What to Do If You Dislocate Your Kneecap «

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What to Do If You Dislocate Your Kneecap

The kneecap is under that brown tendon.

by James Hubbard, MD, MPH

A dislocated kneecap is another one of the multiple knee injuries you can get. And you won’t be going far until it’s fixed. It’s painful, most of the time there’s a lot of swelling, and your knee can’t straighten.

Obviously you have to get to a doctor as soon as you can to make sure nothing else is injured and to put it back in place. Often, the doctor will also drain some of the blood off that’s accumulated around it (which can ease the pain dramatically).

But if getting to a doctor is impossible, here are some things you can try.

Why You Shouldn’t Always Put It Back in Place

Treatment depends, to an extent, on what sort of injury we’re talking about. Beware of bad breaks.

Sometimes it just takes twisting wrong to dislocate the kneecap. Other times there’s an added bump to one side of the kneecap. (For instance, you hit the side of a table while you’re twisting, and the kneecap dislocates to the opposite side of where you hit it.)

When the dislocation comes from something like either one of those scenarios, you can pretty well assume you didn’t break anything. Maybe a there’s little crack in the kneecap or tibia (lower leg bone), but there’s no big break that’s going to dislocate too.

The more forceful the hit, the less you can assume there’s no broken bone. So if there’s been major trauma, just splint the knee in the position it feels best and get off of it (or use crutches). Then get to a doctor as soon as you can.

For those minor bumps and twists, it’s best to try to put the kneecap back in place right away (if you can’t get to a doctor) before more swelling sets in and makes it harder to do.

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How to Relocate a Dislocated Kneecap

Here’s how to put a dislocated kneecap back in place:

  1. If possible, ask someone to help. Your leg will need to flex and straighten, and it’s best to have someone do that for you. Straightening your leg on your own requires contracting the quadriceps muscle in your thigh. That tightens the tendon that connects to your kneecap. The tighter the tendon, the harder it is for the kneecap to move back into place.
  2. Flex your hip by sitting. If you’re lying down grab around your thigh and pull it toward you about 30 degrees or so. This relaxes your quadriceps muscle a bit, which loosens that tendon I mentioned in step 1. (If you don’t know what I’m talking about, read the “Anatomy” section of my post on Osgood-Schlatter disease.)
  3. Have someone slowly straighten the knee while the hip is bent. Or do it yourself if no one is available. Apply gentle pressure to the side of the kneecap to try to tease it back in place.
  4. Go slowly. You can try several times, but never force it since you could break something or make an already broken bone much worse.

After the kneecap is back in place:

  1. Wrap it with an elastic bandage or use a knee brace. This does little or nothing to keep the kneecap in place, but moderate compression can keep the swelling down.
  2. Stay off of your injured leg if you can and apply ice packs, if available, for 10 minutes at a time intermittently. Use a cane or crutches.
  3. Get to a doctor as soon as possible for further evaluation to see what is torn or broken.
  4. Expect it may happen again—maybe not right away, but somewhere down the road. If it dislocates over and over again, you’re going to need surgery to keep that from happening.

Has anyone ever had a kneecap dislocate? Painful? Scary? How did you get it back in place? How’s it doing now?

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  • Lonna

    Hi Doctor, My knee cap has dislocated many times over the years. 3 years ago I had a patella realignment surgery and had high hopes for it’s success. I have only had a dislocation a handful of times since then, the last one 6 months ago and it was rather quick and felt fine the next day. 3 weeks ago I suffered the worst dislocation yet, it just wouldn’t go back on for over a minute then came right back off. My knee instantly swelled up worse than ever before and I couldn’t put any weight on it. After an afternoon in the ER and some x-rays I was sent home immobilized with the R.I.C.E treatment. 2 days later I was seen by my physician who brought in Ortho during my appointment. My knee cap is not in the proper position (it’s much higher than it should be), the MRI shows major strain to the MCL, tears to the meniscus and irreparable damage to my previous surgery. I bruised from above my knee to my ankle within the first week and the swelling has gone down but is not gone. I have noticed that I am still bruising. I have a new bruise today on the arch of my foot and another just in front of my ankle bone. I still have bruising down the entire front of my shin which is now turning black again where it was yellow/green just a few days ago. My leg is very weak, I have been wearing a brace while I wait to see the Sports Medicine Doctor. Should I be concerned about the new bruising?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      See the section on “What if Only the Bruise is Swollen,” at this link http://www.thesurvivaldoctor.com/2012/02/21/bruises-and-blood-clots/

