There are no contraindications to lateral patellar dislocation reduction. J Bone Joint Surg Am. Stefancin JJ, Parker RD. 5 (1):45. 14 (2):117-20. 39 (7):1444-9. We do not control or have responsibility for the content of any third-party site. 2015 Feb 26. The Orthopedic Surgeon may elect to take a conservative approach with the leg in a long leg cast and the knee in full extension for 6 weeks.6 Some Orthopedic Surgeons believe that all first-time dislocations should be repaired surgically. [QxMD MEDLINE Link]. Patella Fractures are traumatic knee injuries caused by direct trauma or rapid contracture of the quadriceps with a flexed knee that can lead to loss of the extensor mechanism. Otherwise it is hidden from view. However, consultation with an orthopedic surgeon should be obtained prior to reduction if an associated proximal tibial or distal femoral fracture (including osteochondral fracture) is present. 52 (1):86-90. If the patella has not reduced, use your other hand to apply gentle force to the lateral edge of the displaced patella, and push the patella medially back to its normal location between the femoral condyles. Obtain an informed consent prior to performing the procedure. There are a few relative contraindications to the reduction of a patellar dislocation. Retinacular Closure. Arrange a follow-up appointment for the patient with an orthopedic surgeon. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. 2. 7. Clin Imaging. Analgesia is usually not needed. Related complications of the dislocation itself may include recurrent dislocations, degenerative arthritis, or osteochondral fractures. Methods: Thirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional . Use for phrases A patella dislocation occurs when the knee cap pops sideways out of its vertical groove at the knee joint. [QxMD MEDLINE Link]. Stand on the lateral side of the leg on which the patellar reduction is to be done, In most cases, The k-wires are passed back through the middle of the patella and out the distal pole, which prevents lateral subluxation of the patella. The patients were divided into trial group ( n=13) and control group ( n=12) according to different . Introduction: Fractures of the patella constitute an estimated 1% of all acute orthopaedic fractures. A knee immobilizer or splinting material (plaster, fiberglass, and prepackaged splints) should be available to temporarily splint the patella and knee after the reduction. Successful reduction is preliminarily confirmed by visible restoration of a normal knee contour and by decreased pain. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA5MjYzLXRlY2huaXF1ZQ==. [QxMD MEDLINE Link]. Tension Band Wiring of the Patella Surgical Techniques Tension Band Wiring of the Patella By admin On Nov 13, 2021 Fractures of the patella are relatively common, accounting for 1% of all fractures. Patients with significant pain or anxiety may be offered procedural sedation and anesthesia (PSA). A non-analgesic reduction attempt is encouraged. Some evidence suggests that reduction of acute patellar dislocation can be performed by emergency medical services providers in the prehospital setting and can provide significant pain relief. Objective: To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. . Knee Surg Sports Traumatol Arthrosc. Computed tomography (CT) can detect small bony fragments that result from patellar dislocation. 19 (4):663-70. Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center Prehosp Emerg Care. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. [QxMD MEDLINE Link]. Patellar dislocations are almost always lateral. [13]. Open Reduction and Internal Fixation of Patella Fracture With Contoured Dorsal . [Full Text]. Value of CT scan-assessed tibial tuberosity-trochlear groove distance in identification of patellar instability. The incidence in males is twice that for females. 2011 Aug. 39 (8):1756-61. Subluxation is partial separation. The trusted provider of medical information since 1899, Overview of Shoulder Dislocation Reduction Techniques, How To Reduce Anterior Shoulder Dislocations Using the Davos Technique, How To Reduce Anterior Shoulder Dislocations Using External Rotation (Hennepin Technique), How To Reduce Anterior Shoulder Dislocations Using the FARES Method, How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation, How To Reduce Anterior Shoulder Dislocations Using the Stimson Technique, How To Reduce Anterior Shoulder Dislocations Using Traction-Countertraction, How To Reduce Posterior Shoulder Dislocations, How To Reduce a Posterior Elbow Dislocation, How To Reduce a Radial Head Subluxation (Nursemaid Elbow), How To Reduce a Posterior Hip Dislocation, How To Reduce a Lateral Patellar Dislocation. B. Medially directed pressure applied to the patella when the knee is fully extended reduces the dislocation. No complications are associated with the reduction procedure. Use to remove results with certain terms This database review study is a starting point in suggesting prehospital patellar reduction is feasible, effective, and safe. Radiographs should be obtained to document reduction. Analgesia is usually unnecessary. In this Technical Note, we have described the surgical technique for treatment of a transverse patellar fracture using a high-resistance tape (FiberTape; Arthrex) and a tensioner (Arthrex) instead of traditional metallic implants. Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P. Patellar shape can be a predisposing factor in patellar instability. , MD, San Antonio Uniformed Services Health Education Consortium, (See also Overview of Dislocations Overview of Dislocations A dislocation is complete separation of the 2 bones that form a joint. 2007 Feb. 455:93-101. #2 to #5 non-absorbable suture Krakow stitches x2 into tendon (4 strands exiting tendon) suture passer from superior to inferior to pass suture ends. Acta Radiol. An evidence-based review of the literature. The technique to reduce a medially dislocated patella is similar with the exception of the application of a laterally directed force on the patella. Hayat Z, El Bitar Y, Case JL. The instability and resultant tracking abnormalities will require strength, proprioceptive, and isometric rehabilitation.7 Patients who are placed in splints or casts should use crutches and not bear weight on the affected extremity. Analgesia is usually not needed. There are no contraindications to lateral patellar dislocation reduction. The immobilizer should be worn for 3weeks. That knee ain't right J Knee Surg. The link you have selected will take you to a third-party website. [17] ; thus, follow-up with an orthopedic surgeon is recommended for all patients with patellar dislocations. Slightly flex the injured leg at the hip to decrease tension on the quadriceps muscles. Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. The reduction process involves flexing the hip, applying gentle pressure to the lateral pole of the patella, in a medial direction, while slowly extending the knee. The presentation is often clinically dramatic. Do a pre-procedure neurovascular examination, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally < 2 seconds). Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. There are numerous theories as to the predisposition, if any, to a patella dislocation.1,2 These include adolescents, females, flat intercondylar groove, joint laxity, knock-knees or genu valgus, large Q-angles, obesity, and vastus medialis muscle atrophy. Objective: To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. Osteochondral injuries of the patella occur often in the setting of traumatic patellar dislocations. Use OR to account for alternate terms Obtain a postreduction radiograph to rule out any osteochondral fractures that were not diagnosed initially and to ensure positioning of the patella. B. Lateral view. Manipulation of the knee begins with gradual extension. First-time traumatic patellar dislocation: a systematic review. Simon.). 2017 Mar - Apr. Burks RT, Desio SM, Bachus KN, et al: Biomechanical evaluation of lateral patellar dislocations. encoded search term (Reduction of Patellar Dislocation) and Reduction of Patellar Dislocation. Enter search terms to find related medical topics, multimedia and more. [Full Text]. Long-term clinical studies are being performed to evaluate the effectiveness . Gently extend the lower leg. 1. Magnetic resonance imaging (MRI) may be considered in patients with acute traumatic patellar dislocations to help determine the nature of any osteochondral and soft-tissue injury. The knee consists of the patellofemoral and the tibiofemoral joints. Acute patellar dislocation in children and adolescents: a randomized clinical trial. Malonga GA: Patellar injury and dislocation. The recipient(s) will receive an email message that includes a link to the selected article. Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine Sillanp P, Mattila VM, Iivonen T, Visuri T, Pihlajamki H. Incidence and risk factors of acute traumatic primary patellar dislocation. Place the patient supine on a gurney. 3 drill holes from inferior pole to superior pole of patella with 2.0mm drill. [QxMD MEDLINE Link]. Example: jdoe@example.com. Superior patellar dislocations require operative reduction. o [ pediatric abdominal pain ] Use OR to account for alternate terms Updated: Nov 17, 2020 Author: Moira Davenport, MD; Chief Editor: Erik D Schraga, MD more. Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Position the patient supine on the stretcher. [QxMD MEDLINE Link]. An Orthopedic Surgeon should be consulted for the evaluation and reduction if the dislocation is superior, horizontal, intercondylar, or associated with fractures of the distal femur or proximal tibia. