Medicines for Dislocated kneecap

What it is

A dislocated kneecap (patellar dislocation) is when the kneecap (patella) — the small bone at the front of the knee — slips out of its normal position, usually to the outer side of the knee. It often happens during a sudden twist, change of direction, or awkward movement (commonly during sports or dancing), or from a direct blow to the knee. Some people are more prone to it because of the way their knee or kneecap is shaped or aligned, or because of looser ligaments. When the kneecap dislocates, it can be very painful, and the symptoms can include: the knee giving way or buckling; the kneecap visibly looking out of place (often to the side); severe pain; being unable to straighten the knee or walk; swelling; and a feeling that something has "popped". Sometimes the kneecap pops back into place on its own (for example when the leg is straightened), while at other times it needs to be put back by a health professional. A dislocated kneecap should be assessed, both to confirm the injury and check for any associated damage (such as to the cartilage), and to guide treatment and rehabilitation. After the kneecap is back in place, treatment usually involves a period of support (such as a brace or support) and pain relief, followed by physiotherapy and exercises to strengthen the muscles around the knee and improve control and stability, which is important for recovery and to reduce the chance of it happening again. Most people recover well with rehabilitation, though the kneecap can be prone to dislocating again in some people, particularly if there are underlying factors, and in recurrent cases other treatment (including surgery) may be considered. The key messages are to get a dislocated kneecap assessed, to follow the rehabilitation (especially strengthening exercises), and that these help recovery and reduce recurrence.

How it is treated

A dislocated kneecap should be assessed and is treated by getting the kneecap back into place, then rehabilitation to restore strength and stability. If the kneecap has dislocated and not gone back on its own, or if there is severe pain, deformity, or inability to move the knee, urgent assessment is needed (at an urgent care or A&E setting), where the kneecap can be put back into place (relocated) if it has not already, and the knee examined and, where appropriate, imaged (X-ray, and sometimes further scans) to confirm the injury and check for any associated damage, such as to the cartilage or bone. After the kneecap is back in place, initial treatment includes rest, ice, elevation, pain relief, and often a period of support for the knee (such as a brace or supportive dressing) to allow the initial injury to settle, while keeping the knee moving gently as advised to avoid excessive stiffness. The key to recovery and to reducing the chance of recurrence is rehabilitation: physiotherapy and a programme of exercises to strengthen the muscles around the knee (particularly the thigh muscles), improve control, alignment, and stability of the kneecap, and gradually restore movement and function, with a graded return to activity and sport. Most people recover well with rehabilitation. However, once a kneecap has dislocated, it can be more prone to dislocating again, particularly in people with underlying factors (such as the shape or alignment of the knee, or looser ligaments); for recurrent dislocations, or where there is associated damage, further assessment and treatment — including, in some cases, surgery to improve the stability or alignment of the kneecap — may be considered. Following the rehabilitation programme, and continuing strengthening exercises, are important both for recovery and for reducing recurrence. The reassuring messages are that a dislocated kneecap, though painful, usually recovers well with the kneecap being relocated and a good rehabilitation programme, and that strengthening exercises help reduce the chance of it happening again — while recurrent dislocations or associated damage may need further treatment.