Dislocation > Treatments
Preparing for Surgery
If your dislocated kneecap does not respond to physical
therapy, an arthroscopic or open surgical lateral release
may be recommended. A lateral release is performed when
the fibrous lateral bands (retiniculum) attached to
the outside part of your kneecap are too tight and helps
to pull the kneecap laterally out of its groove. During
a lateral release, surgeons cut this tight structure,
which helps to allow the kneecap to track normally in
its groove. The decisions you make and the actions you
take before your surgery can be every bit as important
as the procedure itself in giving you the best possibility
of a healthy recovery. Most insurance companies require
a second opinion before agreeing to reimburse a patient
for a surgical procedure. Getting a second opinion from
a surgeon who is as qualified as the surgeon who gave
the initial diagnosis is advisable in any case.
to your return home from the hospital, make sure you
have received any equipment you will need when you get
home from the hospital. This may include a knee brace,
crutches, walker, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor before you go home
from the hospital.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
Prior to surgery, you may be instructed to go to the
hospital for pre-admission testing a few days before
surgery. A nurse will review your medical history and
provide you with all the preoperative instructions you
need.You will be asked about your past medical history,
given a complete physical exam and undergo the appropriate
routine blood and urine tests and diagnostic studies
(e.g. x-rays and electrocardiogram). If you are taking
any medications, you will receive instructions about
which medications to take and the appropriate dosing
prior to your surgery. At most medical centers, you
will go to "patient admissions" to check in
for your surgery. There may be separate areas for ambulatory
outpatients (patients who go home the same day after
surgery) and for overnight inpatient surgery check-in.
Be sure to ask your doctor or one of his assistants
about this. After you have checked in to the hospital,
you will go to a holding area where the final preparations
are made. The mandatory paperwork is completed and your
knee area may be shaved (this is not always necessary).
You will be asked to change into a hospital gown and,
if necessary, to remove all of your jewelry, watches,
dentures, and glasses. You will have the opportunity
to speak with your orthopedic surgeon or one of his
assistants, and meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Unless requested, most patients are not sedated
until they go into the operating room. Here are some
important steps to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
your surgery is going to be an outpatient procedure,
arrange for someone to drive you home when you are released,
as the anesthetic and pain medications may make you
your surgery is going to be an inpatient overnight stay
procedure, pack a bag for yourself that contains toiletries,
underwear, personal phone numbers you may need, and
any other items you would like to have during your hospital
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
To improve kneecap tracking to decrease
the possibility of further subluxations and dislocations,
decease knee pain, and prevent further articular damage,
surgeons can cut the lateral attachments on the side
of the kneecap. The cut lateral band usually scars and/or
heals in a looser state. The lateral release procedure
is done arthroscopically or through a small incision
(open) and usually takes about one hour or less.
anesthesia is typically used for surgery, though in
some cases a spinal or epidural anesthetic is used.
You can expect to be given a sedative in theoperating
room before the anesthesiologist administers the anesthesia
to put you to sleep. After anesthesia is administered,
the surgical team sterilizes the leg with antibacterial
solution and places clean drapes around the site of
or two small incisions are used for the diagnostic portion
of the operation. Any further incisions depend on what
your surgeon will be required to do to help your kneecap
track normally in its groove.
the arthroscope in your knee, the surgeon can see how
the kneecap tracks in its groove and determine which
knee structures attached to your kneecap are too tight,
too loose, or torn.
the problem is identified, the appropriate procedures
can be performed. These may include tightening, releasing,
or a combination of procedures that will ultimately
allow the kneecap to track properly.
a lateral release is performed, the surgeon cuts the
lateral band (reticulum) of the kneecap while watching
with the arthroscope. This reduces the lateral pull
on your kneecap. The kneecap can then track normally
in its groove.
an open lateral release is performed, the surgeon cuts
the lateral band (retuculum) of the kneecap under direct
instruments are removed, the incisions are closed, local
anesthetic is injected, a sterile dressing is applied,
and you are awakened and transported to the recovery
After lateral release surgery, you will be transported
to the recovery room where you will be closely observed
for one to two hours while the immediate effects of
the anesthesia wear off. After surgery, you will experience
some pain. Adequate pain medications will be prescribed
for you. You will be given oral, IV, and/orintramuscular
pain medications when you ask for them. The nurses will
not give you more than your doctor has prescribed and
what is considered to be safe. Your knee will be bandaged
and may have ice on it. There will likely be pain, and
you can expect to be given pain medication as needed.
Be sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
You should try to move your feet, hips, and ankles while
you are in the recovery room to improve circulation.