      In general, any bruise is caused from bleeding in the tissue. Deep bruises may take a few days to become visible, and the blood from many leg bruises travels down with gravity. Blood from, say, an injury to a knee may end up in the foot. It doesn’t mean there is a new injury, just that the blood has migrated. But, if you think this is not the case, or the leg is swelling a lot more despite elevation, or the foot is getting numb or cold, you should see a doctor. It wouldn’t be a bad idea to call yours even if you don’t go in.

  • Sarah

    Hi, I suffered a patellar dislocation a little over a week ago and I have been trying to straighten fully and bend my knee. Could I be causing more damage by doing this? I am just tired of being useless. The ER dr said to stay on Crutches for at least 2-3 weeks. But if I feel fine, is this necessary? It is still sore and very tender, but I just want to go back to normal.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You should follow up with your regular doctor, an orthopedist, or an urgent care clinic. Since every injury can be a little different, they’ll check you and see where to go from here. In general, you have to stay in an immobilizer (with your knee straight) for an average of about 3 weeks, gradually increasing activity, and, finally physical therapy to get the muscle strength back.

  • Giana

    Hi doctor. The first time I fully dislocated my knee cap was ten month ago, and then I did the same thing last week, The first time I did it was after slipping and falling on my back, and I had to push the patella back into place after straightening my leg. It was an awful two month of recovery, with a huge knee that stayed inflamed for about a month, and lots of physical therapy. This time, the same thing with the same knee happened, but the cap went back into place as soon as I straightened my leg without any extra force. Does this mean it wasn’t as severe? It became big quickly, and I couldn’t walk well or bend my knee in any way. This time I started electric stimulation quickly and often at my chiropractor’s office, and one week later it is so much better. It is mostly deflated, less bruised, and I’m walking near normal. I can even bend my knee to 90 degrees, but any more than that is impossible because of the pain. Last time I went to the hospital and had an MRI and discovered I tore a couple of ligaments. I was told to get another MRI, but since I already had this injury I don’t think I need to go spend money to do that when I probably tore the same ligaments as last time. Do you think this is necessary with my improvement over just a week with electric stimulation? I am starting physical therapy as well. I was also told that the only surgery I could get was to repair the ligament if it wasn’t going to be able to on it’s own, since my problem is that the area that holds my patella is flat, so it slides around easily. Is there something else that surgery could do for me?
    Thank you.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      It sounds like your best choice to keep this happening again and again is surgical repair–an appointment with an orthopedic surgery who deals with recurrent patella dislocations and get specific advice on your options.

  • kristie

    hi doc. my knee cap dislocated couple days ago. and i went to go see the doctors and got a x-ray done and it turns out to be perfectly fine. I’m just having some problems here. i can straighten my leg and bent it just a little. but when i go farther it seems like my thigh muscle is pulling my knee. is that normal? and i’m leaving for a vacation in a couple of days. can i still go?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Everyone’s a little different but if you totally dislocated your kneecap, the usual treatment is a brace and limited weight bearing for a while. But, whatever doctor who examined you is in a much better position to give you specific advice. If you weren’t, I’d check back and ask.

      • Kristie

        I do have a brace on right now, I just don’t know if it’s normal to see the muscles being tight

        • Kristie

          I mean feel

          • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

            When muscles get hurt, they tend to contract (tighten).

  • Alex

    Hi Doctor, I dislocated my knee about 4 months ago while I was messing around with friends and it took a while to get back into place since i was scared to put it back but it went back into place on its own.I went to see a doctor and the doctor said there was no real damage and to just wear a knee brace to keep my knee straight and crutches, and it would take about 6 to 8 weeks to heal. After that went by I continued my physical activity since I run track and everything was fine it was like it never happened. But today I was playing football in my gym class and while I was running and getting through people my knee came out of place again but just as fast as it came out of place it went right back in. It doesn’t hurt nearly as much as the first time and I am able to apply pressure on it to an extent. Is there a way I can prevent this from happening during physical activity without surgery or should I just give up on sports?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sometimes a course of physical therapy prescribed from you doctor can help. Sometimes the only option to keep it from recurring is surgery.

