Displacement of the kneecap: treatment, symptoms, consequences

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The patella (kneecap, patella) is a wide bony plate located inside the joint and designed to protect cartilage. Represents the sesamoid bone - a bone formation inside the fibers of the quadriceps femoris tendon. The inside of the patella is covered with a layer of smooth, slippery cartilage that allows the condyles to move freely. Displacement of the patella is a rare pathology caused by traumatic injury to the knee joint or due to chronic diseases of the human musculoskeletal system. It implies a change in the position of structural elements relative to each other while maintaining their integrity.

Displacement classification

Pathological changes in the position of the patella based on pathogenesis factors can be:

habitual – with regular changes in the position of the patella, accompanied by a pronounced pain symptom complex;
partial – with an unstable position of the patella, prone to displacement with minor impacts on the knee joint;
congenital - due to joint injuries received at birth.

Depending on the scale, the displacement is classified into:

partial – provoked by a sharp turn of the leg;
complete – represents a dislocation of the patella with displacement forward or backward due to a strong blow.

When to contact specialists

Visual curvature of the legs is a good reason to make an appointment with an orthopedist. The exception is children under 2 years of age, in whom signs of deformation of the knee joints are a consequence of the natural growth of the body and disappear over time. The presence of pain in the knees with a visible change in their position is also grounds for contacting a specialized specialist.

The sooner a medical examination is performed, the higher the chances of getting rid of the pathology and at the same time maintaining health. After all, curvature of the legs can cause serious dysfunction of the spine and internal organs.

Factors in the development of pathology

Displacement of the kneecap can be caused by:

injuries (impacts and falls);
high loads (weightlifting or triathlon);
damage to the menisci, tendons and ligaments, increasing the vulnerability of the patella;
hypotrophy of the leg muscles (quadriceps femoris) due to a sedentary lifestyle;
abnormalities in the development of the legs, including their X-shaped deformity;
dysplasia of the femoral condyles;
abnormally high localization of the patella;
tumors of the knee joint;
chronic lesions of the knee joints (brucellosis), leading to their instability.

Typically, trauma-induced dislocation is accompanied by ruptures of the collateral ligaments. With torsional horizontal displacement, the quadriceps tendon with the patella ligament apparatus is damaged.

Congenital pathologies predisposing to habitual displacement of the patella include:

valgus joint deformity;
patellar hypermobility;
hyperextension of the leg;
hypoplasia of the femur.

The horizontal and habitual patellar displacements described above are treated surgically, followed by a rehabilitation period of up to six months.

Patella dislocation

If conservative treatment does not improve your condition, surgery may be suggested. There are various methods to diagnose and successfully treat problems associated with the patella. In some particularly complex cases, a combination of these may be required.

Arthroscopy is one of the most effective ways to treat diseases and injuries of the knee joint. By directly examining the articular surface of the patella and femur, the surgeon can assess the location and degree of cartilage wear. The doctor can also observe how the patella moves in the notch of the femur during movements of the knee joint and evaluate the degree of displacement (subluxation) of the patella.

If the articular cartilage of the patella is damaged, the doctor can use a special tool to treat the damaged areas of the cartilage, smooth out the roughness of the cartilage, which can reduce pain.

Arthroscopy is performed through the smallest possible skin punctures, which achieves excellent cosmetic results.

During arthroscopy, it is possible to eliminate the consequences of patellar dislocation. Often, with repeated dislocations, pieces of cartilage break off into the joint cavity.

Moving inside the joint, loose intra-articular bodies damage the structures of the joint and can block it.

In patients with habitual dislocation, the patella is in a state of subluxation to the lateral side. During arthroscopic surgery, it is possible to perform a lateral release. The essence of the operation is to dissect the ligaments along the outer edge of the patella, thereby shifting the patella from a state of subluxation to a normal position to the center of the groove of the femur, and the load on the cartilage is reduced. Also, during arthroscopy, the tissue along the inner edge of the patella can be tightened and capsulorrhaphy can be performed (Yamamoto operation). Performing a lateral release and a Yamamoto procedure balances the pull of the quadriceps muscle and thereby evenly distributes the pressure on the patellar cartilage.

In some cases of severe patellar displacement, lateral release and the Yamamoto procedure may not be sufficient. In addition to lateral release, surgery may be performed to strengthen the patellar tendon ligament (IPFL).

There are various operations that achieve this goal.

In some of them, a graft is formed, which is attached on one side to the edge of the patella, and on the other to the femur. Thanks to this operation, the patella does not have the opportunity to move into a position of dislocation or subluxation during movements in the knee joint.

Correct sliding of the patella in the center of the groove of the femur is achieved at all angles of flexion in the knee joint. The result of the operation can be a significant reduction in pain and crunching in the joint, as well as a reduction in the risk of repeated dislocations of the patella.

Arthroscopic surgeries are usually performed under spinal anesthesia. You will need to spend one or two nights in the hospital.

