What happens after a kneecap has been dislocated twice?

Physiotherapy in Richmond for Knee Issues

Q: I have dislocated my kneecap twice now. Each time it has popped right back in so I haven't had any surgery -- just a brace and therapy. Based on what you know for other people with this problem, what happens now?

A: It sounds like you may be wondering about the natural history of recurrent patellar dislocations. Natural history refers to what happens after an injury in the long-term. For example, will it heal on its own? If not, what should be done to help the healing process?

Based on the evidence from research to date, we can offer the following information:

A second patellar dislocation increases the risk of future repeat dislocations.
Each injury increases the risk of other structures in the knee being damaged (e.g., ligaments, connective tissue, bone).

Conservative care (immobilization with splint or brace) for six weeks is advised. This gives the area a chance to heal without disruption. Physiotherapy to restore joint motion, strength, and proprioception (the joint's sense of position) is recommended.
The presence of a large piece of bone or cartilage detached from the back of the patella and floating freely in the joint is the main indicator that surgery might be a good idea. A surgeon will help you determine if this is a problem for you. MRIs are usually needed to see what changes have occurred in the joint and along the joint surface.

It sounds like you have followed the recommended pathway for the management of patellar dislocations. The physiotherapist may advise a maintenance program of exercise, stretching, and other activities to improve balance and proprioception.

The ongoing presence of any instability within the patellar joint usually helps guide treatment decisions. If you have done everything possible but the knee cap continues to dislocate, then surgery may be needed.

Reference: Neel P. Jain, MD, et al. A Treatment Algorithm for Primary Patellar Dislocations. In Sports Health. March/April 2011. Vol. 3. No. 2. Pp. 170-174.

Cambie Physiotherapy and Health Clinic provides services for physiotherapy in Richmond.

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