Treatment for Displaced Patella (Kneecap)
The treatment of a displaced patella requires immediate closed reduction followed by appropriate rehabilitation, with surgical intervention reserved for cases with recurrent instability or significant functional limitations.
Initial Management
Closed Reduction
- Immediate closed reduction is the first-line treatment for a displaced patella 1, 2
- Reduction technique:
- Administer appropriate analgesia (intramuscular or intravenous) 2
- Apply gentle pressure on the superior pole of the patella while gradually extending the knee
- A successful reduction is confirmed by restored knee mobility and decreased pain
- Confirm reduction with post-reduction radiographs
Post-Reduction Care
- Immobilization in a posterior knee brace or splint for 2-3 weeks 2
- Appropriate pain management
- Early mobilization after the initial immobilization period 3
Rehabilitation Protocol
Early Phase (0-3 weeks)
- Protected weight-bearing as tolerated
- Quadriceps strengthening exercises
- Progressive range of motion exercises
Intermediate Phase (3-6 weeks)
- Continued quadriceps strengthening
- Progressive functional treatment rather than prolonged immobilization 1
- Focus on:
- Vastus medialis obliquus strengthening
- Hamstring flexibility
- Hip abductor strengthening
- Proprioceptive training
Surgical Considerations
Indications for Surgical Referral
- Recurrent patellar dislocations
- Persistent pain despite 3-6 months of conservative treatment 1
- Significant functional limitations
- Osteochondral fractures
- Substantial disruption of the medial patellofemoral ligament
Surgical Options
- Medial patellofemoral ligament repair or reconstruction
- Lateral retinacular release for tight lateral retinaculum
- Tibial tubercle osteotomy for patients with abnormal bony architecture
- For displaced patellar fractures, internal fixation may be necessary 4
Special Considerations
Fracture Management
- Non-displaced fractures can be treated conservatively with immobilization
- Displaced fractures (>1 cm) may require surgical fixation, though nonoperative management may be considered in patients with limited activities due to medical conditions 5
Recurrent Instability
- Higher risk of recurrence (up to 40%) after first-time dislocation 6
- Surgical intervention may reduce the risk of recurrent dislocations compared to non-surgical management 6
Follow-up Care
- Regular assessment of knee function and stability
- Monitoring for complications such as recurrent dislocations or persistent pain
- Progressive return to activities based on functional recovery and pain levels
Complications to Monitor
- Recurrent dislocations
- Patellofemoral pain syndrome
- Osteoarthritis
- Knee stiffness
- Quadriceps weakness
The treatment approach should prioritize early reduction, appropriate immobilization period, and progressive rehabilitation to restore knee function and stability while minimizing the risk of recurrent dislocations.