What does rehab for a patellar dislocation involve? Can you return to sports and exercise without surgery for a dislocated kneecap? I discuss this option in my latest Ask Dr. Geier column.

Stephanie in Echichnes, Switzerland asks:

I just read your article about kneecap dislocations. My kneecaps have shapes that make it too easy for them to go out. It does not happen ALL the time but already 3 times in 3 years. I was wondering if you’d advise me to wear a tight brace on both knees when I train (kickboxing). Also, since it just happened, how do I make the swelling go down? I am icing it, putting cream on it… but I know my ligament on the inside and my tendon are a bit sensitive… I just want to see the swollen parts not last too long. And I am glad you say to not keep the brace for too long because I did the first time and my knee was literally stuck for a while. Do you have any other advice on what to do? I didn’t go to the doctor this time cause I know what I’ve been told before… and PT was about strengthening my muscle, and I remember the exercises too. Thank you for your time!

Please refer to the previous Ask Dr. Geier column about patellar dislocations and the post about patellar dislocations in the Sports Injury Locator for more information about the injuries, treatment, and rehabilitation. Those two posts address some of the points brought up in this question, but I will add two more points worth mentioning.

Swelling after a patellar dislocation

First, mild swelling after an athlete dislocates the patella is not unusual. It is often mild and goes away in a few days. Icing the knee 3 or 4 times a day for 20 minutes and elevating the leg to get the swelling down can alleviate the swelling and help with pain. Significant swelling – patients often describe the knee resembling a basketball – is a little more worrisome, in my opinion. When I see a large effusion (swollen joint), I consider the possibility that when the patella slid out of the trochlear groove of the femur, it knocked off a piece of bone and/or cartilage that could be floating around in the knee. If it doesn’t resolve quickly, I at least bring up the idea of ordering an MRI to evaluate for loose cartilage/bone, because that injury might be treated surgically more quickly.

Rehab for a patellar dislocation

Rehab for a patellar dislocation

As for the anatomical question, some patients with patellofemoral instability (recurrent patellar dislocations) have flat trochlear grooves. In essence, the grooves on the front of the femurs where the patellae normally sit and track are shallow, allowing them to slide out more easily. Also, patients can have abnormal rotations of their femurs or an increased valgus alignment at the knee (be more “knock-kneed”) that can predispose them to this problem. Typically surgeons will still encourage aggressive physical therapy for quad strengthening, lateral retinacular stretching, and other functional training, but patients with these anatomic variants often have lower success rates with rehab for a patellar dislocation. Surgical treatments, which vary depending on the patient’s specific anatomy, are often necessary.

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