Patella Dislocation and Instability Treatment in Louisville, KY
Expert Patella Dislocation and Instability Treatment From a Fellowship-Trained Knee Specialist
A patellar dislocation is a painful and often frightening injury in which the kneecap slips out of its normal position within the trochlear groove at the end of the thighbone. It most commonly occurs in young, active patients, and while some dislocations can be managed conservatively after a first episode, the recurrence rate is high. Without addressing the underlying instability, many patients experience repeated dislocations that progressively damage the joint and limit their ability to stay active.
Dr. Nya Duany is a fellowship-trained orthopedic surgeon in Louisville, KY, with dual training in sports medicine and total shoulder replacement. She specializes in the evaluation and surgical treatment of patellar instability and offers MPFL reconstruction, the treatment of choice for patients with recurrent patellar dislocation. Dr. Duany takes a thorough, individualized approach to every patient, carefully evaluating the underlying anatomy and contributing factors before recommending a treatment plan tailored to your specific needs.
If you have experienced a patellar dislocation or have a kneecap that repeatedly slips out of place, use our online form to request an appointment with Dr. Duany today.
Patellar Instability: Causes, Symptoms & Treatment Options
Understanding Patellar Dislocation and Instability
The patella (kneecap) normally sits within the trochlear groove, a channel at the end of the femur that guides the kneecap during knee bending and straightening. A network of soft tissue structures, including the medial patellofemoral ligament (MPFL) on the inner side of the knee, keeps the patella centered in this groove during movement. When the patella dislocates, it almost always shifts laterally (outward), and the MPFL is torn in the process. This combination of bony malalignment and soft tissue disruption is what drives the high rate of recurrence in patients who do not receive appropriate treatment.
Causes and Risk Factors
Patellar dislocations can be traumatic, resulting from a direct blow or twisting injury, or they can occur with minimal force in patients who have underlying anatomic risk factors. Common contributing factors include:
- Trochlear dysplasia: a shallow or flat trochlear groove that provides insufficient constraint for the patella
- Patella alta: a kneecap that sits higher than normal, reducing its engagement in the groove
- Increased tibial tubercle-trochlear groove (TT-TG) distance: a measurement that reflects the degree of lateral offset between the patellar tendon attachment and the trochlear groove
- Ligamentous laxity: generalized joint hypermobility that reduces the restraining force of the surrounding soft tissues
- Prior MPFL tear: a previous dislocation that damaged the MPFL without surgical repair, leaving the patella susceptible to further instability
Patellar Dislocation Symptoms
Common symptoms of patellar dislocation and instability include:
- Sudden, severe pain at the front or inner side of the knee at the time of dislocation
- A visible or felt deformity as the kneecap shifts to the outer side of the knee
- Significant swelling following the injury
- A feeling of the knee giving way or the kneecap slipping during activity
- Apprehension when bending the knee or pivoting, particularly in patients with recurrent instability
- Tenderness along the inner edge of the kneecap where the MPFL attaches
Patellar Instability Treatment Options
Treatment depends on whether the dislocation is a first-time event or part of a pattern of recurrent instability, as well as the patient's anatomy, age, and activity level.
Conservative treatment may be appropriate following a first-time dislocation, particularly in the absence of significant bony abnormalities or osteochondral damage, and typically includes:
- Immobilization in a brace during the acute phase to allow initial healing
- Anti-inflammatory medications to manage pain and swelling
- Physical therapy focused on strengthening the quadriceps, hip abductors, and surrounding musculature to improve dynamic patellar stability
- Activity modification during recovery
Surgical treatment is recommended for patients with recurrent patellar instability, patients who experience a first-time dislocation with significant associated findings such as an osteochondral fracture or loose body.
MPFL reconstruction is the treatment of choice for recurrent patellar instability. Here is how the process works:
- Diagnosis and planning: Advanced imaging is used to assess the torn MPFL and evaluate bony anatomy to determine whether soft tissue reconstruction alone is sufficient or whether a bony procedure is also needed.
- Graft selection: A graft — typically from the patient's own tissue or donor tissue — is prepared to recreate the medial patellofemoral ligament.
- Reconstruction: The graft is anchored to the patella and the femur at the native MPFL attachment points, restoring the primary soft tissue restraint that prevents the patella from dislocating laterally.
- Addressing bony malalignment (when indicated): In some more complicated cases, MPFL reconstruction may be combined with another procedure called a tibial tubercle osteotomy (TTO) to address all contributing factors comprehensively.
- Recovery: A structured rehabilitation program restores strength, range of motion, and confidence in the knee, with return to sport typically achieved within several months.
Frequently Asked Questions
What are the symptoms of a patellar dislocation?
Common symptoms of a patellar dislocation include sudden, severe pain at the front of the knee, often accompanied by a feeling or sound of the kneecap popping out of place; visible displacement of the kneecap to the outer side of the knee; rapid swelling following the injury; difficulty bearing weight or bending the knee; and a feeling of looseness or apprehension in the kneecap during activity after the initial injury has healed. Because symptoms of a patellar dislocation can resemble those of other knee injuries such as ACL tears or patella fractures, prompt evaluation by an experienced knee specialist is essential for an accurate diagnosis and appropriate treatment plan.
What is MPFL reconstruction and how does it work?
The medial patellofemoral ligament (MPFL) is the primary soft tissue structure that prevents the kneecap from dislocating laterally. It is torn during a patellar dislocation. MPFL reconstruction involves using a graft — typically taken from the patient's own tissue or from donor tissue — to recreate this ligament and restore the restraining force that keeps the patella tracking properly in the trochlear groove. The graft is anchored to the patella and the femur, replicating the native MPFL attachment points. The procedure is highly effective at reducing the risk of recurrent dislocation in appropriately selected patients and may be combined with a tibial tubercle osteotomy (TTO) when significant bony malalignment is present. Recovery involves immobilization followed by a progressive physical therapy program to restore strength and return to sport.
Do I need surgery after a patellar dislocation?
Not every patellar dislocation requires surgery. A first-time dislocation in a patient without significant underlying anatomic risk factors or associated injuries may be managed successfully with bracing and physical therapy. However, surgery is generally recommended when the patient has experienced recurrent dislocation, when imaging reveals a torn MPFL, an osteochondral fracture, or significant bony malalignment, when conservative management has failed to provide adequate stability, or when the patient is young and active with a high risk of recurrence. Dr. Duany will thoroughly evaluate your anatomy using physical examination and advanced imaging before making a recommendation, and she will take the time to clearly explain all of your options.
How do I find a knee specialist near me in Louisville, KY for patellar instability?
If you are searching for a knee specialist near you in the Louisville area, Dr. Duany makes it easy to get started. Simply fill out our online appointment request form or call us at (502) 629-5633, and our team will follow up to confirm your visit. Dr. Duany sees patients at two convenient Louisville locations and is committed to providing expert, personalized knee care to patients throughout the metro area and surrounding communities. We look forward to helping you recover and return to the activities you love.