Here's a comprehensive breakdown of the diagnosis and treatment/reduction of a lateral patella dislocation, including immediate steps and follow-up care. ✅ Lateral Patella Dislocation: Overview Definition:A lateral patella dislocation occurs when the kneecap (patella) moves out of its normal position in the trochlear groove of the femur, almost always laterally (to the outside of the knee). It often results from a twisting injury, a direct blow, or a sudden directional change—especially in sports. Most common demographic: * Adolescents and young adults * Females greater then males * Sports or traumatic injury-related 🧠 Mechanism of Injury * Non-contact: Twisting or pivoting on a planted foot with knee in slight flexion * Contact: Direct blow to the medial aspect of the patella * Anatomical predisposition: Patella alta, trochlear dysplasia, increased Q angle, generalized ligamentous laxity 🔍 Diagnosis 1. Clinical Presentation * Sudden, severe pain with deformity * Obvious lateral displacement of the patella (in locked dislocations) * Difficulty bearing weight * Knee held in slight flexion * Swelling/effusion (hemarthrosis may develop quickly) 2. Physical Exam * Lateral displacement or palpable defect medially * Tenderness along the medial retinaculum * Apprehension sign (fear/pain with lateral patellar movement during exam) * Evaluate for associated ligamentous or osteochondral injury 3. Imaging * X-ray (AP, lateral, sunrise/Merchant view): * Confirm dislocation or rule out fracture (especially osteochondral avulsion) * MRI: * Evaluates MPFL tear, cartilage damage, loose bodies, or predisposing anatomical abnormalities ⚡️ Immediate Management: Reduction Closed Reduction (if still dislocated): * Patient in supine position with relaxed quadriceps * Gently extend the knee while applying medial pressure to the patella * Often spontaneously reduces during gentle knee extension Post-reduction: * Confirm with repeat X-ray * Check for joint stability * Assess neurovascular status 🧊 Initial Treatment After Reduction 1. Immobilization: * Knee immobilizer or hinged brace in extension for 2–3 weeks * Weight-bearing as tolerated with brace 2. Ice & Elevation: * Reduce swelling and pain 3. NSAIDs: * For pain and inflammation 4. Crutches: * May be used short-term depending on patient comfort and stability 🏃‍♂️ Rehabilitation Phase Week 2–6: * Physical therapy focused on: * Range of motion * Quadriceps strengthening (esp. vastus medialis obliquus – VMO * Proprioception and neuromuscular control 6+ Weeks: * Gradual return to sport if no recurrent instability * Functional testing before clearance 🚨 When to Refer or Consider Surgery Refer to Ortho if: * First-time dislocation with large osteochondral fracture * Loose body in the joint * Recurrent dislocations (especially with anatomical risk factors) * Failure of conservative treatment Surgical Options: * MPFL repair or reconstruction * Tibial tubercle transfer (TTT) * Trochleoplasty (in cases of severe dysplasia) * Arthroscopy for loose body removal 📋 What to Do If It Happens (Field/At Home) 1. Do not force movement. 2. Immobilize the leg in the position found (usually slight flexion). 3. Transport to ER or urgent care for reduction (if not spontaneously reduced). 4. Apply ice and elevate the limb. 5. Do not return to activity until cleared by a provider—risk of re-dislocation is high without rehab. 💡 Prognosis * Good with conservative management in first-time dislocations (90% return to sport) * High recurrence (up to 30–50%) in younger athletes or with predisposing factors * Surgery reduces recurrence in chronic instability #sports #basketball #athletics #PatellaDislocation #KneeInjury #Orthopedics #SportsMedicine #KneePain #PatellarInjury #MPFLTear #PhysicalTherapy #InjuryRecovery #KneeRehab #OrthoTips #DislocatedKneecap #AthleteInjury #KneeStability #OrthoEducation - @matthewharbmd