The patella (knee-cap) sits on the front surface of the end of the femur (thigh bone) and forms the patellofemoral joint. Dislocation of the patella most commonly occurs with trauma such as twisting or jumping injuries or contact from opposition players in sport. Atraumatic injuries can occur in those with ligament laxity and a past history of previous dislocation.
Dislocation results in the patella sitting laterally (outside) on the knee. Reduction occurs with straightening the knee out, some cases may require sedative medication to assist the process. Swelling of the knee occurs immediately which should be controlled with the RICE approach (rest, ice, compression, elevation).
The lateral femoral condyle is the main passive restraint to a dislocation episode and damage to the underlying cartilage can often occur. The medial patellofemoral ligament is the other passive restraint which is often torn with dislocation of the patella. Underlying cartilage damage may require surgery to remove bone fragments or repair the cartilage defect. In recurrent episodes, patella stabilisation surgery may be required.
Plain x-rays are routinely taken to exclude fractures and any bone fragments. Severe cases may require an MRI to ascertain the extent of suspected underlying cartilage (chondral) damage or associated ligament damage.
Conservative management is the treatment of choice for first time dislocators. Acute management consists of bracing and the use of crutches to control swelling. Muscle re-training then occurs with specific exercises to strengthen the quadriceps and VMO (inside quadriceps muscle), calf muscles and hip muscles. Re-training the ‘core muscles’ is also important. Your Physica Practitioner may use other modalities such as taping or manual therapy in this phase of the rehabilitation program.
Treatment is then directed at returning you to your chosen sport with higher level balance tasks, sports specific drills and functional retraining which may consist of stepping, squatting and running. This process may take up to three months before returning to competitive sport.
All Physica Physiotherapists have expertise in the management and rehabilitation of patella dislocations. We will assess your injury and guide you through a comprehensive individualised program to get you back to sport.