What is Kneecap Dislocation?
Knee is one of the most complicated hinge joint in the body, where three bones i.e. thigh, shin bone and kneecap unites. Kneecap, which is also called as patella, is largest sesamoid bone in our body and located on the front side of the knee. It sits quite comfortably in a groove located at the bottom of thigh bone. While bending the knee or extending the leg, its stabilize and supports the leg with the help of quadriceps muscles.
The tough fibrous bands called as medial and lateral patella retinaculum attaches the kneecap on either sides of the femur while quadriceps tendon and patellar tendon (ligament) attaches it superiorly and inferiorly. Any normal or sports activity require a stable kneecap because it functions like lever and pulley. Kneecap dislocates when suddenly changing direction while the leg is firmly planted on the ground or acute blow to the inner side of the knee.
Kneecap dislocation is chronic problem. Females are more prone to patellar dislocations than men. According to research studies, 30-72% of patellar dislocations occur in sportsmen, while 28-39% cases are result of osteochrondral fractures. Lateral dislocation is one of the most commonly occurred location in the knee. However, in majority of cases i.e.90%, the dislocated patella return to its groove spontaneously.
50% of individuals, who had previously under any knee injury are most likely to suffer from knee dislocation. Individuals in the age group of 10-17 are also most prone to kneecap dislocation. The ratio of kneecap dislocation in adults is 5.8/100,000, while it is significantly high in adolescents i.e. 29/100,000.
What are the Symptoms of Kneecap Dislocation?
Significant amount of pain and swelling can be experienced after the dislocation. An audible pop or crack sound can be heard at the time of injury. Patients will feel the displacement of kneecap to the outer side of the joint. Entire tissues associated with the kneecap gets swollen pretty quickly.
Patients will feel extremely difficult to even walk let alone other activities. This injury is extremely painful and distressing. Knee will become unstable and a feeling of knee giving away can be felt. There will be difficulty in bending or straightening the knee. It will even causes deformity of the knee joint.
What are the Causes of kneecap Dislocation?
There are two conditions associated with kneecap dislocation i.e. dislocation and subluxation wherein the former is caused when patella completely comes out of groove while the latter is caused when patella partially comes out of groove. Most of the time patella dislocates due to the following causes:
- Excessive jumping.
- Sudden twisting.
- Acute blow inside the patella.
- Rapid pivoting.
- Players and individuals involved in contact sports like soccer and football.
- Hyper-active teenage girls.
- Weak quadriceps muscles.
- Pronation of the foot.
- Increase in the Q angle of knee.
Diagnosis of Knee Dislocation:
Comprehensive physical test along with detailed medical history is conducted by doctors or physical therapists to diagnose kneecap dislocation. X-ray is needed to evaluate any fracture in knee and MRI is needed to rule out any further complications. These test are extremely necessary to assist in accurate diagnosis of knee dislocation.
Treatment of Knee Dislocation :
If you have dislocated your knee for the first time, then doctors will splint the leg. Sometimes, the kneecap settles down in grove by straightening the leg and if this not happens, then doctors will use the method of reduction to manipulate the kneecap back to its original place. Medication will given in order to reduce the severe pain.
If the kneecap fits in the groove, then doctors will perform some more tests to ensure it is settled down in the position properly and correctly. Knee immobilization and medication along with physical therapy is prescribed by the doctors. Surgery is only required if and only the bone is fractured. Or else, physiotherapy and other conservative treatments are sufficient for correcting the position of the kneecap. Some of the common treatment methods for kneecap dislocation are:
- R.I.C.E. Principle: Rest, ice, compression and elevation is crucial components of treatment. Rest the knee for alleviating the pain naturally. Apply icepacks on the point of injury several times day for a period of 15-20 minutes. Compress the affected area with elastic bandage to limit the swelling. Elevate the injured leg above the heart’s level to reduce the blood flow to the affected part.
- Knee Immobilization: Doctors will immobilize the knee with the help of detachable splint or knee immobilizer. Both are extremely effective in keeping the position of leg and patella in still position and even protecting them from any further injury.
- Painkillers: Ibuprofen or paracetamol is often prescribed by the doctors. Consult your doctors before diagnosing any medications.
- Knee Braces: knee braces are extremely effective in protecting the knee joint. Nowadays, knee braces for patella dislocation are specially designed that provides stability and support to the kneecap.
- Crutches: Crutches are useful in preventing the injured leg to bear the weight of the body. Use crutches until and unless the pain and swelling subsides.
- Physical Therapy: Physiotherapy is extremely necessary to strengthen the muscles located around the knee joint to stabilize the knee and prevent it from further injury. Thigh-strengthening exercises such as stationary bicycling, isometric quadriceps contractions, towel quadriceps contractions, leg extension, and quadriceps stretch are useful in strengthening the muscles.
- Surgery: Surgery is very rare in dislocated kneecap. However, if the problems persists again and again, then doctors may advise surgery to make it stable.
Recovery Period for Patella Dislocation :
Kneecap dislocation is chronic problem, which indicates that pain will heal but it will be weak and prone to further injury. So, it’s necessary to avoid any aggravating activities during and after the treatment. Wear knee brace while participating in any sports. The dislocated knee will take approximately 6-8 weeks to fully recover and heal with physical therapy and rehab program. Always stay in contact with your physical therapist.
Conclusion – Kneecap Dislocation:
The outlook is good. Patients will generally feel relieved from knee dislocation from physical therapy. Muscle strengthening exercises are extremely vital in reducing pain and improving the functions of knee joint. It will also provide stability to the knee joint and reduces possibility of kneecap dislocation in the future.