Dislocated Kneecap: Why Self-Reduction is Dangerous, What to Do, and Medical Treatment

How do you push your kneecap back in place?

Attempting to push a dislocated kneecap back into place yourself is strongly discouraged due to the significant risk of further injury; immediate medical attention is required for proper diagnosis and safe reduction.

Understanding Patellar Dislocation

A patellar dislocation occurs when the kneecap (patella) moves out of its normal position in the trochlear groove at the end of the thigh bone (femur). This is a painful and often visibly alarming injury. While the patella most commonly dislocates laterally (to the outside of the knee), it can occasionally dislocate medially or even rotate.

Causes of Patellar Dislocation:

• Direct Trauma: A direct blow to the kneecap.
• Twisting Injury: A sudden twisting motion of the knee while the foot is planted.
• Anatomical Factors: Some individuals have a predisposition due to:
  • Shallow trochlear groove.
  • Patella alta (high-riding kneecap).
  • Ligamentous laxity.
  • Muscle imbalances (e.g., weak vastus medialis obliquus, tight lateral retinaculum).

Symptoms of Patellar Dislocation:

• Sudden, severe pain in the knee.
• Visible deformity of the knee, with the kneecap appearing out of place.
• Inability to straighten or bend the knee.
• Difficulty or inability to bear weight on the affected leg.
• Swelling and bruising that develops quickly.

Why You Should NEVER Attempt Self-Reduction

While the immediate instinct might be to try and "pop it back in," attempting to reduce a dislocated kneecap yourself is extremely dangerous and can lead to severe complications.

Risks of Self-Reduction:

• Further Cartilage Damage: The patella or the femoral condyles can be further damaged, leading to long-term pain and osteoarthritis.
• Ligamentous or Tendon Injuries: You could tear or stretch crucial ligaments (e.g., medial patellofemoral ligament, MPFL) or damage the patellar tendon.
• Fractures: Fragments of bone or cartilage can break off, requiring surgical intervention.
• Incorrect Reduction: Without proper anatomical knowledge and technique, you might not reduce it correctly, or you could cause the kneecap to dislocate in another direction.
• Undiagnosed Associated Injuries: A dislocation often occurs with other injuries that need professional assessment, such as an osteochondral fracture (a piece of cartilage and bone breaking off). These can be missed if not medically evaluated.

Immediate Action: What To Do If Your Kneecap Dislocates

If you or someone else experiences a suspected kneecap dislocation, follow these steps while awaiting medical help:

• Stay Calm: Panic can worsen the situation.
• Do Not Move or Manipulate: Absolutely do not try to push, pull, or twist the kneecap or the leg.
• Immobilize the Leg: Keep the leg as still as possible in the position it landed. You can use pillows or rolled-up blankets to support it.
• Elevate the Leg: If possible, gently elevate the leg above the level of the heart to help reduce swelling.
• Apply Ice: Place a cold pack or ice wrapped in a cloth on the knee to help with pain and swelling. Do not apply ice directly to the skin.
• Seek Emergency Medical Help Immediately: Call emergency services or have someone transport you to the nearest emergency room. This is a medical emergency.

Medical Intervention: Professional Reduction and Treatment

Upon arrival at a medical facility, healthcare professionals will take the following steps:

• Diagnosis: A doctor will examine the knee and usually order X-rays to confirm the dislocation and rule out any associated fractures. In some cases, an MRI may be performed to assess soft tissue damage.
• Reduction: A trained medical professional (doctor, orthopedic surgeon) will gently manipulate the kneecap back into place. This is often done with pain medication or sedation to ensure the patient's comfort and muscle relaxation, making the procedure safer and less painful.
• Post-Reduction Care: After reduction, the knee will typically be immobilized in a brace or splint to allow initial healing and prevent re-dislocation. Pain management will also be provided.
• Assessment for Associated Injuries: The medical team will assess for any damage to ligaments, cartilage, or other structures that may have occurred during the dislocation. These may require further treatment, potentially including surgery.

Rehabilitation After Dislocation

Once the kneecap is back in place and initial healing has occurred, a comprehensive rehabilitation program is crucial, typically guided by a physical therapist.

Key Components of Rehabilitation:

• Pain and Swelling Management: Initial focus on reducing discomfort.
• Restoring Range of Motion: Gentle exercises to regain full knee movement.
• Strengthening: Targeted exercises for the quadriceps (especially the vastus medialis obliquus or VMO), hamstrings, glutes, and core muscles to improve knee stability.
• Proprioception and Balance Training: Exercises to improve the body's awareness of knee position and enhance neuromuscular control.
• Gradual Return to Activity: A structured progression back to daily activities, work, and sports, minimizing the risk of re-dislocation.

Prevention Strategies

While some anatomical factors are beyond control, many instances of patellar dislocation can be prevented or the risk reduced through appropriate measures:

• Address Muscle Imbalances: Work with a physical therapist or knowledgeable trainer to identify and correct imbalances, particularly strengthening the VMO and gluteal muscles.
• Improve Flexibility: Maintain good flexibility in the hamstrings, quadriceps, and hip flexors.
• Proprioceptive Training: Incorporate balance exercises (e.g., single-leg stands, wobble board exercises) into your routine.
• Proper Warm-up and Cool-down: Always prepare your body for activity and help it recover afterward.
• Appropriate Footwear: Wear supportive shoes that are suitable for your activity.
• Avoid High-Risk Activities: If you have a history of dislocation or anatomical predispositions, consult with a medical professional about activities that might put you at higher risk.

When to Seek Immediate Medical Attention

Any suspected kneecap dislocation requires immediate medical attention. Do not delay seeking help if you experience:

• Sudden, severe knee pain.
• Visible deformity of the kneecap.
• Inability to move or bear weight on the leg.
• Significant swelling or bruising around the knee.

Prompt and professional medical care is essential to ensure proper diagnosis, safe reduction, and to prevent long-term complications.