Kneecap Dislocation: Understanding, Professional Relocation, and Rehabilitation

How Do You Relocate Your Kneecap?

Relocating a dislocated kneecap (patellar dislocation) is a medical procedure that should only be performed by a trained healthcare professional due to the significant risk of further injury, nerve damage, or incomplete reduction if attempted improperly. Self-relocation is strongly discouraged and can lead to severe complications.

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). Most commonly, the patella dislocates laterally (to the outside of the knee). This is a painful and often visually dramatic injury.

• Anatomy Involved: The patella is a sesamoid bone embedded within the quadriceps tendon, acting as a fulcrum to increase the leverage of the quadriceps muscles. Its stability relies on the trochlear groove, the medial patellofemoral ligament (MPFL), and the balance of forces from the quadriceps musculature.
• Common Causes: Patellar dislocations often result from a direct blow to the knee, a sudden twisting motion of the leg while the foot is planted, or a rapid change in direction. Individuals with certain anatomical predispositions, such as patella alta (high-riding kneecap), trochlear dysplasia (shallow trochlear groove), or muscle imbalances (e.g., weak vastus medialis obliquus), are more susceptible.
• Symptoms: The immediate symptoms include severe pain, a visible deformity of the knee, inability to straighten the leg, swelling, and a feeling of instability or "giving way." A "pop" sensation may also be felt at the time of injury.

Why Self-Relocation Is Not Advised

Attempting to relocate a dislocated kneecap without proper medical training carries significant risks and is highly discouraged.

• Risk of Further Injury: Without a precise understanding of the knee's anatomy and the specific mechanics of the dislocation, attempting to force the patella back into place can cause further damage to crucial structures. This includes:
  • Articular Cartilage Damage: The smooth cartilage surfaces of the patella and femur can be scraped, bruised, or chipped, leading to long-term pain and increased risk of osteoarthritis.
  • Ligamentous Injury: The medial patellofemoral ligament (MPFL), which is often torn during a dislocation, can be further damaged or other ligaments (ACL, MCL, LCL) can be injured.
  • Fractures: Small bone fragments (osteochondral fractures) can be sheared off the patella or femur, requiring surgical intervention.
• Nerve and Blood Vessel Damage: Although rare, forceful or incorrect manipulation could potentially damage nerves or blood vessels around the knee.
• Incomplete Reduction: An amateur attempt may not fully reduce the dislocation, leaving the patella partially out of place, which can cause ongoing pain and instability.
• Misdiagnosis: Other conditions, such as a severe knee sprain or even a tibial plateau fracture, can present similarly to a patellar dislocation. A medical professional will perform a thorough assessment to rule out other, potentially more serious, injuries.

The Professional Relocation Process (Reduction)

When a patellar dislocation occurs, the immediate priority is to seek medical attention. A healthcare professional, such as a doctor, emergency medical technician, or athletic trainer, will perform the relocation (reduction) after a proper assessment.

• Medical Evaluation:
  • Visual Inspection: The professional will assess the deformity and swelling.
  • Palpation: Gently feeling around the knee to identify the position of the patella and rule out other obvious injuries.
  • Imaging (X-rays): Before reduction, X-rays are crucial to confirm the dislocation, determine the direction of displacement, and rule out any associated fractures (e.g., osteochondral fractures) that would necessitate a different approach or immediate surgery.
• Pain Management: Relocation can be painful. Depending on the setting, pain relief may be administered, ranging from oral analgesics to conscious sedation in an emergency room. Muscle relaxants may also be used to help the quadriceps muscles relax, making the reduction easier.
• Reduction Techniques: The specific technique varies, but the general principle is to gently reverse the path of dislocation.
  • Traction and Extension: The most common method involves gently extending the knee while applying gentle traction to the ankle. This helps to relax the quadriceps muscles.
  • Gentle Medial Pressure: Simultaneously, the professional will apply gentle pressure to the lateral (outer) side of the patella, guiding it back into the trochlear groove.
  • Controlled Flexion: Once the patella is near the groove, slowly flexing the knee may help it seat correctly.
  • Audible "Clunk": Often, a distinct "clunk" or "pop" will be heard or felt as the patella slides back into place.
• Post-Reduction Assessment: After reduction, the professional will re-evaluate the knee's stability, range of motion, and neurovascular status. Another set of X-rays may be taken to confirm proper alignment and check for any new fractures.

Immediate Post-Relocation Care

Once the kneecap is successfully relocated, immediate post-injury management is crucial for pain control and to prevent re-dislocation.

• Immobilization: The knee will typically be immobilized in a brace or splint for a period (e.g., 2-4 weeks) to allow the injured tissues, particularly the MPFL, to begin healing. The degree of immobilization and duration will depend on the severity of the injury and any associated damage.
• Pain and Swelling Management:
  • RICE Protocol: Rest, Ice, Compression, and Elevation are vital to reduce pain and swelling.
  • Medication: Over-the-counter or prescription pain relievers and anti-inflammatory drugs may be recommended.
• Weight-Bearing Status: Depending on the injury, partial or non-weight-bearing may be advised initially, with crutches used for mobility.

Rehabilitation and Prevention

Long-term management after a patellar dislocation focuses on rehabilitation to restore function, prevent recurrence, and address any underlying predisposing factors. This typically involves a structured physical therapy program.

• Physical Therapy: A comprehensive rehabilitation program is essential. It will typically include:
  • Range of Motion Exercises: Gradually restoring full, pain-free knee movement.
  • Strengthening Exercises: Focusing on the quadriceps (especially the vastus medialis obliquus), hip abductors, and gluteal muscles to improve dynamic knee stability.
  • Neuromuscular Control and Proprioception: Exercises to improve balance, coordination, and the body's awareness of the knee's position in space.
  • Gait Training: Re-education of walking patterns to ensure proper biomechanics.
• Addressing Underlying Causes: For individuals with recurrent dislocations, a thorough evaluation will be performed to identify and address anatomical abnormalities or muscular imbalances. This may involve specific exercises or, in some cases, surgical intervention (e.g., MPFL reconstruction, trochleoplasty) to stabilize the kneecap.
• Return to Activity: A gradual, progressive return to sports and activities is guided by the physical therapist and physician, ensuring adequate strength, stability, and confidence before resuming high-impact or pivoting movements.

When to Seek Emergency Care

If you suspect a patellar dislocation, or any significant knee injury, it is crucial to seek immediate medical attention. Do not attempt to relocate the kneecap yourself. Call emergency services or go to the nearest emergency room if:

• The knee is visibly deformed and you cannot straighten your leg.
• There is severe pain and swelling.
• You experience numbness or tingling in the foot or lower leg.
• The skin around the knee is discolored or cold to the touch.