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. These fragments often are not seen on standard radiographs. [QxMD MEDLINE Link]. Dislocation of the patella generally results from a traumatic event.19 It is most commonly due to a direct blow to the flexed knee. A patella may reduce spontaneously prior to evaluation. 10 (12):e3730. In this article, we present a novel patella fixation technique using a low-profile highly contoured dorsal mini-fragment locking plate. Long-term functional outcome after lateral patellar retinacular release in adolescents: an observational cohort study with minimum 5-year follow-up. One or more of your email addresses are invalid. [QxMD MEDLINE Link]. It may also occur from a forceful quadriceps contraction while the femur is internally rotated on the tibia. Diagnosis is clinical; x-rays are taken to exclude fracture. Knee Dislocation. The natural history. Consider bedside pre-reduction X-rays (only if suspected associated fracture) Place one hand around the affected limb's ankle Place the other hand resting on the lateral surface of the displaced patella Extend the knee applying medial upwards force to the lateral patella Relocation usually occurs as the knee is fully extended Post-procedure care 2018 Dec;26 (12):3706-3710. doi: 10.1007/s00167-018-4959-6. Patellar taping was originally developed by Jenny McConnell and is a simple, inexpensive self management strategy. When it slips out of the knee joint, the condition is known as a patellar dislocation. Longo UG, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Treatment of Primary Acute Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature. An error has occurred sending your email(s). [18, 19, 20, 21, 22]. Intraarticular and horizontal patellar dislocations are sometimes reduced by closed manipulation, although most require open reduction. This site complies with the HONcode standard for trustworthy health information: verify here. Purpose: To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures. Knee dislocations are high energy traumatic injuries characterized by a high rate of neurovascular injury. 2018 Dec 14. This procedure is usually performed in the emergency department with some sedation as needed. Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. 5. Patients with these types of patellar dislocations require urgent consultation with an Orthopedic Surgeon and hospital admission for reduction. A. The general principles of orthopedic care can be applied. However, consultation with an orthopedic surgeon should be obtained prior to reduction if an associated proximal tibial or distal femoral fracture (including osteochondral fracture) is present. Mohan K, Ellanti P, Lincoln M, McCarthy T. Magnetic Resonance Imaging Features of Traumatic Patellofemoral Dislocation. 2017 Nov. 27 (6):511-523. Notice Knee Surg Sports Traumatol Arthrosc. Step-by-Step Description of Patellar Dislocation Reduction Do a pre-procedure neurovascular examination, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally < 2 seconds). Treasure Island, FL: StatPearls; 2022. Manipulation of the knee begins with gradual extension. An algorithm guiding the evaluation and treatment of acute primary patellar dislocations. Techniques of reconstruction of the patellar tendon have changed over the past few decades. Xu Z, Zhang H, Yan W, Qiu M, Zhang J, Zhou A. Validating the Role of Tibial Tubercle-Posterior Cruciate Ligament Distance and Tibial Tubercle-Trochlear Groove Distance Measured by Magnetic Resonance Imaging in Patients With Patellar Dislocation: A Diagnostic Study. The patella may reduce spontaneously. Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical AssociatesDisclosure: Nothing to disclose. The patellofemoral joint is a gliding joint. [QxMD MEDLINE Link]. Case: An 87-year-old man fell onto a flexed knee and sustained a closed intra-articular patellar dislocation. All material on this website is protected by copyright, Copyright 1994-2022 by WebMD LLC. Slowly and gently extend the knee (Figure 87-4A). The technique for the reduction of a lateral patellar dislocation is rather simple (Figure 87-4). Post reduction views should include AP, lateral, and sunrise/merchant views to ensure successful reduction and assess for patellar avulsion or osteochondral injury of the lateral . Separate multiple email address with semi-colons (up to 5). osteochondral fracture) are seen on post-reduction radiographs, consult orthopedic surgery, If patella successfully reduced, discharge with knee immobilizer and orthopedic follow up within 1 - 2 weeks. The clinical determination of a lateral patellar dislocation is usually simple and quite obvious (Figure 87-3). Performs reduction of patellar height with adjustable suspensory fixation Is reproducible and fast . Do post-procedure x-rays to confirm proper reduction and identify any coexisting fractures. [QxMD MEDLINE Link]. Patella Dislocation. Verbal consent is usually sufficient, since the reduction of a patellar dislocation is relatively simple, with infrequent complications. [QxMD MEDLINE Link]. This div only appears when the trigger link is hovered over. