Patellar dislocation is a condition that occurs when the kneecap bone separates from its normal position. This condition is relatively commonDalili Medical among athletes after a severe injury. Non-injury causes are less common. In this article, we will discuss the causes of kneecap deviation, the different types of this condition, the severity of kneecap dislocation for the injured person, and ways to put the kneecap back in place, to be your comprehensive reference on this topic.

How can I know if I have a kneecap dislocation?

 

Kneecap dislocation is a very painful injury, and it often occurs in young people, especially in girls between the ages of fifteen and twenty. This dislocation usually occurs as a result of a sudden fall, which leads to swelling in the knee, severe pain, and difficulty walking. The patient often goes to the doctor after several years, complaining of instability and pain in the front of the knee.

What is a kneecap?

 

The kneecap is an essential component of the knee joint, playing a vital role in maintaining the overall health of the knee. It is a small, flat, triangular bone located in front of the knee, and it can cause discomfort and various problems in the knee if it does not work properly.

What is a kneecap fracture?

 

A fracture is a complete or partial separation of bone tissue, which leads to a break in the continuity of the bone, and this occurs for many reasons, most notably traumatic injuries. Knee fractures include a fracture of the femur, or a fracture of one of the shin bones, in addition to a fracture of the kneecap, which is considered the most common among knee fractures. A fracture occurs in the kneecap bone, which is the flat bone located in the front of the joint, which plays an important role in protecting the joint from direct blows.

What is kneecap roughness and what causes it?

 

Kneecap roughness is a condition that occurs when the kneecap is exposed to swelling, leading to pain and discomfort. This condition can result from overuse, injuries, or other health conditions such as arthritis.

What are the symptoms of kneecap roughness?

 

The most common symptoms of kneecap roughness include pain, swelling, and sensitivity in the kneecap area. Some people may also experience a feeling of stiffness, weakness, or a clicking sensation in the knee.

How can I tell if I have patellofemoral pain or another knee injury?

 

If you are experiencing pain or discomfort in your knee, it is best to consult a specialist for an accurate diagnosis. Your doctor may perform a physical examination, imaging tests, or other diagnostic procedures to determine the cause of your symptoms.

**What are the treatment options for patellofemoral pain?**

 

Treatment options for patellofemoral pain may include rest, ice, anti-inflammatory medications, physical therapy, and in severe cases, surgery may be necessary. It is important to adhere to the recommended treatment plan to ensure proper healing and avoid worsening the injury.

**How ​​can I prevent patellofemoral pain?**

 

To help prevent patellofemoral pain, it is recommended to maintain a healthy weight, avoid repetitive movements or excessive stress on the knee, wear appropriate shoes and protective gear during physical activity, and do stretching exercises before and after exercise.

**When should I see a doctor about knee osteoarthritis?**

 

If you are experiencing persistent pain or discomfort in your knee, it is best to see a doctor. You should also seek immediate medical care if you are unable to bear weight on the affected knee, experience severe swelling, or feel feverish, as these may be signs of a more serious condition.

**Symptoms of a kneecap injury**

There are many symptoms that may appear as a result of injuries or dislocations in the kneecap, and they do not necessarily all appear at the same time. The most prominent of these symptoms are:

1. **Pain**: Pain is one of the most common and important symptoms, as it indicates the presence of a real problem in the knee. The pain is often noticeable when moving the knee, especially when bending or leaning on it.

2. **Instability**: The patient feels instability in the affected knee, and may notice a vibration or oscillation in the front of the knee.

3. **Difficulty moving**: The patient may have difficulty moving the knee smoothly, as it becomes stiff and difficult to bend, making movement painful or even impossible in some cases.

4. **Knee cracking**: The injured knee may make cracking sounds, which can be weak and inaudible except when concentrating, or may be loud and clear during movement or walking.

5. **Complications**: If the injury is accompanied by complications, dislocations of the patella may recur significantly, which necessitates the patella being returned to its place.

**Types of knee patella dislocation**

Cases of knee patella dislocation are divided into two main types:

. **Traumatic knee patella dislocation** This type occurs when the knee is in a semi-bent position and is exposed to a force or blow from the inner side (medial side), which causes the patella (patella) to come out of place and slide towards the outer side (lateral side). This type represents 93% of injury cases, and is considered an acute condition resulting from a direct injury or twisting of the knee. This injury may be accompanied by a fracture in the knee patella.

