A kneecap, or patella, dislocation occurs when the patella moves out of its normal position in the trochlear groove of the thigh bone. This displacement can be complete (dislocation) or partial (subluxation). These injuries are common, particularly in athletes, and often result from a sudden twist of the knee or a direct impact. A dislocated kneecap is a serious injury requiring medical attention.
Immediate Actions and When to Seek Professional Help
Recognizing the signs of a dislocated kneecap is important. Symptoms often include severe knee pain, visible deformity, and an inability to straighten or bend the leg. Swelling, tenderness, and sometimes a popping sensation can also occur. The knee might feel unstable or buckle when bearing weight. Even if the kneecap seems to go back into place on its own, medical evaluation is still recommended due to potential underlying damage to ligaments or cartilage.
While waiting for professional medical help, immediate first aid can manage pain and swelling. The RICE protocol (Rest, Ice, Compression, Elevation) is recommended.
Resting the knee involves avoiding activities that cause pain and limiting weight-bearing. Applying ice or a cold pack to the injured area for 15-20 minutes at a time, every 1-2 hours, helps reduce swelling and pain. Compression with an elastic bandage, applied snugly but not too tightly, helps minimize swelling. Elevating the leg above heart level helps reduce swelling.
It is crucial to avoid attempting to self-realign a dislocated kneecap. Manipulating the joint without medical expertise can cause further injury to ligaments, cartilage, or bone fragments. This risks worsening the injury and complicating future treatment.
Immediate emergency medical attention is necessary if the knee appears significantly deformed, if there is an open wound, numbness, or tingling in the leg or foot, or if you cannot move your foot. Seek emergency care for severe pain that does not improve, sudden and significant swelling, or an inability to bear any weight on the knee. A “popping” sound at the time of injury also warrants urgent medical assessment.
Professional Realignment Methods
Medical professionals realign a dislocated kneecap using closed reduction. This non-surgical method involves gently manipulating the kneecap back into its proper position. During this procedure, pain medication or sedatives may be administered to relax muscles and minimize discomfort. The leg is often gradually straightened as the kneecap is guided back into place.
Before and after the reduction, diagnostic imaging is commonly used to assess the extent of the injury and rule out additional damage. X-rays are frequently the initial imaging choice, providing clear images of the bone structure to check for fractures or bone fragments. MRI may be used for suspected soft tissue damage, such as torn ligaments or cartilage injuries. A CT scan can also be utilized for detailed bone assessment.
While closed reduction is the primary treatment, surgical intervention may be considered for complex cases. This includes significant damage to bone or cartilage, severe recurrent dislocations, or other injuries like ligament tears. Surgical options include arthroscopic procedures to repair damage or reconstructive surgery. Non-surgical treatment is often successful, especially for a first-time dislocation.
Post-Realignment Care and Prevention
After realignment, recovery involves several stages to ensure proper healing and to reduce the risk of future dislocations. Initially, the knee may be immobilized using a brace or splint for a period. This provides support, stabilizes the kneecap, and allows injured tissues to heal. Modern recommendations suggest a shorter immobilization period to prevent stiffness and muscle atrophy.
Physical therapy is a fundamental component of rehabilitation. It focuses on strengthening the muscles surrounding the knee, including the quadriceps, hamstrings, and hip muscles, which are important for knee stability. Physical therapy also aims to restore the knee’s range of motion, improve proprioception (the body’s sense of its position), and enhance overall joint stability.
Pain management during recovery often involves over-the-counter pain relievers such as NSAIDs, and the continued application of ice to control swelling. As rehabilitation progresses, strategies to prevent future dislocations become increasingly important. Continuing with strengthening exercises helps to dynamically stabilize the patella.
Proper warm-ups before physical activity, avoiding high-risk movements that involve sudden twisting, and gradual return to sports are also advised. The use of supportive bracing or taping can also play a role in providing additional stability during certain activities or during the rehabilitation phase. Even after a full recovery, ongoing adherence to an exercise program can help minimize the risk of recurrence, which can be as high as 15-60% after a first-time dislocation.