Knee - Patellar Dislocation
Knee - Patellar Dislocation
A word on knee injury management, by Dr Dylan McMahon
WHAT IS MY INJURY?
The Patella is the small (sesamoid) bone at the front of your knee- more commonly known as the Knee Cap. Most commonly the patella will dislocate and move to the lateral aspect of your leg unless there is a rupture of either the quadriceps or patellar tendon.
INITIAL TREATMENT?
Before treatment, irrespective if the patella is naturally relocated or if it requires relocation at a hospital, imaging is encouraged/ required. There can be multiple factors involving a dislocation & making sure there is no structural damage to bone or surrounding ligaments will best benefit patient rehabilitation outcomes.
Initially elevation and rest advised to assist with immobilization for early healing. It is encouraged to begin to walk again within the first 1-2 weeks depending on the severity of the injury. The use of crutches or a brace to mitigate unwanted excessive movement in the early days post injury.
Once there is minimal to no pain, you can then begin to explore gaining range of motion back in the knee, feeling comfortable with this? Walk on your own!
CAN I LIFT?
As the knee is a modified hinge joint, it can sometimes be tricky to know when it is not only safe to walk, but also the severity of the injury will determine when reintroducing actions like squatting or kneeling is applicable in your exercise regime/ rehabilitation plan once it is safe & mobility aids (crutches etc) are no longer required.
PAIN & SWELLING?
The knee contains many bursae (fluid filled sacs), these assist with shock absorption and allow for free motion of the knee joint. This means that again, depending on the degree of injury and other ligaments or soft tissues injured, that there may be minimal or significant swelling.
Simple medical intervention may be advised such as : Paracetamol & Non Steroidal Anti Inflammatories (Nurofen) to mitigate painful symptoms- Consult with your local GP/ Pharmacist beforehand for best options.
RECOVERY TIME?
Most people will begin to regain movement in 1-2 weeks and be able to resume normal daily activities within 3-6 weeks. The minority who have a severe injury may be required to have surgery to correct the damaged structure(s).
WHEN CAN I RETURN TO WORK?
The amount of time you need off work is dependent on your injury and your job description/ demands (how much you use your legs at work).
As a guide, manual handling jobs like trades which require the use of tools, ladders and repetitive lifting may need up to 4-6 weeks to return to full capacity. Office workers are usually able to return to the workplace as soon as the pain has reduced enough for you to complete your normal work routine. Be sure to discuss this with your GP/ Return to work advisor before stepping back into the workplace.
EXERCISES?
As mentioned prior, as soon as it is appropriate to weight bear, we encourage you to get the knee moving. This also includes movements both above and below the injury, incorporating strength to the hips and feet/ ankle.
OSTEOPATHIC TREATMENT?
It is recommended that you speak with your practitioner about treatment options, return to work/ sport, rehab exercises and injury prevention for the future.
WHEN CAN I RETURN TO SPORT?
Book in for a guided assessment and we can discuss the injury and cultivate a plan moving forward to get you back to doing what you love.The sooner you get on top of the injury, the sooner you can be back out there!
MOVEMENT TIME!
Some great pointers below can assist in early stages at-home rehabilitation
While seated with your knee extended, attempt to point your foot in both directions.
Toes to nose & pointing your feet away from your body
Bend and straighten your knee so you can feel a mild to moderate stretch
Heel Slide- Placing your heel on a disc (towel against tiles or floorboards also works a treat, socks for carpet), gently extending your knee, once you are at your end range- to your own comfort level, slowly flex the knee and draw your heel toward your buttock
Isometric Quad Contraction- Resting a pillow or rolled up towel underneath your knee.
Begin with a contraction of the quads for 3-5 seconds.
Star Excursion- Frontal, Lateral, Posterior
Be mindful not to increase the range too aggressively leading to a curtsy lunge. Think about reaching for individual numbers of an analog clock- only aim for the numbers that do not cross to the other side of your body!