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. These dislocations should not be reduced in the Emergency Department. Am J Sports Med. Chapter 87. van Gemert JP, de Vree LM, Hessels RA, Gaakeer MI. The pathophysiology of this dislocation may include abnormalities secondary to malalignment, laxity, and hyper-elasticity of the joint. Terms of Use The aim is to create a mechanical realignment of the patella in the intertrochlear groove and reduce pain. Am J Sports Med. [QxMD MEDLINE Link]. 2008 Jan-Feb. 28 (1):118-23. Arthroscopy. How To Reduce Dislocations and Subluxations. . The patella articulates between the femoral condyles. Early fixation of the displaced fragment(s) is paramount to maintaining the viability of the articular cartilage and the congruency of the patella. Mohammadinejad P, Shekarchi B. The patella may dislocate in numerous directions (Figure 87-1). this Technical Note is to describe a technique for treatment of transverse patellar fractures using cannulated compression screws with tensioned high-resistance suture tape functioning as the tension band. Clin J Sport Med. [QxMD MEDLINE Link]. The fracture fixation is usually performed under general or spinal anesthesia with tourniquet use. Patellar dislocations are common, particularly in adolescent females and athletes. 2022 Apr. 1986 Mar-Apr. (median VAS reduction in pain of 4.0 points, median KSS improvement of 20.0 points; p < 0.05). B. Medially directed pressure applied to the patella when the knee is fully extended reduces the dislocation. AJSM 2004;32:1114-1121, This page was last edited 21:07, 31 December 2020 by WikEM user, https://www.wikem.org/w/index.php?title=Patella_dislocation&oldid=291052, Usual mechanism is blow to extended knee with externally rotated foot, May also occur with sudden lateral cut or twisting at the ankle or knee, Acute traumatic dislocations more common in males, Chronic dislocation seen more commonly in women/teenage girls, typically little or no swelling, Chronic dislocation more common in females, May consider pre-reduction x-ray if concern for fracture (not required), Generally do not need x-rays prior to reduction, Single dose of pain medication may facilitate relaxation, Place the hip in mild flexion by raising head of bed, This facilitates relaxation of the quadriceps, Gently extend the knee with one hand while pushing the patella back in place with the other hand, One provider applies slow downward pressure over quadriceps, This stretches the muscle and slowly straightens the leg, Second provider gently rotates the patella lateral to anterior, Obtain radiographs to rule out associated fracture (consider including sunrise view), If unable to reduce or if fracture or loose bodies (i.e. Share; Email; Print; Feedback; Close . If the patellar is already relocated, still order X-rays to rule out fracture Management of Patellar Dislocation Provide analgesia, Nitrous Oxide with oxygen is generally effective and can also be used during reduction of the dislocation Reduction is achieved by pushing the patellar medially with firm pressure, whilst extending the knee. Sports Med Arthrosc Rev. 9. Epidemiology and natural history of acute patellar dislocation. Surgical versus non-surgical interventions for treating patellar dislocation. Teixeira J, Gamba C, Ophuis J, Buijze GA, Kerkhoffs GMMJ. [Full Text]. [QxMD MEDLINE Link]. Complications are rare when reduction is done gently. Use for phrases Radiol Med. Accessibility Methods: The clinical data of 25 patients with transverse patellar fractures . The patella may relocate spontaneously by simply extending the knee. Cureus. Please confirm that you are a health care professional. Some evidence suggests that reduction of acute patellar dislocation can be performed by emergency medical services providers in the prehospital setting and can provide significant pain relief with low complication rates. 2011 Apr. 8. All rights reserved. Pre-procedure x-rays are recommended to identify coexisting patellar fractures, other bony abnormalities, or foreign bodies. Patellar dislocations are common. No premedication or sedation is required for this procedure. J Pediatr Orthop. Multidetector computed tomography evaluation of bony fragments and donor sites in acute patellar dislocation. Proximal Femoral Focal Deficiency/Congenital Femoral Deficiency, Management of Unicondylar Tibial Plateau Fractures: A Review, Best Practices: Effective Reduction Techniques for Lower Extremity Dislocations. The link you have selected will take you to a third-party website. It is held in place by the vastus medialis muscle, the medial retinaculum, the medial and lateral patellofemoral ligaments, and the patellotibial ligament. