Patellar Dislocation: Symptoms, Treatment, and Recovery

Patellar dislocation

Hello Doctor,
I am 20 years old.
Here are the details of my condition:
Date: January 19, 2005
How the injury occurred: I was squatting on the ground looking for something, and when I tried to stand up, it felt like I pulled something in my right knee.
It was very painful at the time, and there was swelling, making it difficult to straighten my leg.

First treatment: The next day, I went to the orthopedic department at Hospital A.
They did not take an X-ray; the doctor only performed a physical examination and said there was nothing wrong, prescribing anti-inflammatory medication, but my condition did not improve.

Second treatment: A day later, I went to the orthopedic clinic at Hospital B, where the doctor took an X-ray and performed joint aspiration (due to swelling).
They suggested I get an MRI.

Third treatment: Two days later, I returned to my hometown in central Taiwan to see the head of the medical department at Hospital C.
He also took an X-ray and performed joint aspiration.
After his assessment, he said my right kneecap was slightly misaligned to the right, and the aspiration indicated mild inflammation.
He prescribed anti-inflammatory medication and advised me to do quadriceps rehabilitation at home.

From February to mid-May: After resting at home for two to three weeks, my knee gradually reduced in swelling and I could straighten it.
I became lazy with rehabilitation and even went for a light jog in March.
However, it seems that during that jog, I pulled something again on the left side of my right knee.
I rested, thinking it was fine, but during this period, my knee never returned to its pre-injury state.
Standing for too long causes discomfort, and I hear a clicking sound in my knee, along with a sensation of bones rubbing against each other when I straighten my leg.

On May 15: Upon waking up, my kneecap felt very tight, and I experienced discomfort going up and down stairs, but there was "no pain"! When bending my knee, it feels like something is caught in there, and on the left side of my right knee, it feels like something is rolling around.
When I squat, I can see it protruding from my skin and then disappearing.

Fourth treatment: I am now going to the rehabilitation department at Hospital D every day for shortwave therapy and strength training.

Will my symptoms recover? Will I never be able to run or play sports again? Is this "patellar maltracking or patellar chondromalacia? Or is it a ligament injury?" I am not afraid of rehabilitation; I just fear that the treatment is not targeting the right issue and that the strength training will be in vain.
Should I consider arthroscopic surgery? How long will this treatment period take? I am only 20; will my life be ruined? Please explain, Doctor.
Thank you!
P.S.
The doctor ordered an X-ray (merchant view to assess the relative position of the patella and femur) to confirm if there is any dislocation or lateral deviation of the knee.
Based on this medical history, how serious do you think my condition is?

Da Xiong, 20~29 year old female. Ask Date: 2005/06/20

Dr. Shi Guozheng reply Orthopedics

The lateral displacement of the patella may be caused by an injury or may have been present from the beginning.
If it is not severe enough to require surgery, rehabilitation focusing on quadriceps strengthening exercises can help improve the condition.
Currently, arthroscopic surgery may not be necessary; if there is no improvement after some time, it can be reconsidered, as there is a possibility of recovery.
The rehabilitation process may take two to three months.

Reply Date: 2005/06/20

More Info

Understanding patellar dislocation is crucial for anyone who has experienced knee injuries, especially in young athletes. Patellar dislocation occurs when the kneecap (patella) slips out of its normal position, typically laterally (to the outside of the knee). This can lead to significant pain, swelling, and difficulty in moving the knee.

Symptoms
The symptoms of patellar dislocation can vary but typically include:
- Sudden and severe pain in the knee at the time of injury.

- Swelling around the knee joint.

- Inability to straighten the knee fully.

- A feeling of instability or the knee "giving way."
- A visible deformity where the kneecap may appear out of place.

- A popping or cracking sound at the time of dislocation.

In your case, it seems that you experienced a significant amount of pain and swelling immediately after the injury, which is common. The fact that you had difficulty straightening your knee and experienced a sensation of something "catching" or "rolling" in the joint suggests that there may be underlying issues such as ligament injuries or cartilage damage.

Diagnosis
Diagnosis typically involves a physical examination, X-rays, and possibly an MRI. X-rays help rule out fractures, while an MRI can provide detailed images of soft tissues, including ligaments and cartilage. Your experience with multiple consultations and imaging studies is not uncommon, as knee injuries can be complex.

Treatment
Initial treatment for patellar dislocation often includes:
- Rest and ice to reduce swelling.

- Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.

- Physical therapy focusing on strengthening the quadriceps and improving flexibility.

- Bracing or taping to stabilize the knee during recovery.

In your case, it seems you have been following a rehabilitation program, which is essential. However, if symptoms persist, such as the feeling of instability or the knee locking, further intervention may be necessary.

Surgical Options
If conservative treatment fails and you continue to experience dislocations or significant instability, surgical options may be considered. Arthroscopy can be used to assess and repair any damaged structures, such as torn ligaments or cartilage. In some cases, realignment of the patella may be necessary to prevent future dislocations.

Recovery
The recovery period can vary widely depending on the severity of the injury and the treatment approach. Generally, with proper rehabilitation, many individuals can return to their previous level of activity, including running and sports. However, it is crucial to follow your physical therapist's guidance and not rush back into high-impact activities until you are fully healed.

Long-term Outlook
At 20 years old, your body has a good capacity for healing, and with appropriate treatment and rehabilitation, many individuals can expect a full recovery. However, it is essential to listen to your body and avoid activities that cause pain or discomfort during the recovery process.

Conclusion
In summary, your symptoms and history suggest a possible patellar dislocation with associated soft tissue injury. Continuing with your rehabilitation and following up with your healthcare provider is crucial. If symptoms do not improve, further evaluation, including potential surgical options, may be necessary. Remember, many athletes return to their sports after similar injuries, so stay positive and committed to your recovery plan.

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