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Patellar Dislocation: Causes, Symptoms & Treatment
A patellar dislocation occurs when the kneecap slips out of its normal position. It causes sudden pain and instability in the knee and requires medical treatment.
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A patellar dislocation occurs when the kneecap slips out of its normal position. It causes sudden pain and instability in the knee and requires medical treatment.
What is a Patellar Dislocation?
A patellar dislocation occurs when the kneecap (patella) slips completely out of its normal groove at the end of the thigh bone (femur), known as the trochlea. In most cases, the kneecap shifts outward (laterally). This results in sudden, severe pain and a visible deformity of the knee. Patellar dislocations are among the most common acute knee injuries, particularly affecting young, physically active individuals and women.
Causes
A patellar dislocation can result from various factors:
- Traumatic causes: A direct blow or fall onto the knee, a sudden twisting motion, or a sports injury can force the kneecap out of position.
- Anatomical predispositions: A shallow trochlear groove (trochlear dysplasia), a high-riding kneecap (patella alta), or an increased Q-angle can raise the risk significantly.
- Muscle imbalances: Weakness of the inner thigh muscle (vastus medialis oblique) combined with tightness of the outer structures may pull the kneecap laterally.
- Ligament laxity: Generally loose connective tissue increases vulnerability to dislocation.
- Recurrent dislocation: After a first-time dislocation, the risk of repeat events is considerably higher due to damage to the medial patellofemoral ligament (MPFL).
Symptoms
Common signs and symptoms of a patellar dislocation include:
- Sudden, severe knee pain
- Visible deformity or bulge on the outer side of the knee
- Swelling of the knee joint due to bleeding into the joint (hemarthrosis)
- A feeling of instability and limited range of motion
- Tenderness along the inner edge of the kneecap
- Occasional spontaneous return of the kneecap to its normal position (self-reduction)
Diagnosis
The diagnosis is typically established through:
- Clinical examination: Assessment of kneecap mobility, stability tests (e.g., patellar apprehension test), and palpation findings.
- X-ray: To rule out bone fragment injuries (osteochondral fractures) and evaluate kneecap alignment.
- MRI (Magnetic Resonance Imaging): Detailed visualization of ligaments, cartilage, and soft tissue structures, especially the MPFL.
- CT scan: Precise evaluation of anatomical variations such as trochlear dysplasia or the TT-TG distance (tibial tuberosity to trochlear groove distance).
Treatment
Conservative Treatment
For a first-time patellar dislocation without significant accompanying injuries, conservative management is usually the first approach:
- Reduction: The kneecap is guided back into its normal position, often with medical assistance.
- Immobilization: Short-term splinting or use of a brace to relieve the joint.
- Physiotherapy: Targeted strengthening exercises, especially of the vastus medialis muscle, to stabilize the knee.
- Pain management: Use of anti-inflammatory and pain-relieving medications (NSAIDs).
Surgical Treatment
Surgery may be indicated in cases of recurrent dislocation, significant anatomical abnormalities, or associated injuries:
- MPFL reconstruction: Surgical restoration of the medial patellofemoral ligament to stabilize the kneecap.
- Trochleoplasty: Deepening of the trochlear groove in cases of severe trochlear dysplasia.
- Tibial tubercle transfer (TTT): Repositioning of the patellar tendon attachment to correct the line of pull.
Prognosis and Prevention
With appropriate treatment and consistent rehabilitation, the prognosis after a first-time patellar dislocation is generally favorable. The risk of recurrence can be significantly reduced through targeted strength training, sports bracing, and surgical stabilization when necessary. Regular follow-up examinations with an orthopedic specialist are recommended.
References
- Seeley M, et al. - Patellar instability: current concepts. Journal of Bone and Joint Surgery, 2021. PubMed.
- Dejour H, Walch G - Chronic anterior knee instability: proximal and distal realignment. Sports Medicine and Arthroscopy Review, 1994.
- Lippacher S, et al. - Patellar dislocation: incidence of associated injuries, treatment options. Knee Surgery, Sports Traumatology, Arthroscopy, 2012.
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