Have you experienced your knee joint pop out of place?
Have you just dislocated your kneecap ?
Would you like answers to your questions about recovery time , treatment and rehabilitation when knee cap is out of place?
Physical therapist with initial training, I take stock of the subject. Drawing on my experience and data from medical publications.
Head to the comments for any comments, questions, or experience sharing 🙂!
Last update: September 2023.
Declaration of financial interests: none directly related to the subject. My complete declaration of links of interest is in legal notices.
What happens when you dislocate your kneecap?
There are 2 main types of patellar dislocation.
1. Total or complete dislocation : the patella comes completely out of its normal position in the groove of the femur where it slides;
2. Subluxation : the kneecap does not move completely out of its groove, but it slips partially from its normal position.
We sometimes also speak of patellar instability to refer to a subluxation, but patellar instability is a more general term which can also refer to a sensation of “sliding” or “dropping” of the patella without it doesn’t move completely out of its groove.
And in both cases too, the kneecap can come out of where it is by moving in different ways.
1. Dislocation of the lateral patella : the patella moves towards the outside of the thigh. It is the most common.
2. Dislocation of the medial patella : the patella moves towards the inner thigh.
3. Dislocation of the upper patella : the patella moves upwards, towards the thigh.
4. Dislocation of the lower patella : the kneecap moves downward, towards the lower leg.
The direction of movement/dislocation does not necessarily change much behind treatment and rehabilitation.
It is the radio that generally makes it possible to ensure all of this. And sometimes other imaging tests, such as MRI.
We sometimes also talk about dislocation of the patella: it’s the same thing. Patella = patella in modern medical language.
What are the symptoms of a dislocated patella?
The 4 main symptoms are:
- significant pain;
- the knee swells;
- a deformation visible to the naked eye;
- difficulty bending the knee and putting weight on the leg.
We generally do not miss a dislocation of the patella, especially if it is the first time. It is rare that it occurs spontaneously: most often, it is following a fall, a shock, an accident.
Why does the kneecap dislocate more in some people? What cause?
15 to 60% of people who have had a dislocated patella will have at least one more in their lifetime (Hayat 2023).
Why are patella dislocations more common in some people than others?
Especially for anatomical reasons , in relation to the shape of the bones. But also among younger people. The less anatomically predisposed one is to have a dislocation, the lower the risk of recurrence.
What is the treatment for a dislocated kneecap?
Quickly after the diagnosis of dislocation, a doctor performs a reduction of the dislocation : he or she returns the kneecap to its usual place, using a simple maneuver with the hands.
Sedation is sometimes offered to relieve pain and allow relaxation and muscle relaxation.
Then, exams are carried out to see if there are other lesions. Then we opt for conservative treatment (= without operation) most often, especially if it is the first episode of patella dislocation.
More rarely an operation is carried out.
How long to keep the splint or cast on?
Whether or not there is an operation, a splint is quite often prescribed (sometimes a cast). In general, for 3 to 6 weeks , to promote healing of soft tissues such as ligaments, which were damaged (distended or ruptured) at the time of the dislocation.
But also to relieve pain.
Depending on the teams caring for you, different instructions may have been given to you regarding when to wear this splint and when to remove it.
In general, we recommend that you wear it especially when moving outdoors or if you have pain . You can take it off if you are sitting, or even at home, more often than not.
You can discuss it again with your doctor or physiotherapist if the instructions you were initially given seem unsuitable for your lifestyle, or where you are now.
You generally do a follow-up x-ray a few weeks after the dislocation to decide whether or not to remove this splint or cast.
Source: Jain 2011
Operation: patella surgery?
There is no consensus among surgeons and doctors on when to operate or not after a dislocated patella.
However, the operation, even in the event of recurrence, remains the treatment less often carried out than “simple conservative treatment” : gradual and adapted return to activities, rehabilitation.
If an operation is decided, many different operating techniques can be used. Sometimes arthroscopically (which allows a mini-incision to be made), sometimes by opening a little more.
After the operation, conservative treatment and rehabilitation remain necessary.
Source: Rund 2021
What is the physiotherapy treatment for a dislocated kneecap?
It is very common for you to be prescribed physiotherapy sessions after a patella dislocation.
I recommend that you make an appointment directly with a physiotherapist after you have dislocated your kneecap, in the following days, even if you have a splint.
Your physiotherapist will be able to take stock with you and respond to you in a personalized way.
The aim of these sessions is to:
- answer the questions you ask yourself, reassure you ;
- help you find the right balance for you between rest and walking, repeated knee flexions or continually extending legs;
- secondly, help you to resume all your more physical activities from before (walking without crutches, running, carrying loads, sports, driving a car, etc.);
- show you exercises that you can do, adapted to where you are and your goals (return to sport or not, what sport, etc.).
Physiotherapy does not accelerate the healing process of damaged tissues, which takes at least 3/4 weeks.
The objective is simply to help you get through this period more calmly and to be able to resume your activities as soon as possible, without stiffness or excessive muscle loss.
There is no minimum number of physiotherapy sessions: some people will only need 3 to 5 sessions, others will need 2 or 3 sessions per week for several weeks.
There is also no need for specific equipment such as electrotherapy : its use will not make you recover any faster.
The goal of rehabilitation after a patella dislocation is to gradually return to previous activities by regaining flexion and extension of the knee and good stability of the knee , especially in activities that require it a lot such as team sports, jumping, ski.
How long does it take to recover from a dislocated kneecap?
It’s completely normal to be concerned about how long it takes to recover!