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . Dimentberg RA: Intra-articular dislocation of the patella: case report and literature review. Browser Support, Error: Please enter a valid sender email address. Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Crutches may be of use to those placed in a knee immobilizer. Do post-procedure x-rays to confirm proper reduction and identify any coexisting fractures. 6. 15 (2):78-81. Most patients do well with a short course of immobilization followed by physical therapy. We describe a novel approach of anaesthesia for patella fracture fixation using the WALANT technique. 2006 Aug. 22 (8):861-5. Arthroscopy. Diagnosis is clinical; x-rays are taken to exclude fracture. Arthroscopic reduction of a locked patellar dislocation: a new less invasive technique. This procedure is ideally indicated in patients with fracture patterns that are transverse without significant comminution. Multiple guide plates can be used to effectively and accurately reset the crushed bone blocks. o [ abdominal pain pediatric ] 2011 Feb 1. Some patients with complete dislocation may require surgery to prevent recurrence. Mehta VM, Inoue M, Nomura E, Fithian DC. Successful reduction may be accompanied by a perceptible clunk.. Patellar dislocations are common, particularly in adolescent females and athletes. Learn more about the MSD Manuals and our commitment to, How To Reduce Dislocations and Subluxations. Successful reduction may be accompanied by a perceptible clunk.. o [teenager OR adolescent ]. Patellar Fracture Fixation With Cannulated Compression Screws and FiberTape Cerclage - Arthroscopy Techniques Skip to Main Content The patella often reduces spontaneously (eg, before hospital arrival) or when the knee is incidentally extended. Prereduction radiographs should be obtained to document patellar fractures or other bony abnormalities prior to the reduction. The reduction of a lateral or medial patellar dislocation is a safe, simple, and gratifying procedure. Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Intraarticular and horizontal patellar dislocations are sometimes reduced by closed manipulation, although most require open reduction. Position the patient supine on the stretcher. Controversy has been reported in the literature regarding which patients should undergo operative repair of primary dislocations. Positioning for lateral patellar reduction. 2008 Mar. Implementation of a Prehospital Patella Dislocation Reduction Protocol. If the patella has not reduced, use your other hand to apply gentle force to the lateral edge of the displaced patella, and push the patella medially back to its normal location between the femoral condyles. Osteochondral fractures are a very uncommon complication of reduction of a patellar dislocation. No special equipment is required for the reduction of the dislocation. Patellar Dislocation Reduction, (required - use a semicolon to separate multiple addresses). 2:CD008106. Fast Five Quiz: Are You Prepared to Confront Knee Dislocations? Although patellar taping seem to reduce pain and improve performance of individuals with PFPS, the exact mechanisms of these . 2021 Jan. 37 (1):234-242. Enter search terms to find related medical topics, multimedia and more. CT should be considered in first-time dislocation patients and in dislocations that result from significant forces. Patella Fracture. It is suspended between the quadriceps superiorly and the tibial tuberosity inferiorly. Holmes SW Jr, Clancy WG: Clinical classification of patellofemoral pain and dysfunction. Smith TO, Donell S, Song F, Hing CB. Recipients may need to check their spam filters or confirm that the address is safe. Hawkins RJ, Bell RH, Anisette G: Acute patellar dislocations: the natural history. Restoration of the long-term extension and function of the knee joint remains the basic principle of any treatment strategy to avoid severe sequelae. Reduction of Patellar Dislocation Technique. A closed reduction was performed under intravenous sedation by flexing the knee to 90, applying an anterior drawer force to the tibia, and applying pressure to the inferior pole of the patella. When reduction is complete, apply a knee immobilizer so that the knee is in full extension. Summary: In this article, we present a novel patella fixation technique using a low-profile highly contoured dorsal mini-fragment locking plate. Please review before submitting. 