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Patellar Knee Dislocation

About Patella Dislocation

Patellar Dislocation is a condition where the patella or kneecap moves out of its original place. Patella, which lies in front of the knee-joint at the base of the femur (thighbone) may dislocate due to an external force or injury. This condition is common with athletes and adolescent women. The dislocation causes pain, and may lead to a deformed knee & inability to stretch the joint.

Causes

The main causes for Patellar Knee Dislocation include:

  1. An injury to the knee or application of an external force
  2. A person with Patellar Tracking Disorder is more susceptible to Patella Dislocation
  3. Any injury which takes place when the foot points out, with the knee bent and thigh facing inwards may lead to a Patella Dislocation
  4. Certain sporting activities may cause this condition
  5. An external force may lead to a first time dislocation, but later the knee becomes vulnerable to these dislocations

Patients with any of the following conditions are at a higher risk of Kneecap Dislocation:

  1. Patella Alta (High-Riding Patella)
  2. Patellar Subluxation
  3. Increased Femoral Anteversion with Compensatory External Tibial Torsion
  4. Generalized Joint Laxity
  5. Genu Valgum
  6. Tear of Medial Patellofemoral Ligament
  7. Below-the-Knee Amputations

Signs and Symptoms

The important signs & symptoms of Patellar Dislocation include:

  1. Severe pain
  2. Deformed knee
  3. A popping sensation
  4. Inability to bend or straighten the knee or stiffness
  5. Swelling in the knee
  6. Cool and pale skin
  7. Numbness
  8. Tingling sensation
  9. Bruising
  10. Inability to stand or walk
  11. Abnormal movement of the leg or knee
  12. A locked knee
  13. Inability of the knee buckles to support the body weight
  14. Knee catches during movement
  15. Kneecap slips off to the side
  16. Knee catches during movement

Consultation

A General Physician or an Orthopedic Surgeon is the subject matter expert.

Tests and Investigations

The physician diagnoses a Kneecap Dislocation through a physical examination. X-rays and MRIs help confirm injuries and fractures if any.

Treatment Modalities Available

Surgery and Conservative treatment (rehabilitation & physiotherapy) are the two types of treatment modalities available to treat a Patellar Dislocation. Usually surgeries are not advisable for young patients as they may obstruct the normal growth of structures in the knee.

In case of complete dislocation, the physician tries to set it back. This process, called ‘Reduction’, involves applying a gentle push to get the kneecap to get it to its original place.

Physicians recommend immobilizers, braces or casts if X-Rays do not show any fractures or damaged cartilages. This prevents knee movement and usually after 3 weeks the kneecap shifts to its original place. Physiotherapy sessions follow removal of the cast, brace, or immobilizer. This helps in improving the knee’s range of motion and strength of the muscles.

A dislocation accompanied by a fracture or cartilage damage may need an Arthroscopic or Open Surgery. Also, patients with intolerable pain or repeated dislocations may need Surgery. The important surgeries include Lateral Release Surgery and a realignment surgery. Lateral Release Surgery is a process of cutting the tight lateral ligaments to enable the patella to get back to its normal position. Surgical realignment of the muscles and kneecap are inevitable in case of repetitive dislocations.

Complications

Kneecap Dislocation may lead to the following complications:

  1. Tearing or stretching of ligaments, tendons, muscles, and cartilage in or around the joint
  2. Breakage in the knee-joint
  3. Once dislocated, the kneecap may repetitively get dislocated

Risk Factors

Patellar Dislocations are common after a serious injury. Once dislocated, the kneecap becomes susceptible to dislocation and even a minor injury may lead to recurrence. Adolescents and athletes are at a higher risk of having a dislocated kneecap.

A dislocation may damage the end of the thighbone and the part below the kneecap resulting in pain & arthritis.

Risks associated with surgeries include adverse reaction to anesthesia or an infection.

Physical Activity Requirements during the Course of the Treatment

Physicians advise total rest of the knee in case of dislocation, especially when they prescribe immobilizers, braces or casts. Once the kneecap gets back to its original position, physiotherapy and knee strengthening exercises help in getting back to a normal routine.

Prevention to Avoid Occurrence and Recurrence

Using proper techniques while playing sports and exercising is the best way to prevent a Patellar Dislocation. Indulging in knee strengthening exercises is a good precautionary measure too. Glucosamine and NSAIDs supplements aid in keeping the knee strong. A good rehabilitation program reduces the chances of recurrence. External support, including orthotic devices may prevent injuries and dislocations. However, at times it is difficult to prevent the dislocation.

Support from Family

Kneecap Dislocation is very painful and may result in the patient getting restless. Family support helps the patient to recover physically as well as psychologically.

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