The Dislocation
As soon as the hip pops out or dislocates, call for help or visit an emergency room. The hip will be experiencing chronic pain so an urgent care facility can treat the pain before the person receives actual treatment. Do not attempt to pop the hip back in place. After the injury, the entire hip will be sensitive. Attempting to fix the dislocation may cause even more damage. Too much pressure on the thighbone can lead to a hip fracture or permanent nerve damage. Do not walk or put any pressure on the hip either. See a physician who can immediately care for the hip dislocation.
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How Do You Know If You Popped Or Dislocated Your Knee
If your knee gets dislocated, you will hear a popping sound as the injury occurs. It would be extremely painful and swollen and your whole knee joint would look deformed.
Further, there is a high chance that you will not be able to bend and straighten your knee fully. It will feel highly unstable and you will not be able to put weight on your leg. Standing and walking will also be very difficult.
What Are The Symptoms Of Patellar Dislocation
Your child may or may not complain of pain with a patellar dislocation. In a partial dislocation, your child may complain of a feeling like the kneecap is sliding around when they run or are active. Afterward, it may pop back in place. You or your child may hear a popping or grinding sound in the knee.
Complete dislocations can be painful. The knee may look misshapen or appear swollen. A displaced kneecap may cause the knee to buckle and can lead to a fall. If a young child appears to fall frequently when running, you should have a doctor rule out kneecap disorders that may cause slight instability in the knee.
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How Is Patella Dislocation Treated
Reduction: As long as the diagnosis is clear, a knowledgeable healthcare provider will manually relocate the kneecap as soon as possible. This is called a reduction. A patellar dislocation injury that occurs on the playing field can be reduced immediately by a trained healthcare provider if there is one on-site. If you go to the emergency room, they may give you sedatives and pain medication first. Theyll usually correct the joint first and then look at it on an X-ray.
Imaging: Healthcare providers will take imaging tests to see that the kneecap has been properly replaced and plan any additional treatment. X-rays and CT scans can help reveal any preexisting anatomical conditions that may have contributed to the dislocation, as well as any additional injuries. An MRI can give more detailed information on the cartilage and ligaments if its needed. Sometimes an MRI will reveal a previous transient dislocation that wasnt suspected before.
Surgery: If there is significant damage to the bone or to the cartilage and tendons of the knee, your healthcare provider may recommend surgery to repair it. Surgery may also be recommended if you have recurrent patellar dislocations or chronic patellar instability. Repairing and strengthening the cartilage and ligaments is a preventative measure to restabilize the knee. When patellar dislocation is congenital, the joint can only be repaired through surgery.
How Effective Is Surgery
Researchers from the analyzed six studies comparing surgery with conservative treatments. Nearly 350 teenagers and young adults participated in these studies.
Each of them had either conservative treatment or surgery. The surgery in these studies involved stitching and tightening the torn MPFL or replacing it with a tendon. There are currently no comparative studies on any of the other types of surgery.
The studies showed that the procedure can lower the risk of dislocating your kneecap again:
- Without surgery, 21 out of 100 participants dislocated their kneecap again in the following years.
- With surgery, 12 out of 100 participants dislocated their kneecap again.
It’s not clear whether the surgery led to a greater improvement in symptoms and knee function than conservative treatment did. Previous studies have not shown that surgery has any advantages here. Because only a few studies looked into these aspects, further research is needed.
Only one study provided information on the frequency of complications. A few of the people in this study had complications after surgery, such as an infection or a poorly healing wound.
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If You Keep Dislocating Your Kneecap
Most people who dislocate their kneecap will not dislocate it again. But in some people it can keep happening.
This often happens if the tissues that support the kneecap are weak or loose, such as in people with hypermobile joints, or because the groove in the bone beneath the kneecap is too shallow or uneven.
Regularly doing the exercises your physiotherapist recommends can help strengthen the tissues that hold the kneecap in place and reduce the risk of dislocating it again.
Surgery may occasionally be needed if the kneecap keeps dislocating. A common procedure is a medial patellofemoral ligament repair.
This is where the connective tissue that helps hold the kneecap in place is repaired and strengthened.
Page last reviewed: 20 May 2019 Next review due: 20 May 2022
When To See A Doctor
If you have any pain along with these symptoms, have a doctor look at your knee as soon as possible. Doing so may prevent a more serious knee injury including anterior cruciate ligament injuries. They affect between 100,000 and 200,000 Americans each year.