38 (4):1288-1298. All rights reserved. Cradle the affected lower leg in one arm. The patella often reduces spontaneously in the radiology suite as the leg is extended to obtain the radiographs. Stand on the lateral side of the leg on which the patellar reduction is to be done. [QxMD MEDLINE Link]. Narcotic analgesics are not necessary or required in most cases. Radiographs may also be used to identify a foreign body if abrasions or lacerations are present over the knee. (Photograph courtesy of Dr. Robert R. Analgesia is usually unnecessary. Patellar dislocation: cylinder cast, splint or brace? Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center Reduction of Patellar Dislocation Technique: Approach . [QxMD MEDLINE Link]. The patella often reduces spontaneously (eg, before hospital arrival) or when the knee is incidentally extended. , MD, San Antonio Uniformed Services Health Education Consortium, (See also Overview of Dislocations Overview of Dislocations A dislocation is complete separation of the 2 bones that form a joint. Reduction of a lateral patellar dislocation. Methods: The clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. Daynes J, Hinckel BB, Farr J. Tibial Tuberosity-Posterior Cruciate Ligament Distance. Patients with significant pain or anxiety may be offered procedural sedation and anesthesia (PSA). 2016 Sep. 121 (9):729-34. Davenport M: Joint reduction, patella dislocation: This site uses cookies to provide, maintain and improve your experience. 42:83-87. The patella, commonly known as the kneecap, is one of the four bones (femur, tibia, fibula, and patella) that make your knee joint. 40 (4):606-11. Clin Orthop Relat Res. Obtain prereduction and postreduction radiographs to rule out any osteochondral fractures, if such lesions are suspected on the basis of mechanism of injury or findings from physical examination. Complications are rare when reduction is done gently. Reduction Technique. Explain the risks, benefits, complications, and aftercare to the patient and/of their representative. Manual manipulation of the patella is used to reduce a lateral patellar dislocation. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Slightly flex the hip (relaxes quadriceps tension). The patella may also dislocate superiorly, medially, and intraarticularly in rare instances.3,4. The trusted provider of medical information since 1899, Overview of Shoulder Dislocation Reduction Techniques, How To Reduce Anterior Shoulder Dislocations Using the Davos Technique, How To Reduce Anterior Shoulder Dislocations Using External Rotation (Hennepin Technique), How To Reduce Anterior Shoulder Dislocations Using the FARES Method, How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation, How To Reduce Anterior Shoulder Dislocations Using the Stimson Technique, How To Reduce Anterior Shoulder Dislocations Using Traction-Countertraction, How To Reduce Posterior Shoulder Dislocations, How To Reduce a Posterior Elbow Dislocation, How To Reduce a Radial Head Subluxation (Nursemaid Elbow), How To Reduce a Posterior Hip Dislocation, How To Reduce a Lateral Patellar Dislocation. Osteochondral fractures are common but seen only on arthroscopy.1,2,5 Magnetic resonance imaging, bone scans, and arthroscopy are considerations for further evaluation and diagnosis of the patellofemoral joint by the Orthopedic Surgeon. Analgesia is usually unnecessary. Patellar dislocations are almost always lateral. For a medial dislocation, use the same technique, but stand medial to the dislocation and apply an anterolateral force. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. Diagnosis is made clinically with careful assessment of limb neurovascular status. The patella is an oval-shaped sesamoid bone that develops in the tendon of the quadriceps muscle. Balcarek P, Jung K, Frosch KH, Strmer KM. 90 (3):463-70. Appointments 216.444.2606. Reduction of a lateral patellar dislocation. Fixation. The knee joint is usually stable. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=683§ionid=45343728. The patient should follow up with an Orthopedic Surgeon in 5 to 7 days. Pain over the parapatellar ligaments may be the only clinical sign in patients whose patellar dislocation has spontaneously reduced. Med Sci Sports Exerc. Extend the knee while applying gentleanteromedially directed force on the lateral patellar edge to lift the patella over the femoral condyle. Gerbino PG, Zurakowski D, Soto R, Griffin E, Reig TS, Micheli LJ. Any medial or lateral patellar dislocation that does not reduce spontaneously should be reduced manually. It's usually caused by force, from a collision, a fall or a bad step. Step-by-Step Description of Patellar Dislocation Reduction Do a pre-procedure neurovascular examination, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally < 2 seconds). https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=683§ionid=45343728. . Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012, Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. 