Patella Dislocation
The patella is the kneecap. When the kneecap slides out of position, it is called patella dislocation.
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Causes
There are a number of reasons why patella dislocation may occur. Some common ones include:
Thigh muscles are tight,weak or imbalanced, which prevents the patella from sliding smoothly when knee is in motion
Flat feet, overpronation
Knock-knees, malalignment of the patella
Shallow trochlear groove, which is the groove that the patella usually slides up and down in in the knee
Symptoms
Common symptoms related to patella dislocation are:
Knee looks deformed
Immediate pan
Swelling
Tenderness
Inability to move knee or weight bear
Diagnosis
To determine if your child has a patella dislocation, our specialists will perform a physical exam that may include flexibility tests, stress tests, muscle tests and gait analysis. These tests will help our specialized team better understand your child’s condition, assess range of motion and identify abnormalities that might occur in bone alignment or muscle function.
After a physical exam, our specialists may also order imaging tests such as an our specialists may order imaging tests such as an X-ray, MRI, or computed tomography.
If a patella dislocation is diagnosed, our sports medicine team will promptly reduce the dislocation with techniques to minimize pain and discomfort.
Treatment
Possible non-surgical treatments your doctor may offer or recommend to treat your child’s patella dislocation injury include:
Reduction (moving the dislocated joint back in place)
Physical therapy and home exercise program
Activity modification
If our doctors and surgeons believe surgery is the best option for your child, we may recommend minimally invasive arthroscopy, reconstruction of torn ligaments, and/or correction of bone pathology causing dislocations.
At-Home Care
Common at-home treatment options for patella dislocation include:
Icing the Area:
Put ice packs wrapped in a towel or thin cloth on your child’s affected area for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.
Elevating the Injured Limb:
If your child has a broken leg, elevate it by placing it on a pillow when your child is lying down. Elevating it above the heart level can help reduce swelling and pain.
Apply Elastic Bandage:
Gently wrap the knee with an ACE bandage to help reduce swelling.
Taking Non-Prescription Medication:
Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.
Exercising:
Your doctor may recommend doing exercises at home. These are designed to stretch the affected area, maintain range of motion in the joint and strengthen your child’s muscles and bones.
Braces and knee immobilizers may decrease symptoms and ease recovery.
Rehabilitation Exercises
Below are common exercises a doctor may recommend to help your child recover after a patella dislocation. Always check with your doctor to find out which exercises are right for your child.
Stretching
Vastus Medialis Oblique Quadriceps Sets
Sit on the floor with injured leg straight in front.
Press the back of the knee down while tightening the muscles on the top of the thigh.
Concentrate on tightening muscles on the inner side of kneecap.
Hold for 5 seconds. Complete 3 sets of 10.
Straight Leg Raise
Sit on the floor with the injured leg straight and the other leg bent, foot on the floor.
Pull the toes of the injured leg in as far as possible, while pressing the back of the knee down and tightening the muscles on the top of the thigh.
Raise the leg six to eight inches off the floor and hold for 5 seconds.
Slowly lower back to the floor.
Complete 3 sets of 10.
Straight Leg Stretch
Lay in a bed or on the floor.
Place a towel or pillow under ankle or heel.
Sit for 3-5 minutes allowing for gravity to straighten knee.
Heel Slides
Lay in a bed or on the floor.
Drag heel towards buttocks so knee bends.
Stop if it gets painful; a small stretch is normal.
Hold for 5 seconds, repeat 10 times.
Do 3 sets of 10.
Abduction Leg Lifts
Lie on the uninjured side and lean on the elbow of the uninjured side.
Use the arm of the injured side in front to stabilize the body.
Slowly with the injured leg up, hold for 5 seconds then lower slowly.
Be sure to keep hips steady and don’t roll forwards or backwards.
Complete 3 sets of 10.
Abduction
Lie on the injured side with top leg bent and a foot placed in front of the injured leg, which is kept straight.
Raise the injured leg as far as possible, while remaining comfortable.
Hold for 5 seconds keeping hips still while lifting leg.
Slowly lower leg.
Complete 3 sets of 10.
Extension
Lie on stomach.
Raise injured leg as far as possible and hold for 5 seconds.
Keep hips still while lifting leg.
Hold for 5 seconds, then slowly lower leg.
Complete 3 sets of 10.
Core Exercises
Abdominal Contraction
Lie on back with knees bent and hands resting below ribs.
Tighten abdominal muscles to squeeze ribs down towards back.
Be sure not to hold breath.
