Many knee injuries begin with a snap or a pop. Turning and twisting while running puts a lot of stress on the knee. Most of you are aware that a pop in the knee while twisting can cause an ACL tear. What most people are not aware of is that many athletes who felt a pop in the front of their knee during sports actually had a dislocated kneecap. The kneecap is also called the patella. Patella or kneecap dislocations are far more common than we thought many years ago. There are many potential issues you need to be aware of if you had a kneecap dislocation.
Anatomy of the Kneecap
The kneecap or patella is an oval shaped bone that sits in a groove on the front of the femur. The groove is called the trochlea. The kneecap stays in the trochlea groove because of two ligaments which try and prevent it from slipping out. The ligament which appears to cause the most trouble is the medial patellofemoral ligament or the MPFL. If the MPFL is stretched or torn, then your kneecap can dislocate.
Why Did My Kneecap Dislocate?
The stability of the kneecap is determined by:
- the quadriceps muscles
- the anatomy of your bones
- the quality of the ligaments(MPFL)
All of the above contribute to hold the kneecap in place. Your quadriceps muscles need be strong and well balanced For that matter, so do the muscles of the hip and pelvis. If those muscles are weak, they will affect the stability of your kneecap.
Discussing the anatomy of your kneecap and the trochlea groove that it sits in is a difficult topic to understand. Many people have a trochlea groove in the femur that isn’t very deep. That’s how you were born. A “shallow” trochlea can make it easier for a patella to dislocate.
The MPFL or the medial patellofemoral ligament is the most important structure when it comes to determining why your kneecap dislocated.
How did I tear my MPFL ?
The MPFL can tear because of two different types of injuries. First, you were running and your kneecap was struck or hit by someone. If you are struck on the inside of your kneecap then the MPFL might tear, thus creating a dislocated kneecap. The more common injury is that your knee was bent when you twisted and tried to turn and run. That puts a lot of stress on the MPFL, and can cause it to tear.
We know that most ACL tears in the knee occur due to non-contact twisting or pivoting injuries. The same is true for kneecap or patella dislocations.
How Do I Treat My Dislocated Kneecap?
In most people the kneecap will reduce or snap back into place on its own. If you felt the knee pop and your knee looks distorted or strange then your kneecap is still dislocated. That will require a trip to the emergency room if you do not have an Athletic Trainer to put the kneecap back into place. The sooner the kneecap is reduced the better.
After your dislocated kneecap is reduced your knee will swell. It will usually swell a lot. The fluid in your knee is usually blood. Sometimes we will aspirate or remove the blood from the knee, but that is not always necessary.
It is very important that you see a Sports Medicine Doctor if you suspect that you had a dislocated kneecap. Many different injuries can occur after the dislocation. We will need to check to make sure that you did not damage the cartilage on the kneecap or the femur. Some cartilage injuries can be severe and require treatment sooner rather than later. We will also be able to determine if your MPFL is torn.
An MRI is almost always necessary after a kneecap dislocation. The MRI will show if the cartilage has been damaged. The MRI will also show if the MPFL is torn, and it will also tell us about the anatomy of your bones. That means that we can tell how deep the groove is that the patella sits in. Using the information from the MRI and from our examination we can determine the risk that you might have a second or third dislocation.
Does a kneecap dislocation require surgery?
Determining if you need surgery for a patella dislocation involves many different considerations. We need to determine:
- Was this your first dislocation ?
- Was the cartilage damaged?
- Does the cartilage need to be repaired?
- Is your MPFL torn?
- Does your bone anatomy affect your risk?
Most people who have had only one dislocation and do not have any cartilage damage do not need surgery. You will be rested to let the MPFL try to heal. Then you will be placed into physical therapy to rehabilitate the knee.
If you have a repairable cartilage injury then we will likely suggest surgery to repair the cartilage, and repair the MPFL ligament at the same time.
If you have had more than one kneecap dislocation then you will need to consider surgery to repair or reconstruct the MPFL (medial patellofemoral ligament) in order to minimize the risk of another dislocation. Each time your kneecap dislocates there is a risk that you will damage the cartilage. It is therefore a good idea to repair the kneecap to prevent further damage after your second dislocation.
In future posts I will go into more depth about the various surgical techniques used to prevent the patella from dislocating again. This is a very complicated process. Be sure that you are seeing a physician who is very experienced in managing kneecap or patella dislocations.