From the Guidelines
Treatment for a dislocated kneecap (patellar dislocation) should initially involve the RICE protocol, followed by reduction and immobilization, and potentially surgery for severe cases or repeated dislocations, as recommended by recent guidelines 1. The RICE protocol consists of Rest, Ice, Compression, and Elevation, which helps to reduce pain and inflammation. Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can also be used to manage pain and reduce inflammation. If the kneecap hasn't naturally relocated, immediate medical attention is necessary to manipulate it back into place. After reduction, a knee immobilizer or brace should be worn for 2-4 weeks to stabilize the joint while healing occurs. Physical therapy is crucial for recovery, focusing on strengthening the quadriceps and inner thigh muscles to prevent recurrence, with exercises including straight leg raises, quad sets, and gradually progressing to more advanced movements, as supported by recent studies 1. Surgery may be necessary for severe cases or repeated dislocations to repair damaged ligaments or realign the kneecap, with autograft considered over allograft to improve patient outcomes and decrease ACL graft failure rate, particularly in young and/or active patients 1. Most patients can return to normal activities within 6-8 weeks with proper rehabilitation, though athletes may require longer recovery periods of 3-6 months before returning to sports. Key considerations in treatment include the severity of the injury, patient factors, and the potential benefits and risks of different treatment options, as outlined in recent clinical practice guidelines 1. In general, the goal of treatment is to restore knee function, reduce pain and inflammation, and prevent future dislocations, with a focus on individualized care and rehabilitation to optimize outcomes.
From the Research
Treatment Options for Dislocated Kneecap
- Nonoperative treatment is often recommended for first-time patellar dislocation without an osteochondral fracture, with a consensus of 99% among respondents 2
- Physical therapy starting within the first month postinjury is also recommended, with a consensus of 99% 2
- Return to sport after 2 to 4 months with a brace is suggested, with a consensus of 68% and 75% respectively 2
Surgical Treatment
- Surgical treatment is recommended if there are patellar subluxation episodes after 6 months of nonoperative treatment, with a consensus of 84% 2
- Medial patellofemoral ligament (MPFL) reconstruction is an effective treatment to prevent recurrent dislocations and yield excellent outcomes with a high rate of return to sport 3, 4, 5
- Patellar stabilization should be considered for a first-time dislocation with an osteochondral fracture, with a consensus of 81.5% 2
Rehabilitation
- Rehabilitation after MPFL reconstruction should focus on resolving pain and edema, restoring motion, and incorporating isolated and multijoint progressive strengthening exercises targeting the hip and knee 3, 4, 5
- Early functional rehabilitation after patellar dislocation is becoming more common, with a tendency towards earlier functional rehabilitation after surgical MPFL reconstruction than after conservative treatment 6
- Prior to return to sports, both functional and isolated knee strength measurements should be used to determine leg symmetry strength and to utilize patient-reported outcome measures to assess the patient's perceived physical abilities and patellofemoral joint stability 5