Dislocation of Kneecaps – A Simple Solution


By Dr Philip Dupre - Orthopaedic Surgeon

This condition invariably presents in adoles­cence and mainly affects girls. The first disloca­tion usually occurs with a twisting movement while the knee is in slight flexion. Reduction is often spontaneous so diagnosis of what has happened may not be obvious.

There is always tenderness medial to the patella where the capsule has been torn and severe apprehension is demonstrated if the patella is gently pushed laterally while flexing the knee. (Apprehension test).

Following the initial dislocation, recurrence is common, because the medial patello-femoral ligament and capsule have been torn and stretched. Physiotherapy is usually arranged initially in order to strengthen the medial quadri­ceps muscle. Operative correction is required if the problem becomes recurrent and fails to re­spond to conservative measures.

The aim of surgery is to tighten the medial cap­sule and release the lateral. More severe cases may require realignment of the patellar tendon.

An alternative to operative treatment is to con­tract and strengthen the medial capsule and patello-femoral ligament by injecting a mixture of 50% glucose solution mixed with local anaes­thetic in equal parts. This has the effect of causing an inflammatory reaction which con­tracts and thickens connective tissues.

The technique is to infiltrate 3mls. of this mix­ture into the medial patello-femoral ligament which lies supero-medial to the patella. Symptomatic improvement is usually noticed about a week later and repeat injections may be necessary at 3 to 4 week intervals which will give successive improvement.

About 3 to 4 injections are usually required over the next few weeks or months to give complete stability and symptomatic relief.

In older patients with patello-femoral pain, the same principle applies if skyline x-rays of the patella show lateral shift or malalignment.

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