. **Recurrent patellar dislocation** This type of injury is uncommon, and it usually occurs in females in adolescence (after the age of 15). This dislocation occurs as a result of several factors:

**Knock knee**Injuries to the ligaments surrounding the knee joint.

Incomplete growth of the lateral condyle of the femur.

Narrowing of the space between the femoral condyles.

The posterior surface of the patellar cap is characterized by a triangular articular facet, and any anatomical defect in it may increase the likelihood of patellar dislocation.

**Types of patellar fractures**

Patellar fractures occur in several ways, and their severity depends on the degree of injury, as they can range from a hairline or a crackSimple to fracture that results in a tear and fragmentation of the bone. Types of patella fractures include:

. **Stable (undisplaced) fracture**: The broken bone fragments remain in their normal position, and only hair is visible at the kneecap.

. **Displaced fracture**: The broken bone fragments are displaced, causing a change in their original position, as they are no longer connected as they were.

. **Transverse fracture**: The patella splits into two parts, resulting in a transverse crack in the patella.

. **Open fracture**: The bone tissue is exposed to the external environment, accompanied by skin damage and damage to the ligaments, tendons, and muscles.

. **Comminuted fracture**: The patella shatters into multiple small bone fragments.

**Risk factors for patella dislocation**

Risk factors that may lead to patella dislocation include:

- Athletes, especially in sports that require strong physical contact.

- Teenagers with abnormal joints and ligaments.

- Men with a large build and tall height, as their joints are under greater pressure.

- Women with a large pelvis and weak ligaments.

- Individuals with unstable patellas or who have previously dislocated their patella.

- Genetic factors play a role in the occurrence of patellar dislocation.

- Patients with Down syndrome.

**Diagnosis of patellar deviation and dislocation**

 

To achieve an accurate diagnosis of patellar deviation or dislocation, doctors follow a set of basic steps that help in understanding the injury comprehensively:

1. **Physical examination**: The doctor begins by evaluating the patient's knee through a manual examination, where he presses on specific points around the knee and moves it in different directions to determine the areas of pain and detect any other injuries that may have similar symptoms.

2. **X-ray imaging**: This step is necessary to check the position of the bones and ensure that there are no abnormalities in the alignment of the bones or the path of the patellar joint.

3. **MRI**: In some special cases, doctors resort to performing an MRI to obtain an accurate and clear picture of the extent of the injury or erosion in the joint cartilage.

4. **Surgical arthroscopy**: This procedure is used in certain and rare cases to obtain a direct view of the inside of the knee and assess the damage to the cartilage or any other parts. If there is a suspicion of a deviation or dislocation of the patella, the doctor conducts an initial examination to assess the condition of the patella and its stability. If necessary, the patient is directed to undergo an X-ray to ensure the safety of the knee and detect any potential problems or complications.

**Treatment of knee cap**

The treatment plan for knee cap initially requires the doctor's skill in accurately diagnosing the condition, as the actual treatment steps begin with strengthening the muscles in the front of the knee, through physical therapy sessions.

Treatment of knee capitis may also include surgery to reconstruct the internal ligaments of the injured knee in the body to replace the damaged ligament, as the old ligament is removed and the new one is installed, which helps stabilize the capitis and prevent it from deviating from its natural path. In addition, treatment of knee capitis depends on other factors that are evident through the x-rays and examinations requested by the doctor, as there are two types of capitis fractures that can be explained with their treatment methods.

The external fracture of the capitis occurs in the external joint, and its treatment is usually easy and does not require surgery, but rather it is sufficient to treat with medication, physical therapy and rest.

As for the internal fracture, it is the one that affects the inside of the knee joint directly, and treatment depends on the type and shape of the fracture, and treatment often requires first-degree surgery.

As for the closed fracture, it occurs without affecting the external appearance of the knee, as there are no wounds or bleeding, and treatment requires making a suitable splint to stabilize the area and relieve pain.

In the event of a knee fracture with dislocation of the patella, which is accompanied by external effects such as bleeding or a skin wound, treatment requires sterilizing and disinfecting the wound, then using an antibiotic, after which it may be necessary to resort to surgery to treat the fracture from the inside.

**Exercises to treat knee patella deviation**

 

**Quadriceps Stretch** Stand straight and fix one hand on a wall or chair to maintain your balance. Use your other hand to hold your ankle and pull your foot towards your buttocks, making sure to bring your knees together. Hold this stretch for 20-30 seconds, then switch legs.

