Patella (Kneecap) Dislocations
A patellar dislocation occurs when the patella (kneecap) slips out of its normal position. It is usually caused when the knee is straight, and the lower leg is bent outwards when twisting. It is a common knee injury for those who partake in sports such as soccer, gymnastics and ice hockey. Reduction of a kneecap dislocation is generally done by pushing the patella towards the midline while straightening the knee, putting the kneecap back into position. After having a dislocation of the kneecap, there is a 30% chance of recurring patella dislocations thereafter.
Treatment options for patella dislocations
There are several different conservative options for treatment of patella dislocations which may include wearing a brace for four weeks after the dislocation has been reduced. In addition, a specific exercise program to stabilize the core muscles and quadriceps will be needed for rehabilitation. You will also need to do training and strengthening exercises to prevent the recurrence and facilitate your return to various sports that you may have participated in.
Surgical treatment options for patella dislocations
Surgical treatment is limited to those who are high-risk patients and suffer from recurring patella dislocations.
MPFL reconstruction
Reconstruction of the MPFL using a tendon graft has changed the treatment of recurrent patellar dislocation and has excellent results. With the accurate placement of drill holes for the attachment of the graft tendon, as well as proper tension of the tendon transplant, good results can be obtained with this surgery.
Tibial tuberosity distalisation or medialisation
If the patella is too high or lateral, a surgical medialisation of the tibial tuberosity can be performed.In chronic patella dislocations, a lateral retinaculum release may be required.
Enhanced recovery after a knee surgery
Soft tissue healing after knee surgery is important for good outcomes. The more tissue that is left intact in the knee joint, the better the healing and outcome post-surgery. Early mobilisation also plays an important role in the prevention of post-operation complications. The advantage of early mobilisation is that it will lead to less pain and lower risk of deep vein thrombosis. Post‐operative rehabilitation will include mobilization with only partial weight bearing for 4 weeks. During this time a brace may also be advised. Physiotherapy will be advised post-surgery to train and strengthen the quadriceps and hamstrings. You will need 4-6 months of recovery before returning to sport.
Surgical treatment
(Limited to for recurring dislocations and high-risk patients).
MPFL reconstruction.
Tibial tuberosity medialization procedures.
MPFL reconstruction
Reconstruction of the MPFL with autograft (double-stranded gracilis or semitendinosustendon) has changed the treatment of recurrent patellar dislocation and excellent results can be achieved. Accurate placement of bony boreholes for attachments and tension of the tendon transplant is essential for a good result.
Tibial tuberosity distalisation or medialisation
If the patella is too high (patella alta) or lateral (insertion on tibial tuberosity) medialisation carried of the tibial tuberosity can be performed.
In chronic patella dislocations a lateral retinaculum release required.
Post ‐ operative rehabilitation:
Partial weight bearing mobilization for 4 weeks.
Optional brace for 4 weeks.
Quadriceps and hamstring training program.
Return to the sport 4-6 months.