What is the management for a superior dislocation?

Management of Superior Patellar Dislocation

For superior patellar dislocation, perform immediate closed reduction using intramuscular analgesia without sedation in most cases, followed by knee immobilization for 3 weeks, with arthroscopic removal of causative osteophytes if recurrence occurs. 1, 2

Diagnosis and Clinical Recognition

Superior patellar dislocation presents with a pathognomonic clinical and radiographic picture that allows diagnosis without extensive imaging:

• The superior pole of the patella protrudes anteriorly and is extremely tender on palpation, while the patellar tendon remains intact 1
• The knee is locked in extension with inability to flex, typically following hyperextension trauma or striking the knee on an object 1, 3, 2
• Radiographs show the superior patella tilted away from the femur due to pull of the patellar tendon with simultaneous quadriceps tendon relaxation—this is the pathognomonic radiographic finding 2
• Interlocking occurs between notches or osteophytes in the inferior pole of the patella and anterior surface of the femoral condyle 3, 2

Immediate Reduction Technique

Closed reduction should be attempted immediately as the primary treatment:

• Use intramuscular analgesia for pain control; most cases (83.7%) do not require intravenous sedation 1
• Reduction is typically achieved without difficulty through gentle manipulation, providing immediate pain relief 1, 3
• General anesthesia is rarely needed (only 9.3% of cases in one series) and should be reserved for failed closed reduction attempts 1

The reduction maneuver itself is straightforward—gentle traction and manipulation to disengage the interlocked surfaces, which typically reduces easily once adequate analgesia is achieved.

Post-Reduction Management

Immobilize the knee for 3 weeks in a posterior long knee brace or similar device to allow soft tissue healing 1

Monitor for recurrence, which indicates the need for definitive surgical treatment:

• If recurrence occurs within days to weeks, arthroscopic removal of causative osteophytes is indicated 2
• Osteophytes on the inferior pole of the patella and anterior femoral condyle are the primary causative factor in most cases, particularly in patients over 50 years 2
• Younger patients without osteophytes may have alternative anatomic factors, though this is extremely rare 3

Expected Outcomes

• Immediate pain relief follows successful closed reduction 1, 3
• Full knee range of motion is typically restored after the immobilization period 1
• Recurrence risk is eliminated with arthroscopic osteophyte removal in cases where bony prominences are the causative factor 2
• Patients can often walk without pain within one week of reduction 3

Critical Pitfalls to Avoid

Do not mistake this for a lateral patellar dislocation—the locked extension position and superior displacement are distinctive 2

Do not perform extensive imaging before reduction—plain radiographs are sufficient for diagnosis, and CT/MRI are unnecessary unless there are concerns for associated fractures or soft tissue injuries 1, 3, 2

Do not delay reduction—this is a painful condition that responds immediately to closed reduction, and prolonged dislocation serves no purpose 1

Do not dismiss recurrence as a minor issue—recurrent superior dislocation indicates the need for arthroscopic intervention to remove the mechanical cause 2