Kneecap Dislocation Specialist Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Kneecap dislocations are fairly common injuries, more often seen in children or young adults. They are usually the result of sports injuries.
What is a Kneecap Dislocation?
The patella dislocates when it shifts out of the patellofemoral groove, or trochlea, and lands on the bony head of the femur.
It is referred to as a subluxation if there is only a partial separation of the kneecap from the groove. Additionally, it is referred to as luxation or dislocation if there is a total separation of the kneecap from the groove.
Women are more prone to kneecap dislocation because of wider and bigger pelvises.
What is a recurrent patellar (kneecap) dislocation?
A patellar dislocation that occurs more than once is termed recurrent patellar dislocation. After two incidences of dislocation, the probability of subsequent dislocation arises at approximately 70% to 80%.
What are the causes of recurrent patellar dislocation?
The causes of recurrent patellar dislocation are:
What Are The Causes of A Kneecap Dislocation?
What Are The Symptoms Of A Kneecap Dislocation?
The following are symptoms of kneecap dislocation:
Diagnosis Of A Kneecap Dislocation
Physical Examination
- Your doctor may perform an in-depth examination of your symptoms and review your medical history to determine the cause of your injury.
Imaging Tests
- Imaging procedures such as x-ray and MRI scans may be recommended by your doctor to see if there are any other injuries and determine the severity of your case.
What Treatment Options Are There?
If the kneecap is acutely dislocated, it needs to be put back in place as soon as possible. This is usually easily done once pain-killers have been administered and the knee can be straightened. This will usually allow the kneecap to pop back in place by itself.
If it were the first time a kneecap dislocation had occurred, there may be a role of conservative treatment in the form of RICE (rest, ice, compression, elevation) and physiotherapy.
There is a significant risk however, that the kneecap dislocation may occur again as the MPFL is often torn and its function is impaired.
In patients who do not or cannot afford to risk another kneecap dislocation, a relatively simple surgical procedure where the MPFL is either repaired (in acute cases) or reconstructed (in recurrent cases), can be performed.
Treatment Procedures for Kneecap Dislocation
- PRICE. Majority of minor injuries can be treated with the PRICE protocol. PRICE is the acronym for Protect, Rest, Ice, Compression, and Elevation.
- Protect. Protect your knee from further injury.
- Rest. Immediately stop engaging in the activity that injured you.
- Ice. Apply cold packs to reduce pain and swelling.
- Compression. Wear a stretchable compression bandage to prevent swelling.
- Elevation. When resting, lean back and elevate your leg above your heart to help minimise pain and swelling.
- Protect. Protect your knee from further injury.
- To lessen the aftermath effect of the trauma, your doctor may advise you to take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or naproxen to reduce pain, swelling, and discomfort.
- Keep the knee immobilised. Thus, a brace or cast may be applied to your knee to hasten the healing of the medial patellofemoral (MPF) ligament.
- Put on footwear to control your gait as you walk or run to decrease the pressure on your kneecap.
- Physical therapy may be needed since it helps reduce pain and swelling, promote collagen production, and avoid soft tissue scarring. Your knee is extended by your physical therapist, who then applies lateral to medial pressure to the knee to aid in its relocation.
- Hip exercises such as strengthening and straightening may be advised to increase your range of motion.
Your doctor may prescribe the following procedures after a thorough examination:
- Medial patellofemoral ligament reconstruction. Using an arthroscope, the damaged medial patellofemoral ligament is removed and repaired with a graft. The graft is attached to the patella tendon using screws. The grafts can be taken directly from the patient (autograft) or a donor (allograft).
- Tibial tubercle realignment or transfer. The tibial tubercle is shifted towards the centre and secured with two screws using an arthroscope. The screws maintain the bone’s position, hasten the healing process, and prevent the patella from slipping out of the groove.
- Lateral release. The lateral ligaments tend to tighten, thereby increasing pressure on the cartilage, causing dislocation. These ligaments are loosened or severed using an arthroscope to prevent dislocation.
- Trochleoplasty. Trochleoplasty is a rare procedure that involves reshaping or deepening the groove of the lower end of the femur. Some of the bones are removed, and the patella is secured with soluble sutures or nails.
Following the surgery, you may be advised by your doctor to use crutches and wear a brace for the first few weeks. You may also be recommended to undergo physical therapy after the bone has healed. You may start with easy exercises to help your knee regain its normal function and prevent it from swelling. You may resume your regular activities after a few months.
Anatomy/ Pathology
The kneecap (patella) is a small bone sitting at the front of the knee joint (comprising the thigh bone and shin bone). It should stay at the front of the knee joint throughout the entire range of movement of the knee. It is kept in place by a combination of neatly fitting in a groove in the thigh bone at the front of the knee, as well as a thin, flat ligament connecting the inner edge of the kneecap to part of the thigh bone. This ligament is known as the medial patella-femoral ligament (MPFL).
Frequently Asked Questions
Can I still walk with a dislocated patella?
What is the difference between patella dislocation and knee dislocation?
Can it heal?
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The following are accredited For Singaporeans, Singapore Permanent Residents and Foreigners. If your insurance is not listed, you will still be able to make claims for eligible procedures! We have experience processing claims from many other various insurance providers. Please contact us if you have any queries.
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