  • Julie

    Hi Doctor, I have a friend who dislocated his kneecap 2 weeks ago, he is 40 and its happened a few times in his life but this was the worst time according to him, it went all the way out. He did go to hospital and saw a specialist a week later. My question is, what can I say to him to convince him to take this seriously and look after his leg? He has a knee brace on but still drives a car and puts full weight on it all the time. He refused to use the crutches offered by the nurse. He is walking very very slowly and does not walk much now except to go to the toilet, etc. He says the specialist did not tell him whether or not to bear any weight on the knee or how much. He was told not to drive a car. As he also has Crohns’ Disease, I am very concerned for his health, and that he will lose physical fitness and his muscles will atrophy and make it so much harder to recover properly. Thank you very much in advance.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Julie, in general, weight bearing as tolerated is started about a week or two after the injury. The knee immobilizer is worn for several weeks. Hopefully, he will start physical therapy soon. A patella dislocation injures muscles and ligaments, often tearing them. It also can injure the cartilage that surrounds and cushions the bone. Not taking care of it (walking too soon, etc) will risk injuring more cartilage. The more cartilage injured, the more severe his arthritis may become in the next few years. On the other hand, he will need supervised physical therapy to build the muscles back. Not doing that will weaken his leg and increase his risk of another dislocation. Also, hopefully, he will talk to his doctor about a surgical repair. If he’s done this several times, he’s likely had some tears which will lead to more dislocations. The more this happens, the more risk he will suffer with arthritis down the road. As far as driving with with a knee immobilizer that’s taking an unnecessary risk to himself and all the others on the road.

  • Diane Hennessey LaMont

    Every now and then if I move my leg one way it seems like my knee goes the other way, popping out of place. It hurts and I have to straighten the leg and pop it back in place. Usually in the tub or sitting. Why does this happen?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If you’re referring to your kneecap and not your joint, it could be slightly loose kneecap. If it’s checked out and is that, sometimes some exercises or physical therapy can help.

  • John Ritter

    Sorry hit enter, what to do when surgery won’t even keep it in, first surgery was at 15 then at 35 now its over 12 yrs and it still goes out. What else can be done?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Call around and try to find an orthopedist in your area who has an interest, not only in knees, but in patellar dislocations or at least has treated a lot of them. Then go in for an evaluation and to discuss your options along with the pros and cons of each–surgery, injections, physical therapy, etc.

  • John Ritter

    I had two surgery’s and it still dislocated and it hurts more than broken bone to me. I was told bone under kneecap isn’t curved enuf so that might be why just moving muscles and tendons over knee to try to the it down might not be enuf to keep it in.

  • Emsikj

    I have what was called by my orthopedist “loose joints” and my mom is double jointed. For the past 18 years (since I was 13) I have had full and partial dislocations of each of my knees, multiple times, at random intervals. For the past few years I’ve been good at being able to “tell” as this was happening and straighten my leg right away in order to prevent it from coming out. It’s been pretty successful. At first, they were hoping id outgrow the condition at 18, but that didn’t happen. I tried wearing a knee brace but it put pressure on my knee and ground into the bones around it as I bent my leg. I’ve never been told about any treatment before and have always been able to pop it back in and ice/elevate it, but to avoid activities where my leg pivots at the knee and my foot stays planted. Since then I’ve done that, but have also been through two pregnancies, which may have also weakened my tendons. Today it came out fully (hasn’t happened in a while) and again was able to put it back, iced it, was and am able to weight bear and started having full range of motion, but now have trouble bending it past 90 degrees and am not sure how best to care for it. Can you help? Thanks!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I don’t really know anything to add to by post about that. However long-term, you should definitely have your knees evaluated by an orthopedist that has a special interest in knees. Now is a good time. After the evaluation you should asks the pros and cons of treatments like aggressive and intense physical therapy or surgery–what are the chances that they would help. If not that, what might. Unless the ortho tells you otherwise and you get a customized brace, I don’t think it’s a long-term answer. And since you’re continuing to have problems, hopefully there are better alternatives than just. avoiding certain activities. Every time you dislocate, you run the risk of damaging the cartilage that pad it from the rest of your knee, chipping off fragments, and bad arthritis of the area down the road.