Patella Dislocation

The patella can dislocate outside of its normal position,

usually round the outside of the knee. It can also partially dislocate, called a
subluxation.

Symptoms of patella dislocation

Pain will be felt immediately at the time of injury. There is likely to be swelling in the
knee joint and there will be an obvious displacement of the kneecap. Often the
kneecap may briefly dislocated and then return to its normal position, although pain
and swelling will usually be present.

Patella dislocation explained

The patella, or kneecap lies in front of the knee joint. It glides up and down a groove
called the patellofemoral groove at the front of the thigh bone or femur as the knee
bends. The patella is attached to the quadriceps muscle via the quadriceps tendon
and acts to increase the leverage from this muscle group when straightening the
knee.
The patella normally lies within the patellofemoral groove and is only designed to
slide vertically within it. Dislocation of the patella occurs when the patella moves or is
moved to the outside of this groove and onto the bony head of the femur (lateral
femoral condyle). The patella may also sublux rather than fully dislocate, meaning it
moves partially out of position. A patella dislocation is not the same as a dislocation
of the knee joint itself which is a much more severe traumatic injury.

It is usually a result of an acute blow or twisting action of the

knee. In most cases the patella will relocate to the patellofemoral groove on
straightening of the knee, however this is usually extremely painful. The factors which
make a patella dislocation more likely are insufficient quadriceps strength on the
inside of the knee, over pronation of the feet and an what is known as an increased
Q angle of the knee.

The vastus medialis obliqus muscle or VMO for short is the quad
muscle on the inside of the thigh and is responsible for maintaining the stability of the
patella towards the inside of the knee. If the VMO muscle is not strong enough, or its
fibers are not adequately oriented the patella is much more susceptible to
dislocation.
Over pronation of the feet is where the feet roll in or flatted too much when running.
This causes the leg to turn inwards which leaves the patella susceptible to moving
outwards as the quadriceps contract.
The Q-angle of the knee relates the the angle of the lower leg to the knee and people
with an increased Q ankle are often termed knock kneed. When they straighten their
leg patella is forced to the outside of the knee potentially resulting in patella
dislocation.

Mechanism of Injury:

Generally there is two types of mechanisms that result in patella dislocations.

Type 1: results when there is a powerful contraction of the quadriceps in combination

with sudden flexion and external rotation of the tibia on the femur. This is the most
common reason for the patellar to dislocate.

Type 2: results from direct trauma to the patella with the knee in flexion, can cause
dislocation, however this is seen uncommonly.

Patellar Dislocations are common in patients with the following:

Genu valgum

Genu recurvatum

Excessive femoral neck anteversion or internal femoral torsion

External tibial torsion

Lateral insertion of patella ligament on the tibia

Contracture of the lateral patellar retinaculum

Relaxation of attenuation of medial patellar retinaculum

Hypoplasia or dysplasia of the patellar

Hypoplasia or flattening of the trochlear grove

Patellar alta or high riding patellar

Atrophy of the vastus medialis muscle

Pes planus

Generalised joint laxity