KNEECAP DISLOCATION
A dislocated kneecap refers to a common injury that normally takes about 6 weeks to heal. It’s often caused by a blow or a sudden change in direction when the leg is planted on the ground, such as during sports or dancing. The kneecap (patella) normally sits over the front of the knee.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Kneecap Dislocation
When the patella bone, positioned in the front of the knee, shifts, the kneecap dislocates. The connective fibers that keep the bone in place might strain and rip as a result.
When the patella slips out of its groove at the knee joint, doctors consider this as a dislocation. Three bones meet in the knee joint: the thighbone, the shinbone, and the kneecap in the center. The kneecap typically moves up and down in a vertical groove between the lower end of the thighbone and the higher end of the shinbone as your child’s leg bends and straightens (the trochlear groove). The kneecap remains fixed inside the groove by a web of tendons and ligaments, which flex when the kneecap moves.
When the patella dislocates, it no longer remains in the trochlear groove and becomes immobile. This causes the knee to lock and torn ligaments are moved from their normal positions. The kneecap usually protrudes laterally, to the side of the groove, 93% of the time. A quick spin and twist or an impact can result in a patellar dislocation, which becomes an acute injury. Children will suffer pain and the leg will be incapacitating until the knee gets fixed. However, the kneecap may occasionally realign itself.
Kneecap Dislocation Symptoms
Symptoms may vary from person to person. The following are the most prominent signs:
- Edema and/or stiffness in the knee’s anterior region that gets worse with activity
- trouble using or moving the leg normally because of the kneecap slipping over to the side
- the region around a displaced kneecap appears deformed
- Warmth, bruising, or redness around the place that was hurt
- Movement-related creaking or cracking noises
Always get a diagnosis from your doctor because dislocated kneecap symptoms may mirror other ailments or health issues.
QUESTIONS AND ANSWERS
What causes kneecap dislocations in children?
- Trauma: The most common cause of kneecap dislocation in children occurs because of a traumatic event, such as a fall or a direct blow to the knee. Trauma can push the kneecap out of its normal position.
- Anatomical Factors: Children with certain anatomical factors, such as a shallow groove in the thigh bone (femur) where the kneecap (patella) rests, may get more dislocations.
- Muscle Weakness or Imbalance: Weakness or imbalance in the quadriceps muscles, which control knee movement, can increase the risk of kneecap dislocation.
How do doctors diagnose a kneecap dislocation in a child?
- Clinical Assessment: Healthcare providers begin by taking a thorough medical history, assessing the mechanism of injury, and performing a physical examination. The kneecap’s position and its stability will aid in the final diagnosis.
- X-rays: Doctors use X-rays to assess the dislocated kneecap, determine the direction of the dislocation, and check for any associated fractures.
- MRI: In some cases, doctors will use an MRI to assess soft tissue injuries and the extent of damage to ligaments and other structures around the knee.
How does a doctor treat a kneecap dislocations in children?
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- Closed Reduction: The initial treatment often involves closed reduction, where the healthcare provider manually manipulates the kneecap back into its normal position. This will occur under anesthesia to minimize pain and muscle tension.
- Immobilization: After reduction, the child’s knee may be placed in a brace, splint, or cast to immobilize the joint for a period to allow healing.
- Physical Therapy: Once the knee becomes stable, physical therapy will help strengthen the surrounding muscles and improve joint stability.
- Prevention: It’s essential to address the underlying causes of the dislocation. This may involve exercises to improve muscle strength, balance training, and activity modifications.
- Surgery: In some cases, surgical intervention may be required, particularly when doctors find significant damage to the knee structures, repeated dislocations, or anatomical abnormalities. Surgical procedures aim to correct these issues and stabilize the knee.
The treatment for kneecap dislocations in children is often successful, and many children can return to their regular activities with proper care and rehabilitation. The specific treatment approach will depend on the child’s age, the severity of the dislocation, any associated injuries, and the risk of future dislocations. Parents should consult with a pediatric orthopedic specialist to ensure appropriate diagnosis and management.
It’s important to be able to go to doctors who specialize in children. The doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists are experts in children and their knees.
Causes of Kneecap Dislocation
When it is not a congenital condition (congenital dislocation), knee dislocation results from severe trauma, such as:
Car accidents
Your child’s knee may become dislocated if your child strikes it with enough force on a hard object, like the dashboard.
Sports injuries
When a child bends his or her knee and collides with another player or the ground with significant force, or if your child overextends his or her knee by bending it back more than it should, your child runs the risk of dislocating his or her knee, which happens less frequently than in vehicle accidents.
Hard falls
Losing control and falling on a bent or extended knee can happen to skiers or runners. In the event that your child stumbles after unintentionally walking into a hole in the ground, your child’s knee might possibly dislocate.
Kneecap Dislocation Diagnosis
Your doctor will examine your child’s knee and ask him or her about how it was hurt. They’ll take note of whether or not your child’s knee appears swollen and malformed, as well as if your child can move it. In order to check for any ligament damage—bands of tissue that aid in holding the knee in place—your doctor may apply pressure to various sections of your child’s leg.
When your child dislocates a knee, ligaments are frequently torn. They might use this test to check for variations in blood flow. It contrasts the readings of blood pressure taken at the ankle with those taken regularly on the arm. In order to examine your child’s muscles and nerves, your doctor could employ the following tests. To capture electrical activity, the doctor will implant a needle into your child’s muscle. To identify nerve signal velocities and intensities, the doctor will place electrodes on the skin.
