Patellar Instability and Kneecap Dislocation Treatment in Atlanta
Patellar instability occurs when the kneecap shifts partially or completely out of its groove. We evaluate the cartilage, MPFL, trochlear groove, kneecap position and overall alignment to determine why the instability occurred and how to keep it from happening again.
What Is Patellar Instability?
The patella normally tracks within the trochlear groove at the end of the femur. Patellar instability develops when the kneecap moves too far toward the outside of the knee, partially shifts out of place or completely dislocates.
Patients may describe a visible dislocation, a painful shift, repeated buckling or a constant feeling that the kneecap is about to come out during running, jumping, pivoting, stairs or squatting.
First-Time and Recurrent Instability Are Different
Most first-time dislocators can be treated with a patellar-stabilizing brace followed by extensive physical therapy when there is no major cartilage fragment or other injury requiring surgery.
Recurrent instability usually means there is a mechanical reason the kneecap continues to escape. That reason must be identified rather than repeatedly treating every episode with another brace alone.
Signs and Symptoms of an Unstable Kneecap
Symptoms may remain even after the kneecap has returned to its normal position.
Dislocation or Shifting
The kneecap may visibly dislocate or briefly slide toward the outside of the knee during activity.
Pain and Swelling
Pain around the front or inner side of the kneecap and substantial swelling may follow a dislocation.
Giving Way or Apprehension
The knee may buckle, feel loose or create anxiety during stairs, pivoting, squatting or sports.
We Obtain an MRI Promptly After a Patellar Dislocation
A kneecap dislocation can break off a piece of cartilage or cartilage with underlying bone. This damage may not be clearly visible on standard X-rays.
We generally obtain an MRI promptly after a dislocation to evaluate the cartilage, identify loose fragments, assess the MPFL and better understand the trochlear groove. When a significant cartilage or osteochondral fragment is present, surgery is commonly recommended to repair, restore or remove the fragment and address the instability when appropriate.
A very swollen knee, locking, catching, inability to fully straighten the knee or difficulty bearing weight increases concern for cartilage damage or a loose body.
Why Does the Kneecap Keep Dislocating?
Patellar instability is frequently caused by more than one factor. The MPFL may be torn, but the shape of the trochlear groove, patellar height, overall alignment and the direction of pull on the kneecap may also contribute.
X-rays help us assess alignment, patellar height, tilt and tracking. MRI evaluates the cartilage, MPFL and trochlear anatomy. CT imaging may be useful in selected complex cases when more detailed rotational or alignment measurements are needed.
Treatment After a First Dislocation
Most first-time patellar dislocations are treated without stabilization surgery when MRI shows no significant loose cartilage fragment, repairable osteochondral injury or other major surgical problem.
Treatment commonly includes a patellar-stabilizing brace, swelling control and extensive physical therapy. Therapy restores knee motion and strengthens the quadriceps, hips and core to improve kneecap control and confidence.
Return to running, jumping and sports is gradual and should occur only after swelling, motion, strength and functional stability have improved.
Treatment for Recurrent Instability
Repeated dislocations or continued symptomatic shifting commonly indicate a mechanical instability problem. Each new episode may create additional cartilage injury.
Surgery may be recommended when instability continues despite appropriate therapy, when the kneecap repeatedly dislocates or when imaging identifies an anatomic problem that makes continued instability likely.
The operation must match the cause. MPFL reconstruction alone may be appropriate for some patients, while others need alignment correction, cartilage treatment or a combined procedure.
Patellar Instability Surgery Is Individualized
MPFL Reconstruction
A tendon graft recreates the main medial restraint that helps keep the kneecap from dislocating laterally.
Tibial Tubercle Realignment
The attachment of the patellar tendon may be repositioned when abnormal alignment or pulling direction contributes to instability.
Cartilage Treatment
Loose or damaged cartilage may require fixation, removal, restoration or another cartilage procedure.
Severe trochlear dysplasia and other complex anatomic problems require individualized planning. A lateral release alone is generally not a complete treatment for true recurrent patellar instability.
Recovery After Patellar Stabilization Surgery
Recovery depends on whether surgery involves isolated MPFL reconstruction, cartilage repair, bony realignment or a combination of procedures.
Early Protection
A brace and crutches are commonly used while swelling decreases and controlled motion begins.
Progressive Therapy
Physical therapy advances knee motion, quadriceps activation, walking mechanics and lower-extremity strength.
Return to Sports
Return is based on healing, strength, stability and functional testing rather than a single fixed date.
When Should You See a Knee Specialist?
Seek prompt evaluation after a first-time kneecap dislocation, especially when the knee is very swollen, locked, catching or difficult to straighten. Recurrent dislocations, repeated shifting or a persistent feeling that the kneecap will give way should also be evaluated because continued instability can damage the cartilage.
Patellar Instability Care in Atlanta and the East Metro Area
Atlanta Bone and Joint Specialists evaluates kneecap dislocations and recurrent patellar instability for patients from Atlanta, Decatur, Snellville, Loganville and surrounding communities. We assess the cartilage, MPFL, trochlear groove and alignment before recommending bracing, extensive therapy or surgical correction.
This page provides general educational information and does not replace an examination or individualized medical advice. Treatment depends on cartilage damage, skeletal maturity, alignment, trochlear anatomy, number of dislocations and the complete clinical evaluation.