A dislocated kneecap, or patella dislocation, is no fun. Your knees support you in nearly every daily activity, and when something goes wrong, you want it fixed as quickly as possible. But is surgery always necessary? Thankfully, the answer is no: there are other options to explore. The first step is to understanding what has happened. The next is learning about your options and getting help from our world-class team at Olsen Orthopedic in Oklahoma City, OK, headed by Oklahoma’s leading orthopedic surgeon, Dr. Todd Olsen.
What Happens in a Patella Dislocation?
The patella, commonly referred to as the kneecap, is a small bone that sits between your shinbone and thighbone. This cap is connected to both of these larger bones by flexible tissue known as cartilage. The kneecap allows the knee to bend while protecting all the delicate ligaments inside. The kneecap is so important that almost every motion you ever make with your leg requires some motion from the kneecap.
The kneecap is made to sit in a particular place. Your femur, which is the big bone of your thigh, actually has grooves in it that your patella normally sits in. The kneecap can be forced out of place by a fall, a hard blow, or even a funny twist or rotation of your knee. Many people get a patella dislocation when dancing, running, playing a sport, or in military training.
But some people dislocate their kneecap just turning around quickly to flip a light switch. If you’re experiencing the symptoms of a kneecap dislocation, don’t dismiss it just because you weren’t playing sports when you first noticed them! A dislocated knee may sometimes move back into place on its own. At other times, a doctor can move it back into place. Even with the kneecap back in place, however, there can still be other concerns you need to have looked at.
It’s possible that bone nearby was sheared off when you injured your knee, and that bone can get stuck in the joint. There may also be an injury to the connective tissues around the kneecap that will take time to heal. Until this healing happens, the kneecap will be weak and liable to fall out of joint again.
Symptoms to Watch for
The only way to know for certain is you have a dislocated kneecap is to visit our offices and get an orthopedic diagnosis, but there are some symptoms to watch for. Come see us if you:
- Feel pain and swelling in your knee
- Notice your kneecap feels “wrong” or out of place
- Can’t bend your knee
- Can’t put weight on your leg
- Feel your knee is about to “give way”
- Have numbness below the knee
- Can see the knee doesn’t “look right”
If you’re still on the fence about seeing a doctor, consider whether you have any of the risk factors for kneecap dislocation. They are:
- Being tall
- Being overweight
- Having weak or imbalanced muscles in your leg
- Having a kneecap that doesn’t line up straight on the joint
- Having a family or personal history of kneecap issues
How Patella Dislocations Are Diagnosed
First, the doctor will manipulate your kneecap by hand, feeling it and moving it around. If this causes you discomfort, or if the doctor feels a dislocation, the next step will be diagnostic imaging to show what’s going on within the knee. This will give the doctor a clear indication of the problem and helps you make a decision about your next step.
At Olson Orthopedic, we don’t turn to surgery first. Our ultimate goal is to see you back up and on your feet, but surgery should always be a last resort if there are other, gentler means of returning you to full function.
If your patella isn’t already back in place, the orthopedist will gently move it to the correct position. The next step is stabilizing the joint so it has time to heal. In most cases, this involves using a splint or brace to keep everything in place. This will also help to relieve pain, and you can take over-the-counter pain killers such as acetaminophen or ibuprofen to manage any discomfort.
In very extreme cases, you may need prescription medication. If that’s the case for you, always follow the doctor’s instructions about how much to take and when to stop. Many forms of prescription pain killers come with acetaminophen, so never take Tylenol, cold medications, or anything else containing acetaminophen with your prescription pain meds.
In some cases, the kneecap may have trouble going back into place because a severe injury has caused blood or another fluid to pool in the knee. Aspiration relieves this pressure by removing the fluid. This only takes a few minutes and can often be done without setting up a special appointment.
If the doctor recommends an aspiration, you should first disclose any medications or supplements you are taking and whether you’re allergic to any medications or items such as latex. If you have a bleeding or clotting disorder, this is also the time to let the doctor know. If you are taking blood thinners or similar medication, you may need to stop taking them for a few days before your aspiration.