Imaging
Your doctor will probably want to examine your child’s knee to discover what’s going on inside. Therefore, your doctor will order an X-ray. The scan will show broken bones and reveal whether the injury caused any shattered bones.
If any ligaments or other soft tissues in the knee become injured, an MRI can reveal this information. In addition, it might aid a surgeon in planning your knee reconstruction. To determine whether there if nerve damage exists, doctors use an MRI or ultrasound. Your doctor may order an arteriogram, an x-ray that shows the blood flow in your child’s arteries and veins. Doctors will also check for blood vessel injury following a knee dislocation.
Kneecap Dislocation Treatment Options
There are many levels of pain associated with dislocations. It depends on how much the surrounding muscles and ligaments, blood vessels, and nerves become damaged, as well as how far out of alignment the bone has been pressed. The displaced joint will constantly hurt when you move it or put pressure on it. Until the joint gets fixed, your child will not utilize the leg as he previously did.
Your child’s discomfort and mobility may become better if the displaced patella heals on its own. However, your child should still visit your doctor. They’ll examine your child’s ligaments for any further problems and help you through the prolonged recovery process.
Non-Surgical Treatment
If the damage appears small, the doctor could suggest protections for the knee as it heals naturally over time. Typical alternatives to surgery include:
- Physical therapy
- RICE therapy, which includes: Using ice packs to minimize swelling and discomfort while the kneerests to prevent future damage.
- Elevating the knee to minimize swelling and wearing a compression bandage to alleviate edema and offer support
- Ibuprofen or aspirin are examples of nonsteroidal anti-inflammatory medications that treat pain and inflammation.
- Crutches or a cane to ease movement and take the weight off the knee.
- A knee support and kneecap stabilization brace.
- Orthotics are shoe inserts that lessen knee stress.
- A quick clinical technique drains any extra fluid from a joint.
Surgical treatments
Doctors will usually recommend surgery if the damage appears severe or if further dislocations appear likely following a first-time dislocation of the kneecap.
Arthroscopic surgery
In this minimally invasive procedure, doctors insert a camera and surgical instruments through a small incision around the knee. Surgeons can use tools to assess the extent of damage and potentially repair it.
Reconstructive surgery
Doctors use reconstructive surgery on patients with more serious wounds or recurring dislocations to:
- Mend strained or torn ligaments.
- Remove and repair damaged bone and cartilage.
As previously written, the medial patellofemoral ligament, which connects the inside of the kneecap to the long bone of the thigh, is the most frequent structure repaired during reconstructive surgery. In as many as 90% of kneecap dislocations, this ligament gets torn, according to the analysis.
Tibial tuberosity transfer
In this most complex and complicated type of recurrent patellar dislocation surgery, the tibia or part of the tibia becomes resected and placed in a position that improves the stability and alignment of the patella. The surgeon then inserts screws to help hold the implanted bone in place until it heals.
Reoccurrence
Anyone with a dislocated kneecap may get one again. Analyzes show that people who receive non-surgical treatment for their first kneecap dislocation have about a 50% chance of recurrence. The risk of dislocation increases when the body does not have enough time to fully recover from the original injury. According to a recent review, Doctors believe in treating first-time dislocations who are at high risk of a recurrence with surgical treatment. However, surgery may also increase the risk of other knee problems, such as arthritis. Doctors recommend regular exercise, strength training, and physical therapy to help prevent re-injury.
Recovery
To give the knee time to recover and stop future damage, the doctor can advise a brief period of immobility in a brace. To keep weight off the knee during the initial phases of recuperation, children frequently use crutches or a cane. In order to restore the range of motion and strengthen the muscles that support the knee, doctors frequently advise physical therapy. This lessens the possibility of repeated dislocation. Before they can walk independently and regain their entire range of motion, it might take them around 6 weeks. A person’s return to sports activity typically takes longer. It may take a patient after surgery six months or more to start back up with regular sports or exercise.
Kneecap Dislocation Complications
Knee dislocation is a dangerous injury that, if left untreated, can lead to catastrophic consequences. Your doctor could have to amputate your child’s legs if the dislocation results in a significant loss of blood supply to them. Additionally, blood clots in your legs’ deep veins might result from knee dislocations (deep venous thrombosis). Another frequent consequence for children occurs when pressure builds in the blood vessels, nerves, and muscles as a result of the swollen muscles. The child will experience pain when this takes place and at this time parents should take their child to the doctor.
Make an appointment to see the best
Finally, selecting a pediatric orthopedic doctor for your child remains a crucial decision that requires careful consideration. By seeking recommendations, researching credentials, assessing hospital affiliations, reviewing patient testimonials, evaluating communication and bedside manner, considering the supportive team, discussing treatment options, seeking second opinions, prioritizing accessibility, and trusting your instincts, you can make an informed choice. Remember, finding the right orthopedic doctor will ensure that your child receives the best possible care, leading to optimal outcomes and a healthier, happier future. The Medical City Children’s Orthopedics and Spine Specialists doctors only treat children. With offices in Arlington, Dallas, Frisco, and McKinney, Texas, Doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them.
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Footnote:
Medline Plus: Kneecap Dislocation
Call 214-556-0590 to make an appointment.