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eMedicine - Joint Reduction, Patella Dislocation : Article by

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AUTHOR AND EDITOR INFORMATION

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Author: Adam J Rosh, MD, MS, Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center

Adam J Rosh is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, Medical Society of the State of New York, and Society for Academic Emergency Medicine

Coauthor(s): Moira Davenport, MD, Assistant Professor of Emergency Medicine, Bellevue Hospital Center, Hospital for Joint Diseases, Assistant Professor of Orthopedic Surgery, New York University Medical Center

Editors: Andrew K Chang, MD, Department of Emergency Medicine, Albert Einstein College of Medicine, Assistant Professor, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Emergency Medicine Center, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital

Author and Editor Disclosure

Synonyms and related keywords: patellar dislocation, orthopedic reduction, subluxation, immobilization, knee dislocation, patella dislocation, kneecap, patella, patella injury, patella reduction, kneecap reduction, kneecap injury

OVERVIEW

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Patellar dislocations are common, particularly in adolescent females and athletes. Patients usually present with inability to extend their knee and an obvious deformity. These injuries may be due to a direct trauma to the patella or a valgus stress combined with flexion and external rotation. The most common type of dislocation is lateral; however, horizontal, vertical, superior, and intercondylar dislocations occur. Reduction of the patella is a simple and safe procedure.


INDICATIONS

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  • Any lateral or medial dislocation of the patella
  • Any dislocation associated with vascular or neurologic compromise of the distal extremity


CONTRAINDICATIONS

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  • Patellar dislocation associated with a fracture of the proximal tibia or distal femur should not be reduced in this manner.


  • Any superior, intercondylar, or horizontal dislocation should be examined by an orthopedic surgeon.
  • Any dislocation with suspected locked osteophyte should be examined by an orthopedic surgeon.


ANESTHESIA

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  • Anesthesia is usually not required for this procedure, though some patients have significant anxiety and pain.


EQUIPMENT

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  • No equipment is needed for the reduction.


  • A knee immobilizer, crutches, or both are needed for aftercare.


POSITIONING

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  • Place the patient supine or with the legs hanging off the side of a gurney.


TECHNIQUE

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  • Explain the procedure, risks, and benefits to the patient.


  • Stand on the lateral side of the patient.


    Positioning for a lateral patellar reduction.


  • Slightly flex the injured leg at the hip to decrease tension on the quadriceps muscles.


  • Extend the knee while applying gentle, anteromedially directed force on the lateral patellar edge to lift the patella over the femoral condyle.


  • For a medial dislocation, use the same technique, but stand medially to the dislocation and apply an anterolateral force.


  • When reduction is complete, apply a knee immobilizer so that the knee is in extension.


  • Arrange a follow-up appointment for the patient with an orthopedic surgeon, as some patients with complete dislocation may require surgery to prevent recurrence.



Conducting a patellar reduction.


PEARLS

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  • Lateral patellar dislocations are common and typically occur in adolescent girls.  
  • Lateral and medial reduction is a safe and technically simple procedure.


  • Obtain a postreduction radiograph to rule out any osteochondral fractures.


  • To optimize successful rehabilitation, educate the patient regarding aftercare.


COMPLICATIONS

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  • No complications are secondary to reduction. Related complications of the patella may include recurrent dislocations, degenerative arthritis, or osteochondral fracture.


FOR MORE INFORMATION

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American Medical Society for Sports Medicine
11639 Earnshaw
Overland Park KS 66210
913-327-1415
 
American Academy of Orthopedic Surgeons
6300 N River Rd
Rosemont IL 60018-4262
847-823-7186


FURTHER READING

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eMedicine.com, Inc: Patellar Injury and Dislocation

eMedicine.com, Inc: Patella, Fractures

eMedicine.com, Inc: Knee Injury, Soft Tissue

eMedicine.com, Inc: Patellofemoral Joint Syndromes

Wheeless’ Textbook of Orthopaedics: Subluxation/Dislocation of the Patella


MULTIMEDIA

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Media file 1:  Conducting a patellar reduction.
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Media type:  Presentation

Media file 2:  Positioning for a lateral patellar reduction.
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Media type:  Photo


REFERENCES

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  • Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med. Mar-Apr 1986;14(2):117-20. [Medline].
  • Kling MP. Patellar dislocation reduction. In: Reichman EF, Simon RR, eds. Emergency Medicine Procedures. New York: McGraw-Hill Professional; 2003:640.
  • Simon RR, Koenigsknecht SJ. Dislocations of the knee, fibula, and patella. In: Emergency Orthopedics: The Extremities. 4th ed. New York: McGraw-Hill; 2001:480-1.
  • Ufberg J, McNamara R. Management of common dislocations. In: Roberts JR, Hedges RJ, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia: WB Saunders Company; 2004:982-3.

Joint Reduction, Patella Dislocation excerpt

Article Last Updated: Feb 6, 2007
Topic originally published: Feb 6, 2007