"My kneecap slipped out of place!" - What is it? What to do?

What is a Patella Dislocation?

In a normal knee, your patella is positioned within a groove at the bottom of the femur (thigh bone).

patella dislocation

Patella dislocation refers to when the kneecap is completely displaced out of its normal alignment. The most common direction for a patella to dislocate is outwardly (laterally). When this happens, the muscles and ligaments on the inside of the knee become overstretched and damaged.
Patella subluxation refers to when the kneecap is partially displaced out of its normal position.

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What Causes Patella Dislocation?

Dislocation of the patella is primarily caused by a traumatic incident (often twisting or a direct blow) to the knee.

However, there are a variety of factors which can predispose you to dislocating your patella. These include:

History of patella dislocation or subluxation
Patellofemoral joint hyperlaxity or maltracking
Shallow femoral groove
Weak inner quadriceps muscles
Tight lateral retinaculum, ITB, hip flexors, vastus lateralis and biceps femoris muscles.

Patella dislocation is most common in athletic teenagers. Pivoting your femur (thigh bone) internally on a planted foot while bending your knee if the most common dislocating movement. (Greiwe et al 2010)

What are the Symptoms of Patella Dislocation?

Patients with a dislocated patella will report that “my kneecap slipped out of place”. It may self relocate, otherwise a health professional may need to relocate your patella.
Visible translation of the kneecap (often to the outside of the knee).
Pain, particularly with weight bearing activities and active straightening of the knee.
Swelling and a wobbly kneecap.
Tenderness around your kneecap.
Feeling of instability or giving way during weight bearing.
Weakness of the quadriceps muscles.

How is Patella Dislocation Diagnosed?

On examination, your physiotherapist or doctor will look for signs of patella dislocation and associated muscle and ligament damage.

An X-ray, ultrasound or MRI may also be used to confirm the diagnosis and identify damaged structures surrounding the kneecap or to the patella joint surface, which is quite common.

What is the Treatment for Patella Dislocation?

Patella Relocation

The initial treatment will involve relocating the patella, which should only be done by a health professional if it did not occur spontaneously.

Physiotherapy

Most patients with patella dislocation start to feel better within a few hours of the relocation.
However, your rehabilitation will take at least six weeks to prevent recurrent dislocation.

Your physiotherapy treatment will aim to:

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Surgery

The majority of patients with patella dislocation will respond well with conservative treatment. Nikku et al 2005 compared post-surgical repair and exercise treated patients at 7 years follow up with no significant functional difference.

In some cases however, surgery may be required to repair significant bone or ligament damage caused as a result of the dislocation. This may include injury to the medial patella ligaments and muscles, kneecap surface or even performing a lateral ligament release.

Post-Surgical Rehabilitation

Post-operative knee rehabilitation is one of the most important, yet too often neglected, aspects of post-dislocation surgery. It is important to rebuild your muscles and function to avoid future dislocations.

The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.

Your rehabilitation following knee surgery focuses on...

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Your sports physiotherapist is an expert in this field. We suggest you contact them for the best advice in your circumstances.

How to Prevent Recurrent Patella Dislocations?

Following an initial patella dislocation, the risk of recurrence is almost 50% if no (or insufficient) rehabilitation is received. The risk of re-injury increases substantially each time the patella is dislocated.

For this reason, it is very important to discuss your injury with your physiotherapist. They will advise you of the best treatment plan for you, and ensure that you receive adequate rehabilitation to greatly decrease your risk of ongoing knee problems.

Return to Sport with Patella Dislocations?

Athletes often have particular difficulty once they have sustained a patella dislocation. This is primarily due to the increased instability around the kneecap, as well as residual weakness and balance as a result of the injury.

Your physiotherapist will ...

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For more information, please ask the advice of your physiotherapist.

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