Your temperature, blood pressure, and heartbeat will
be monitored by a nurse, who, with the assistance of
the doctor, will determine when you are ready to leave
the hospital or, if necessary, be admitted for an overnight
stay. You will likely be able to bear some weight on
your leg, but you may need to use crutches, a walker,
or a cane for a short period of time. For most people,
crutches are used only until you feel steady on your
feet. Your physician may prescribe a brace to help support
your knee and keep it from bending too far. Physicians
may recomment that older patients continue using crutches
or a cane for a longer period of time. In addition,
you will be given an appointment to return and a prescription
for pain medication. As soon as you are fully awakened,
you usually are allowed to go home. You will probably
be unable to drive a car, so be sure to have arranged
a ride home.
You will likely feel pain or discomfort for one to
two weeks, and you will be given oral pain medications
as needed. A prescription-strength pain medication is
usually prescribed and should be taken as directed on
the bottle. There may be some minor drainage on the
dressing since fluid may have accumulated during the
surgery. Do not be alarmed to see some bloody drainage
on your dressing over the first 24 hours. Here is what
you can expect and how you can cope after an arthroscopic
or open lateral release:
should usually continue with the ice for at least 24
to 72 hours and remove the dressing as instructed by
your physician. Icing your knee as much as possible
during the first two days after arthroscopy will help
reduce pain and swelling. Ice therapy is most effective
in the first 24 to 48 hours.
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows or blankets under your ankle.
bathe and keep your wounds dry. Do not shower or take
a bath until your surgeon tells you it is safe to do
or a cane may be needed for a few days following arthroscopy,
but you can usually put your weight on your knee and
begin walking soon after surgery. The pain typically
feels like you bumped into a table. However, it is difficult
to predict the amount of pain any given patient will
two or three days after surgery, you may experience
a low-grade fever of up to 101. Your physician may suggest
acetaminophen, coughing, and deep breathing to get over
this. This is common and should not alarm you.
may return to work a few days after surgery, depending
on the severity of your pain.
Usually, you will be asked to try
a well-supervised rehabilitation program for between
six weeks for a subluxation and up to six months for
a dislocation. In most cases, you will need to continue
the exercises you learn in physical therapy for your
entire life. After a dislocation, the knee is immobilized
for four to six weeks. After a subluxation, motion is
resumed when the pain decreases enough to make it tolerable.
Generally, most people can begin range of motion and
strengthening exercises within a week after a subluxation.
Your physician and physical therapist can help design
a customized rehabilitation program that is best for
you. You will start slowly with range of motion exercises
and proceed to stretching exercises. In most cases,
patients respond to non-operative treatment. Most people
can begin stretching the muscles and tendons around
the kneecap within a week. Physical therapy after a
kneecap dislocation follows a general pattern. It often
involves an elaborate daily stretching routine that
helps ensure muscles pull evenly on your kneecap. When
stretching, try to avoid bending your knee past 90 degrees,
which is roughly the knee angle when sitting in a chair
with your feet flat on the floor. Rehab progresses into
strengthening exercises that focus on the quadriceps
and hamstrings the main stabilizing muscles for
your knee. Physicians suggest you gradually increase
the amount of weight as your leg muscles get stronger.
Strengthening exercises require dedication because results
often take weeks and pain may recur. After about six
to 12 weeks of rehab, physical therapy can become activity-oriented
as you regain the ability to perform complicated movements,
using stationary bikes, elliptical machines, and cross-country
skiing machines. Coordination exercises continue for
months until your kneecap is fully rehabilitated. Physicians
usually suggest that you continue strength training
even after your kneecap has been rehabilitated. Have
your physician periodically check your kneecap for strength
and proper tracking.
strengthening exercises: Kneecap (patella) injuries
Your main prevention goal following
kneecap dislocation should be to strengthen your quadriceps
and hamstring muscles so they are stronger than before
the dislocation. You should try to feel comfortable
that your leg muscles are powerful enough to snugly
keep your kneecap in a normal alignment. Physicians
usually suggest that you wear your knee sleeve during
any activities that may stress your knee. The knee sleeve
by itself may improve the tracking of your kneecap,
however, to prevent kneecap dislocations, your rehab
exercises are ultimately more important than bracing.
Making the strengthening exercises you learned in rehab
part of your regular conditioning routine is the best
way to prevent future kneecap dislocations. Like any
dislocated joint, once the first dislocation occurs,
less force may provoke subsequent dislocations. You
will have to rely much more on muscle strength to hold
your kneecap in a normal position after a dislocation.
Depending on the severity of your dislocation and the
success of your rehab program, your physician may recommend
that you avoid contact sports or risky, high-speed activities.
In general, your kneecap can become healthy and stable
after a dislocation, but you may need to be cautious
of activities that could result in accidental collisions
or falls. Besides the knee sleeve, consider wearing
sturdy kneepads designed for crashes during activities
like in-line skating and padded knee braces during contact
sports. Your physician can recommend the best types
of protective gear for your knees. You may know some
people who seem able to pop their joint in and out of
place painlessly. This should be avoided at all costs.
The more your kneecap is popped out of place, the greater
your chances of arthritis and the higher your risk of
re-injury during activities.