Patellar Dislocation – An Overview
Patellar dislocation is the condition in which the patella (knee cap) shifts out if its normal position (dislocation) from the trochlea (knee groove). This is a painful and debilitating condition and needs prompt and efficient medical care for complete recovery as well as relief from the painful symptoms.
This patellar dislocation is mostly caused due to a trauma (severe injury) to the knee region or if the knee joint gets twisted while performing a physical activity. This dislocation may be partial or it could be a complete dislocation as well.
Causes of Patellar Dislocation
There are several causes that may result in the patella (knee cap) getting dislocated from its normal position. If the patella is unstable by nature then it is more vulnerable to suffer a dislocation.
An uneven (shallow) groove in the femur (thigh bone) where the patella fits may make dislocation more likely. In some cases the patient’s ligaments are unusually loose and it makes their joints more likely to get dislocated. This problem is more prevalent in women as compared to men. Certain pre-existing medical disorders (such as Down Syndrome and cerebral palsy) cause instability and weaken the muscles around the joints, including the knee joint, and this puts the patella more at risk of getting dislocated.
In normal and healthy people, patellar dislocation is seen caused mostly by a direct trauma or an injury to the knee joint and is more often seen in high-contact sports.
Signs and Symptoms of Patellar Dislocation
The common signs and symptoms associated with patellar dislocation are:
- Feeling the patella shift out of the femoral groove
- Feeling the knee buckling
- ‘Pop’ sound is heard mostly at the time of dislocation
- Knee appears deformed/misshapen
Diagnosing Patellar Dislocation
Most patellar dislocation cases are a result of a direct trauma or an injury to the knee and this is an emergency medical situation that needs to be addressed in a well-equipped emergency unit of a hospital or an emergency clinic. The doctor will perform a few diagnostic tests, mainly to determine the severity of the dislocation, restriction of movement and the pain felt in the injured region.
This information will help the doctor prepare an efficient and effective treatment plan for the patient.
The common emergency diagnostic tests for determining the presence, as well as the nature, of a patellar dislocation are:
- X-Ray test – This imaging test is helpful in providing a clear picture of the bone structure of the knee to assist the doctor in assessing the extent of damage to the knee as well as check it for any form of abnormalities, such as shallow femoral groove.
- Magnetic Resonance Imaging (MRI) scan – This imaging test is helpful in providing a clear image of the soft tissue surrounding the injured knee joint, such as ligaments. This diagnostic test is usually performed to gain additional information about the dislocation, which has not been gotten from a simple x-ray test.
An imaging test can also show debris (broken bone pieces) that could have resulted from a dislocated patella.
Patellar Dislocation Treatment
A patellar dislocation where the knee cap does not shift back into its normal position on its own after the dislocation, needs emergency medical treatment for relief from pain and to gain full recovery from the injury. The emergency room procedure for patellar dislocation is known as the ‘reduction’ method, in which the doctor will administer local anesthesia to numb the region of the injured knee joint. Then the doctor gently applies pressure on the patella to shift it steadily towards its natural position in the femoral groove.
There are several other treatment methods that are applied for a patellar dislocation, such as:
Non-Surgical Treatment Methods:
- Immobilization – This treatment requires the patient to wear a knee brace for around 3-4 weeks to stabilize the knee joint for it to heal naturally.
- Physical Aids – As the injured knee joint will not be able to bear the weight of the body for a few weeks the doctor may advise the use of certain walking aids, such as crutches, to help the patient walk with less pain.
- Physical Therapy – As the knee starts to heal naturally, the doctor may advise a physical therapy treatment to regain the lost strength as well as restore the restricted range of motion of the knee to normal levels.
In case of a severe injury to the knee joint, the dislocation might also be accompanied by other complications such as tissue damage which will not let the patella (knee cap) fit normally into the femoral groove. This requires a surgical treatment for patellar dislocation.
Surgical Treatment Methods:
In case the patella suffers multiple dislocations, or does not prove stable after continuous non-surgical treatment attempts then a surgery is required to treat the condition and to help relieve the problems. There are also several techniques used to perform the surgical procedure and the exact type of surgical treatment will depend mainly on the cause of the unstable patella.
A surgical treatment for patellar dislocation mostly involves reconstruction of the ligaments that support the knee cap (patella) and hold it in place. This surgery is nowadays performed using highly-efficient and advanced minimally invasive arthroscopic surgical technique. This new surgical method requires less number of incisions (that are smaller in size as well) as compared to the conventional ‘open-type’ surgical methods. This arthroscope is a set of tiny and flexible tubes, one of which is attached with a tiny video camera and a light source, that when inserted in the knee joint, allows the surgeon/doctor to see a real-time detailed and magnified image of the dislocated knee cap.
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