Hold 30 seconds. Relax.
Repeat 3 times on each side.
Pelvic Tilt
Lie on back with both knees bent and feet planted on the floor.
Tuck buttocks under and move front of hips slightly up
Think of pulling belly button in towards the back.
Hold for 10 seconds. Repeat 10 times.
Abdominal Crunch
Lie on back with both knees bent and feet planted on the floor.
Tuck buttocks under like in the pelvis tilt exercise.
Gently place both hands behind head for support and tuck upper body in.
Do not pull head with hands.
The movement should come from squeezing abdominal muscles.
Forearm Plank
Lie down facing the floor on forearms.
Raise up until resting on knees and elbows.
Maintain body straight from head to knees.
Hold for 10 seconds.
Try again, lifting knees up off the floor.
Work up to 30-60 seconds, if possible.
Plank (Upper Pushup)
Lie down facing the floor with hands planted on either side next to chest.
Raise up until resting on knees and hands.
Maintain body straight from head to knees.
Hold for 10 seconds.
Try again, lifting knees up off the floor.
Work up to 30-60 seconds, if possible.
Opposite Arm and Leg
Lie down facing the floor.
Lift up the opposite arm and leg 2 inches above the floor.
Hold for 10 seconds. Repeat 10 times on each side. Do three sets.
Use a rolled-up towel under forehead for comfort.
Dead Bugs
Lie on back and place both hands under buttocks.
Bring both legs up to point to the ceiling with knees slightly bent.
Gently lower one leg towards the ground then slowly back up.
Try to keep lower back on the floor and repeat with opposite leg.
Complete 3 sets of 10
Stage 2 Exercises
Standing Calf Stretch
Facing a wall, put hands against the wall at about eye level.
Keep the uninjured leg forward and the injured leg back about 12-18 inches.
Keep the injured leg straight and the heel on the floor.
Keep toes pointed towards the wall.
Next, do a slight lunge by bending the knee of the forward leg. Tell your child to lean into the wall until they feel a stretch in the calf muscle.
Hold for 30-60 seconds. Repeat 3 times.
Standing Soleus Stretch
Facing a wall, put hands against the wall at about eye level.
Keep the uninjured leg forward and the injured leg back about 4-6 inches behind the uninjured leg.
Tell your child to keep both heels on the ground and gently bend their knees until they feel a stretch in the calf muscle.
Hold for 30-60 seconds. Repeat 3 times.
Hamstring Stretch
Lie on back and bring the affected leg towards the chest.
Grab the back of the thigh and try to extend the leg.
Your child may also try this with a towel around the foot if it is more comfortable.
Hold for 30-60 seconds. Repeat 3 times.
Quadriceps Stretch
Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside.
Facing straight ahead, keep the hand nearest the wall against the wall for support.
With your other hand, grasp the ankle of your injured leg and pull your heel up toward your buttocks. Do not arch or twist your back.
Hold this position for 30 seconds.
Repeat three times.
Note: This may also be done while lying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times.
Alternative Quadriceps Stretch
Place the affected leg on a sturdy chair or low stool.
Place the opposite hand on a wall to your child’s side
Bend front leg slowly.
Hold for 30 seconds. Repeat 3 times.
Clamshells
Lie on side with knees slightly bent, keeping legs and ankles together.
Open and close knees like a clam by lifting the top knee up until it’s parallel with the hip.
Keep feet together throughout the exercise.
Move slowly and controlled as if someone is pushing against the knee while your child is pressing it up.
Complete 3 sets of 10.
Side Steps with Latex Resistance Band
Place a band around ankles.
Lower down into a half squat with knees bent and toes pointing forward.
Step to the right with the right foot while staying low in squat position.
Bring left foot in.
Repeat 10 times in each direction. Do 3 sets.
When Will My Child Return to Play?
After your child has had an injury like an patella dislocation, it’s normal to want to know how long the injury will take to heal and what you can expect.
Every child is unique, every injury is different and your doctor will be able to give you general guidelines as to when your child may be able to return to play. Recovery from a patella dislocation or subluxation typically takes a minimum of a few weeks to months.
The best thing you can do for your child is to make sure you consistently follow your doctor’s instructions, including doing at-home exercises regularly. When it is okay to do so, our doctors and staff will let you know when your child can return to play at a controlled level.
How to Prevent Patella Dislocation
Stretch before doing any strenuous activity, including the knee
Strengthen the thigh, hip and trunk muscles
Increase training gradually
Use proper running gear and form
Use proper running form