Please note that it is impossible to predict with certainty . Many parameters come into play:
- the type of dislocation, and whether it is the first or not;
- if you have had other problems (fracture, etc.);
- your general health;
- your history on this knee;
- whether you smoke or not;
- your weight ;
Average recovery times
Here are the average delays that I observe in the people I support.
|Stage||Usual time from the day of dislocation of the patella (subluxation or complete dislocation)|
|You have much less pain in the knee and leg||2-3 weeks|
|Your soft tissues injured by the dislocation (such as ligaments) are well healed||3-6 weeks|
|Your knee edema (swelling) disappears||Several days or weeks or even months|
|You resume walking with crutches and splint||Right away|
|You resume walking without crutches and splints||A few days to a few weeks|
|You can drive a car||A few days to a few weeks|
|You return to work||A few days to a few weeks, or even a few months for very physical jobs|
|It’s back to sport!||2-6 months. Return to the exercise bike after a few weeks.|
Football, basketball, skiing, team sports, combat sports, jumping and dancing should be resumed in an even more gradual and careful manner, because they place greater demands on the stability of the knee.
55% of people have difficulty returning to sport within 6 months (Hayat 2023)
3 years after an unoperated patella dislocation, 1 in 4 people (26%) were able to return to sport as frequently and intensely than before and at the same level (Magnussen 2017)
|You have fully recovered functionally and muscularly||Some months. 6 months after patella dislocation, 58% of people are still hampered in their daily lives (Hayat 2023)|
Please note that no physiotherapy technique can accelerate bone consolidation time: this time cannot be reduced.
The healing time for a dislocated patella is a few months.
How long is the work stoppage?
Health Insurance recommends typical sick leave periods for major fractures, sprains and leg operations. But not for patella dislocation.
As always, the duration of work stoppage depends above all on your professional activity. The more your profession requires a lot of standing or even running, the longer your break will likely be.
Some people return to work straight away (especially those who work remotely). Others wait 2/3 weeks , and still others need several months off after a patella dislocation.
Can you walk with a dislocated patella?
Yes, as soon as the reduction has been carried out (the maneuver which allows the patella to be put back in its place, in the axis), you can walk again (unless contraindicated, particularly in the event of a displaced fracture of the patella).
You can generally support your foot the same way, with all your weight if it is not painful or unstable.
In general, you will need at least crutches , at least for the first few days. The crutches are there for at least 3 things:
- Relieve pain by putting less weight on the knee when walking or standing statically;
- Avoid the knee giving way and “twisting” again. It is a little unstable while the damaged tissues heal. Crutches stabilize you;
- Allow you to walk longer than you would walk without it. Walking is one of the best rehabilitation exercises in the world !
It is common to be limited in the distance you can walk, mainly because of pain or feeling unsteady. As the days go by, you will gradually be able to walk longer , then let go of 1 crutch cane, then the other crutch cane.
That’s what I wanted to tell you about patellar dislocation. If you have any questions or feedback, all are welcome in the comments !
If you feel the need to learn more about the recovery period, I wrote this guide in eBook format:
- Kneecap Fracture: Physical Therapy & Recovery Tips
- Jumper’s Knee: Exercice, Physio’Tips
- Fractured Knee: How to Recover?
Hayat Z, El Bitar Y, Case JL. Patella Dislocation. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538288/
Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M, Agel J, Arendt EA. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc. 2017 Aug;25(8):2352-2356. doi: 10.1007/s00167-015-3716-3 . Epub 2015 Jul 28. PMID: 26215775.
Rund JM, Hinckel BB, Sherman SL. Acute Patellofemoral Dislocation: Controversial Decision-Making. Curr Rev Musculoskelet Med. 2021 Feb;14(1):82-87. doi: 10.1007/s12178-020-09687-z . Epub 2021 Feb 1. PMID: 33523411; PMCID: PMC7930146.
Jain NP, Khan N, Fithian DC. A treatment algorithm for primary patellar dislocations. Sports Health. 2011 Mar;3(2):170-4. doi: 10.1177/1941738111399237 . PMID: 23016004; PMCID: PMC3445142.
Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA. Factors Associated With an Increased Risk of Recurrence After a First-Time Patellar Dislocation: A Systematic Review and Meta-analysis. Am J Sports Med. 2020 Aug;48(10):2552-2562. doi: 10.1177/0363546519888467. Epub 2019 Dec 11. PMID: 31825650.
Image: Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. J Surg Case Rep. 2012 Mar 1;2012(3):10. doi: 10.1093/jscr/2012.3.10 . PMID: 24960814; PMCID: PMC3649502. / Rhatomy S, Purnama H, Singh C, Setyawan R, Utomo DN. Management of valgus knee with irreducible patellar dislocation and MCL rupture: A case series. Int J Surg Case Rep. 2019;60:175-182. doi: 10.1016/j.ijscr.2019.06.018. Epub 2019 Jun 16. PMID: 31229772; PMCID: PMC6597494.
Moiz M, Smith N, Smith TO, Chawla A, Thompson P, Metcalfe A. Clinical Outcomes After the Nonoperative Management of Lateral Patellar Dislocations: A Systematic Review. Orthop J Sports Med. 2018 Jun 11;6(6):2325967118766275. doi: 10.1177/2325967118766275 . PMID: 29942814; PMCID: PMC6009091.
Written by Nelly Darbois
I love writing articles based on my experience as a physiotherapist (since 2012), scientific writer, and extensive researcher in international scientific literature.
I live in the French Alps 🌞❄️, where I work as a scientific editor for my own website, which is where you are right now.