Typical symptoms of dislocation

Most often, the displacement occurs outward, extremely rarely - medially. Accordingly, lateral or medial hyperpression is diagnosed. Clinical symptoms are determined by the stage of the disease:

There is a feeling of discomfort in the area of the patella. It may be temporarily displaced, accompanied by acute pain.
Knee deformity is determined by palpation. The pain is moderate. Occurs due to mechanical impact on the knee area.
Deformation is determined visually. The pain is pronounced, movements are constrained.

Common symptoms include:

pain localized in different areas of the joint depending on the topography of the damage;
a crunching or clicking sensation when moving;
limitation of joint mobility;
decreased sensitivity of the skin in injured areas;
change in the shape of the knee;
hyperemia of the skin and periarticular edema.

A serious complication is a displaced fracture of the patella. Manifested by severe edema and hemarthrosis. The upper fragment of the patella, as a result of a reflex contraction of the quadriceps muscle, moves upward, and the rapidly growing bruise moves down to the foot.

Symptoms of knee damage

The very first sign of patellar damage is pain. The severity of the pain largely depends on the degree of damage. Typically, with subluxations, pain occurs only when you try to move your leg. When the tibia is injured, severe pain occurs even in a calm state. Specific signs of a knee dislocation also include:

complete or partial loss of the ability to move the leg;
deformation of the patella due to bone displacement;
swelling and changes in skin color;
manifestation of hematomas;
impaired skin sensitivity in the area of injury.

Most often, pain appears immediately after injury. And the manifestation of hematomas or edema can progress within 24 hours.

If damage to the kneecaps is accompanied by an injury to the tibia, then the following symptoms may appear:

change in leg length compared to a healthy one;
the occurrence of paralysis or the appearance of tubercles on the outer part of the lower leg.

Congenital patellar displacement

Congenital dislocation is extremely rare. Usually directed outward. Can be one- or two-sided. There are three degrees of the disease:

there may be no complaints, the knee is abnormally mobile;
there is instability when walking with the patella turning outward;
periodic blockades are observed that prevent flexion; the calyx is in an unnatural position with a pathological lateral deviation of the tibia.

Diagnosing congenital displacement of the patella becomes possible after the small patient begins to walk. Therefore, early diagnosis of pathology is difficult.

Conservative therapy is usually prescribed, aimed at strengthening muscles and ligaments:

electromyostimulation;
massage;
exercise therapy complex.

If congenital displacement becomes habitual, surgery is indicated.

Examination by an orthopedist, tests and diagnosis

The diagnosis is made based on:

typical patient complaints;
anamnestic data indicating the fact and mechanism of injury;
results of an objective examination;
data from instrumental research methods:
radiography (of both joints in a standing position in the infero-anterior and lateral projections);
Ultrasound (to verify soft tissue damage);
CT scan (can be done with the joint flexed);
MRI (the most accurate method, allows you to identify damage to tendons and muscles);
results of biochemical studies indicating an inflammatory process in the joint area:
examination of the joint fluid (articular puncture is performed);
biochemical and general blood tests.

Rehabilitation after kneecap dislocations

Recovery after arthroscopic surgery, due to its minimally invasive nature, occurs quite quickly. However, in this case, strict adherence to the doctor’s recommendations is necessary. The use of orthoses or braces may be recommended for the first time after surgery. A course of intra-articular injections of hyaluronic acid may be recommended. Physiotherapy promotes rapid restoration of joint tissue and muscles. As the swelling of the joint decreases, its motor activity is gradually increased. Kinesiotherapy and mechanotherapy are prescribed. After a course of rehabilitation measures, patients quickly return to their normal lives, and athletes return to training.

For diagnosis and effective treatment of dislocations and other injuries, contact our clinic!

Treatment methods

The classic treatment regimen for patellar displacement is:

repositioning of the kneecap by a traumatologist;
local use of cold (in the first 48 hours);
if necessary, use anesthetics (Novocaine derivatives) and analgesics (Diclofenac);
immobilization of the damaged joint using rigid orthoses or a plaster cast (for 1 month, movement on crutches is allowed);
ERT (usually UHF, magnetic and laser therapy, electrophoresis);
Exercise therapy and massage in order to gradually develop the damaged joint and strengthen the muscular-ligamentous apparatus.

Surgical treatment is indicated for:

damage to soft tissues;
lack of effect from conservative treatment.

The method of choice is arthroscopy - a minimally invasive approach using an arthroscope, under the control of which surgical procedures are performed.

Formation of product cost

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Materials used. Inexpensive dense fabrics and corsets are visible under clothing. Expensive materials preserve the aesthetics of appearance, do not slip due to silicone inserts and allow you to wear beautiful clothes.
Cut. An ordinary cut does not provide a tight fit to the body, and the healing effect is worse. Anatomical cut ensures a snug fit to the body.
Processing the edges of the product. Rough processing will cause abrasions. High-quality treatment will protect against skin irritation.