Even if the knee popping isn’t painful, you may still want to have it checked out. In some cases, it may be an early warning sign of an overuse injury. This may require weight loss, a change of footwear, or knee-strengthening exercises to protect the joint.
The best treatments are targeted directly at the specific problem that is causing the abnormal popping or snapping inside the knee joint. You can ease crepitus and tendon problems with treatments to reduce inflammation in the knee joint, such as rest and anti-inflammatory medications.
Most mechanical problems are best treated with arthroscopic knee surgery. This is a procedure in which a camera and tools are passed through small incisions into the joint to repair any damage.
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How Do You Treat Patella Dislocation
There are a few different ways that patella dislocations can be treated, depending on the severity of the injury. For less severe cases, the doctor may simply recommend resting and icing the knee to reduce swelling. They may also prescribe a physical therapy regimen to help strengthen the muscles around the knee, and a patellar stabilization brace to help the kneecap stay in place.
For more severe cases, or in the case of recurrent instability, surgery may be necessary to repair any damage to the ligaments or bones. After surgery, you will likely need to go through physical therapy to regain strength and flexibility in your knee.
What Is The Difference Between Patella Subluxation Versus Dislocation
Patella subluxation is a partial dislocation of the patella, meaning that the patella partially pops out of place. A patella dislocation is a complete dislocation, meaning that the patella completely pops out of place.
Patellar subluxation and patellar dislocation can both cause pain, swelling, and instability in the knee joint. Patellar subluxation is often treated with physical therapy and knee braces. Patellar dislocation may require surgery to repair the ligaments around the knee joint.
If you think you may have patellar subluxation or patellar dislocation, it is important to see a doctor or orthopedic surgeon.
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How To Stop Knee Cracking And Popping
If youre having any type of pain, swelling, catching, or locking, those are warning signs that you need to see a doctor, Dr. Slabaugh says. But if youre not having any pain , then doing exercises on your own is very appropriate.
To get started, youll need a few pieces of equipment you can easily find online.
Youll need a long foam roller like this one to do the IT band release.
To alleviate the awkward noises and keep potential injuries at bay, try these exercises, courtesy of Eun Jung Decker at React Physical Therapy, three times a week for maximum results.
What Else Should I Know
After dislocating a kneecap, kids and teens must stay out of sports and other physical activities for a few weeks. Most kids can return to these in about 46 weeks with therapy and exercises to build strength. Some kids might need to also use a supportive knee wrap or athletic brace during sports for a while. Your care team will let you know when your child is ready.
To help your child heal as quickly as possible, follow the doctors advice about:
- which activities to avoid
- which activities are OK
- strengthening exercises
- going to all follow-up doctor visits
Talk to your health care provider about ways to prevent a future dislocation, such as:
- stretching before and after sports
- working to strengthen the leg muscles
These steps also can help protect against other injuries.
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How Painful Is A Dislocated Patella
Dislocations are often very painful, but there is a range. It depends how far out of joint the bone has been forced, and how much the surrounding muscles and ligaments, blood vessels and nerves have been injured. It will always be painful to move the dislocated joint or bear weight on it. You wont be able to use the limb normally until the joint has been corrected.
If your dislocated patella corrects itself, your pain and mobility may improve. But you should still see your healthcare provider. Theyll check for secondary injuries to the ligaments and guide you through the longer rehabilitation process.
How Is Patellar Dislocation Treated
After a patellar dislocation, the kneecap will often return to its normal position spontaneously. When a kneecap remains dislocated, a trained specialist may be able to gently push the kneecap back into its groove in some cases, this procedure requires sedating medications and monitoring.
Treatment for an initial patellar dislocation involves a stepwise process of rehabilitation. Initially, use of a brace will keep the patella in its groove crutches may be needed for walking more comfortably. Rest, ice and elevating the affected leg will help reduce pain and swelling in the knee.
Rehabilitation exercises focusing on improving range of motion and strengthening the hip and thigh muscles to keep the kneecap aligned are added gradually. The final phase of the rehabilitation process includes skill-specific training to prepare for a return to sports.
Recurrence of patellar dislocation is relatively common, particularly in younger patients. Some patients with loose bone or cartilage fragments or recurrent dislocations require surgical treatment. The type of surgery varies depending on the underlying cause of the dislocations.
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