**Hamstring Stretch** Sit on the floor with one leg extended in front of you and the other bent so that the foot is close to the inner thigh. Slowly bend towards the extended leg and try to reach your toes. Continue the stretch for 20-30 seconds, then switch legs.

**Hip Flexor Stretch** Get into a lunge position with one leg forward and the other back. Slowly push your hips forward while keeping your back straight. Hold the stretch for 20-30 seconds, then switch legs.

**Inner Thigh Stretch** Sit with your legs extended in a wide V shape. Slowly bend forward between your legs and reach your hands to the floor. Hold the stretch for 20-30 seconds.

**Piriformis Stretch** Sit on the floor and bend one leg so that your ankle is over the other knee. Slowly pull the bent knee toward your chest until you feel a stretch in your outer hip. Hold the stretch for 20-30 seconds, then switch legs.

**Calf Stretch** Stand one foot away from a wall, placing your hands on it to help you maintain balance. Step back with one leg, keeping the heel on the floor and the knee straight. Hold the stretch for 20-30 seconds and then switch legs.

**Aerobic Exercises for Patellofemoral Spina**

**Patellofemoral Spina** is considered aAerobic exercise is an effective way to treat kneecap deviation, as it contributes to improving overall fitness and strengthening the muscles surrounding the knee without putting too much stress on the joints. Here are some suitable aerobic exercises:

**Stationary cycling** Cycling helps strengthen the quadriceps and hamstrings without much impact on the joint. Make sure to adjust the seat height so that your knee is slightly bent when the pedal is at its lowest point. Start at a slow speed and gradually increase the resistance.

**Swimming** Swimming is an excellent low-impact exercise that improves fitness and strengthens the muscles surrounding the knee. It is preferable to focus on freestyle swimming (crawl) or swimming on the back, while avoiding harsh movements that may increase stress on the knee.

**Water exercises (aqua aerobics)** Exercises in water help reduce stress on the joints and provide resistance to improve muscle strength. These exercises can include walking in water.

**Walking** Walking is an activity that strengthens the muscles surrounding the knee and improves the stability of the joint. It is preferable to start with short distances and then gradually increase the distance. Try to walk on flat surfaces to reduce stress on the knee.

**Using an Elliptical** The elliptical is an excellent low-impact exercise that improves fitness and strengthens your quadriceps and hamstrings. Make sure to adjust the resistance and incline level to suit your fitness, and start with short sessions and gradually increase the duration.

**Functional Exercises for Patellofemoral Brachii**

 

**Exercises**

1. **Quadriceps Strengthening**

**Straight Leg Raises**

Lie on your back with one knee bent and the other straight. Slowly raise your straight leg until it reaches the level of your bent knee, then slowly lower it back to the starting position. Repeat 10-15 times for each leg.

2. **Inner Thigh Strengthening**

**Ball Squeeze**

Sit in a chair and place a small ball or pillow between your knees. Squeeze the ball or pillow with your knees, hold for 5-10 seconds, then release. Repeat 10-15 times.

3. **Balance Exercises**

**Single Leg Stance**

Stand on one leg and maintain your balance. Try to hold this position for 20-30 seconds. Repeat 2-3 times for each leg. You can increase the difficulty by closing your eyes or standing on an unstable surface.

**General Strengthening Exercises**Partial Squats** Stand with your feet shoulder-width apart. Slowly bend at the knees and lower your body slightly as if you were sitting in a chair. Make sure that your knees do not extend beyond your toes. Then slowly return to the starting position. Repeat the exercise 10 to 15 times.

**Treatment of dislocated kneecap**

Treatment of dislocated kneecap varies depending on the type of injury. In the case of traumatic dislocation, treatment is simple, while recurrent or recurrent dislocation requires surgical intervention. Treatment includes the following:

**Treatment of dislocated kneecap** A mobile kneecap is treated by extending the injured person's leg, then pushing the patella toward the inner (medial) side. After that, a splint is placed to stabilize the kneecap for a period ranging from one to two months, while ensuring that there is no tear in the ligaments surrounding the kneecap.

**Treatment of recurrent or recurrent dislocation of the kneecap**

 

This type of dislocation requires surgery, where the attachment of the patellar tendon (the tendon of the kneecap) is moved downward and medially. There are also other surgical techniques that can be used.