2011 Jul. Multiple fixation techniques have been described to ensure stable fixation, including wires, screws, and all-suture techniques with both absorbable . The lateral patellar dislocation. This requires immediate reduction by the Emergency Physician if, after phone consultation, the Orthopedic Surgeon is not immediately available to perform the reduction. These include rest, ice, elevation, and nonsteroidal anti-inflammatory drugs. The patella usually dislocates laterally due to its asymmetrical shape and the normal upward and lateral pull of the quadriceps muscle. 2008 Apr. [QxMD MEDLINE Link]. Copyright McGraw HillAll rights reserved.Your IP address is Patients with significant pain or anxiety may be offered procedural sedation and anesthesia (PSA). 2012 Dec 31. A dislocated patella is painful and will prevent you from walking, but it's easy to correct and sometimes corrects itself. The physical examination usually reveals mild edema in the parapatellar recesses. Cradle the affected lower leg in one arm. A. Analgesia is usually unnecessary. . The knee is held in partial flexion. [QxMD MEDLINE Link]. The immobilizer should be worn for 3weeks. Most of these fractures occur in patients between 20 and 50 years of age. The only exception to this is if there is neurologic and/or vascular compromise of the distal extremity. This website also contains material copyrighted by 3rd parties. They could be considered for a 2020 Nov-Dec. 24 (6):800-803. Maenpaa H, Lehto MUK: Patellar dislocation. Knee Surg Sports Traumatol Arthrosc. Often, a dislocated joint remains dislocated until reduced (realigned) by a clinician read more and Patellar Dislocations Patellar Dislocations Patellar dislocations are common and almost always lateral. Value of the tibial tuberosity-trochlear groove distance in patellar instability in the young athlete. A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation. The long-term results of non-operative management in 100 patients. Virtual reduction of the patella can guide the identification of each broken bone block during the operation and confirm the mutual positional relationship between the broken bone blocks. Conclusion Patients with high-normal patellar height index or patella alta, as well as a craniolateral type of arthritis with additional lateralization, should be considered contra-indicated for an inlay technique PFA. Be sure that the injury was not actually a knee dislocation. Education of the patient and follow-up with an Orthopedic Surgeon is a requirement for successful rehabilitation. Patients with significant pain or anxiety may be offered procedural sedation and anesthesia (PSA). Pre-procedure x-rays are recommended to identify coexisting patellar fractures, other bony abnormalities, or foreign bodies. [QxMD MEDLINE Link]. Treatment is reduction and immobilization. [Full Text]. Gently extend the lower leg. Ylmaz B, iek ED, irin E, zdemir G, Karaku , Muratl HH. Su P, Hu H, Li S, Xu T, Li J, Fu W. Tibial Tubercle-Trochlear Groove/Trochlear Width Is the Optimal Indicator for Diagnosing a Lateralized Tibial Tubercle in Recurrent Patellar Dislocation Requiring Surgical Stabilization. o [teenager OR adolescent ]. Reduction & Splinting of Forearm Fractures--Quick Version Boxer's Fracture Reduction and Splinting Trimalleolar Ankle Fracture Dislocation Reduction Traumatic Knee Dislocation Reduction-Quick Version The High Ankle Sprain Shoulder Dislocation Emergency Hip Dislocation Reduction and Traction Pinning Posterior Elbow Dislocation Reduction Lord S, Brodell J, Lenhardt H, Dailey M, Cushman J. [15, 16], Medial patellofemoral ligament injury typically results from patellar dislocation Patients usually present with an inability to extend an obviously deformed knee. A. Anteroposterior view. o [ abdominal pain pediatric ] This will allow the patella to move into its normal anatomic position in the intercondylar fossa of the femur. Am J Sports Med. A patellar apprehension test is generally positive. Int J Emerg Med. The patella may reduce spontaneously. 210.65.88.143 Often, a dislocated joint remains dislocated until reduced (realigned) by a clinician read more and Patellar Dislocations Patellar Dislocations Patellar dislocations are common and almost always lateral. Be sure that the injury was not actually a knee dislocation. Patellar dislocation is distinct read more .). place knee in extension on triangle and tie 2 pairs of knots over patella. Thus, phone consultation with an Orthopedic Surgeon is recommended before the patient is discharged home. Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Subluxation is partial separation. Please consult the latest official manual style if you have any questions regarding the format accuracy. Techniques for closed reduction Single operator Place the hip in mild flexion by raising head of bed This facilitates relaxation of the quadriceps Gently extend the knee with one hand while pushing the patella back in place with the other hand Two operators One provider applies slow downward pressure over quadriceps Privacy Policy Share cases and questions with Physicians on Medscape consult. Do a pre-procedure neurovascular examination, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally < 2 seconds). Manual manipulation of the patella is used to reduce a lateral patellar dislocation. Table 3 Pearls and Pitfalls Open table in a new tab Supplementary Data Download .mp4 (58.15 MB) Help with .mp4 files [QxMD MEDLINE Link]. Diagnosis can be made clinically with the inability to perform a straight leg raise and confirmed with radiographs of the knee. There is often laxity in the tendons and ligaments surrounding the patella. Treatment is reduction and immobilization. Acute management of an acute patella dislocation is prompt reduction of the dislocation. Peltola EK, Koskinen SK. This condition is most commonly seen in adolescents and females. o [ pediatric abdominal pain ] Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Nothing to disclose. This procedure is ideally indicated in patients with fracture patterns that are transverse without significant comminution. 4. Immediately immobilize the knee in full extension with a knee immobilizer or splint. This site complies with the HONcode standard for trustworthy health information: Many patients may not notice the dislocation as it may spontaneously reduce immediately after the injury. The patient will most likely need physical therapy. [QxMD MEDLINE Link]. Successful reduction is preliminarily confirmed by visible restoration of a normal knee contour and by decreased pain. We do not control or have responsibility for the content of any third-party site. Patellar dislocation is distinct read more .). Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. If it is still dislocated, apply gentle and medially directed pressure to the lateral surface of the patella (Figure 87-4B). Patient preparation is minimal in the case of a lateral or medial patellar dislocation. Use to remove results with certain terms Check out the new My Emergency Department app - a single source of truth for all your ED team's guidelines, policies and education content. Arthroscopic reduction of a locked patellar dislocation: a new less invasive technique. The patella can be seen and palpated on the lateral surface of the knee. Slightly flex the patient's hip to release the tension on the quadriceps muscles. For simple lateral dislocations (most common), many dislocations will spontaneously reduce. These may be difficult to obtain if the patient has significant discomfort and may be delayed until after the reduction. Epub 2018 May 11. This may be accompanied by edema and/or ecchymoses over the anterolateral knee. Moira Davenport, MD Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital Arthroscopy. Lateral dislocations are the most common type (Figure 87-2). Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW. If you log out, you will be required to enter your username and password the next time you visit. [QxMD MEDLINE Link]. Anatomy of a lateral patellar dislocation. 2007 Jun. Apostolaki E, Cassar-Pullicino VN, Tyrrell PNM, et al: MRI appearances of infrapatellar fat pad in occult traumatic patellar dislocation. A patella may reduce spontaneously prior to evaluation. 2018 Dec. 26 (12):3706-3710. As with any traumatic injury, the evaluation and management of the patient's airway, breathing, circulation, and other significant injuries take priority over the reduction of a patellar dislocation. Maintain the knee in extension by immobilization with a long leg splint or knee immobilizer until follow-up for reevaluation. verify here. Patellar reduction is a relatively straightforward procedure, and early reduction can relieve pain as well as potentially decrease downstream resource utilization. Patellar dislocations are subject to degenerative arthritis, osteochondral fractures (which may be difficult to diagnosis initially), and recurrent dislocations or subluxations. Please confirm that you are a health care professional. 2016 Aug. 29 (6):471-7. Slightly flex the hip (relaxes quadriceps tension). Immediately immobilize the knee in full extension with a knee immobilizer or splint. Cochrane Database Syst Rev. (See the video below.) [14, 6] It may be useful for evaluating the anatomic sequelae of the dislocation, assessing the risk of recurrence, and determining whether conservative or surgical management is warranted in the acute setting. Please confirm that you would like to log out of Medscape. Release in adolescents and females adjustable suspensory fixation is usually performed in parapatellar. With the exception of the patella when the knee G: acute patellar dislocation: a clinical. 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