First, you’ll lie down in a comfortable position with your knee slightly elevated. The doctor will mark the correct spot on your knee with a pen and then thoroughly clean the site. In some cases, the doctor might use some kind of imaging device to guide the needle, but this isn’t always necessary.
The doctor will numb the area so you don’t feel anything, and if needles make you particularly anxious, let us know so we can discuss how to make you more comfortable. Once the numbing agent has done its work, the doctor will insert a small needle and pull back on the plunger to fill it with the fluid in your knee. Once the knee is free of excess fluid, it will feel much more comfortable.
After you’ve worn your brace or knee stabilizer for a while, we will remove it and evaluate the knee and surrounding muscles. This involves physical therapy, and the goal of this therapy is to restore your knee and leg to full strength. It will also be important to correct any problems with muscle imbalance or alignment that may have resulted from either the dislocation or the time you spent in a brace. Physical therapy targets two key parts of your body:
The Knee Itself
During physical therapy, your therapist will target the knee itself to restore it to full range of motion and ensure the patella is aligned properly and tracking correctly as you move your knee. It’s important that you be able to flex, bend, and twist your knee in all the necessary ways you’ll need to walk and move normally.
The Surrounding Muscles
Your knee is only as strong as the muscles around it. In fact, one way to prevent knee problems is to regularly exercise all the muscles around this key joint so they can support the tissues, bone, and ligaments of your knee. One part of your recovery physical therapy will be to target your quadriceps and hamstrings. These are the important muscles above, below, and around your knee.
Once you’ve gone through your initial bracing period, you may be able to go without a brace. However, your doctor may advise you about using a brace for special activities or movements. In some cases, a kneecap dislocation will resolve on its own with just a bit of help from support sleeves readily available online or in pharmacies. If you have a history of kneecap dislocation, you may also choose to wear these regularly as support to protect your knee.
The orthopedist will give you particular advice about which of these supports would be best for your condition or whether you may need a special orthopedic support device, instead. These can help you recover from a patella dislocation, but they can also support your kneecap and prevent future problems by addressing the way you walk, and particularly over-pronation.
The Problem of Over-Pronation
Most of us do not walk perfectly. We either over-pronate or under-pronate, with the first being by far the most common. To tell whether your walking and running gait causes you to pronate improperly, check the bottom of an older pair of shoes. If you see an uneven wear pattern to the soles, you are walking with your foot rolling towards the inner or outer edge.
When we walk incorrectly, we put extra pressure on our knee and all its ligaments, tendons, and connections. Over time, this can result in a kneecap dislocation and other serious knee issues.
How Orthotic Supports Help
An orthotic insert fits into your shoe and moves your foot into the right position to force you to walk, jump, and run in an anatomically correct way. Small wedges tilt your foot while still keeping the foot protected and comfortable. Orthotics are very personal and have to be designed to fit your unique foot size, body weight, and gait style.
One of the most promising treatments in orthotics is regenerative treatment. These programs use the healing powers of your own body, hacked and amplified, to increase the strength of tendons and muscles, repair damaged cartilage, and hurry along the healing process.
Your body’s tissues are capable of healing themselves, and regenerative treatments simply take your own stem cells, platelets, or growth factors and inject them directly into damaged tissues. These regenerative tissues signal to your body to speed up the recovery process. Regenerative treatments are highly effective and greatly reduce the need for surgery, even for severe injuries. When used in conjunction with physical therapy and proper bracing, regenerative therapy can heal your knee and bring you back to full function more quickly and without surgery.
When Is Surgery Necessary?
In the vast majority of cases, a dislocated kneecap will get better through rest, bracing, regenerative treatments, and physical therapy. However, an extremely severe case or a dislocation that has caused a lot of damage to surrounding tissues may still need surgical repair. This is something to discuss with your orthopedist, and often the first step is to try all non-surgical interventions first, reserving surgery only for the worst cases that don’t respond to other treatments.
What’s the Next Step for Me?
If you suspect you have a dislocated kneecap, or if you’ve been told that surgery is your only option and want to explore other treatments, contact Olsen Orthopedic in Oklahoma City, OK. We can help you understand what’s really going on, and, in most cases, can help you find a solution that doesn’t involve surgery.