It is also possible to resort to folding the soft tissue surrounding the kneecap from the medial side to increase the tensile strength in this area.

**Medicine** The medications used to treat dislocation are the same as those used to treat fractures resulting from bruises, and include non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. It is important to note the possibility of the patient being allergic to these medications.

**Treatment of knee pain with herbs**

 

Many herbs are used to relieve knee pain, and are considered effective in treating many conditions. The most prominent of these herbs are:

**Ginger:** Ginger is considered one of the best spices used in cooking, and it is also drunk after boiling to benefit from its many benefits. Ginger is known for its antiseptic properties for the throat and respiratory system, in addition to its ability to reduce inflammation and swelling resulting from joint problems, thanks to its content of components similar to non-steroidal anti-inflammatory drugs.

**Cinnamon:** Cinnamon is used in many dishes and drinks, and its benefits are due to its anti-inflammatory and antioxidant properties.

**Willow bark:** This herb is used by drinking, and plays a major role in relieving joint and knee pain and reducing inflammation. However, caution is advised for people with digestive problems, diabetes, or liver problems, as well as those taking blood-thinning medications, and children under the age of 18.

**Cat's Claw:** This herb is a plant found in South America, and is available in the form of nutritional supplements in the markets, and is used to support joint health.

**What is the role of physical therapy in treating kneecap deviation?**

 

**Evaluation of the condition**

- **Accurate diagnosis:** Physical therapy begins with a comprehensive assessment of the condition, which includes examining the extent of the deviation and the accompanying symptoms, in addition to the impact of the condition on daily activities.

- **Determining the causes:** Possible causes of the deviation are identified, such as muscle weakness, muscle imbalance, or previous injuries.

**Strengthening the muscles**

- **Strengthening the quadriceps muscles:** Exercises such as straight leg raises, whichContributes to strengthening these muscles, which enhances the stability of the kneecap.

- **Strengthening the inner and outer thigh muscles:** Strengthening these muscles contributes to improving the balance and stability of the knee.

**Improving balance and stability**

- **Balance exercises:** such as standing on one leg, which aims to improve neuromuscular stability around the knee joint.

**Plyometrics exercises:** contribute to enhancing coordination and balance.

**Increasing flexibility:**

**Stretching exercises:** such as stretching the posterior thigh muscles and hamstrings, help improve the flexibility of the muscles and joints surrounding the knee.

**Posture correction:**

**Improving movement:** Correcting incorrect movement techniques that may lead to deviation of the kneecap, such as modifying the walking or running style.

**Teaching correct posture:** Educating patients on how to maintain correct posture while sitting and standing to reduce pressure on the knee.

**Reducing pain and inflammation:**

**Device therapy:** Using techniques such as ultrasound, ice therapy, or electrical stimulation to relieve pain and inflammation.

**Manual Therapy:** Applying manual therapy techniques to relieve muscle tension and improve movement.

**Progressive Rehabilitation:**

**Progressive Program:** Design a gradual rehabilitation program that is appropriate to the patient's level of progress and endurance.

**Return to Activity Exercises:** Include specific exercises that help patients return to their daily or sports activities safely.

**Prevention of Future Injuries**

**Education and Awareness:** It is essential to educate patients on how to avoid movements and procedures that may exacerbate the deviation or cause new injuries.

**Detailed Program:** A program should be developed that includes regular exercises aimed at maintaining muscle strength and joint stability.

**Prevention of Patellar Dislocation**

When a dislocation of the Patellar Dislocation occurs, the likelihood of recurrence of the injury increases if exposed to the same conditions. Therefore, it is preferable to follow some procedures that contribute to reducing the chances of dislocation, including:

**Physical Rehabilitation:** In the case of the first dislocation, it is essential to ensure complete recovery from the injury. It is advisable to consult a specialist in physical therapy for appropriate advice and instructions, in addition to therapeutic exercises that target strengthening the muscles supporting the patella, which helps to hold the kneecap in its correct place.

Doing sports exercises correctly: Performing exercises incorrectly may increase the possibility of dislocating the kneecap. Therefore, it is preferable to seek the help of specialized trainers to guide athletes on how to perform the exercises correctly.

Performing a kneecap fixation procedure: In the event of a deformity in the anatomical shape of the patella, doctors may consider performing surgery for the patient to support and strengthen the affected kneecap as part of the treatment of kneecap deviation.