By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Surgery is often recommended for repeat kneecap dislocations
- Return of near normal strength and function will give the athlete the best chance of a successful return to sports
- Achieving near normal strength and function may take eight months or more after the surgery
The kneecap (“patella”) can sometimes come completely out of its normal alignment. This is called a “dislocation” and if you’ve ever had one you know how incredibly painful this can be. If you have a single dislocation, we’ll typically recommend rehab without surgery. If you go on to have multiple dislocations, surgery is often recommended to stabilize the kneecap.
Results from surgery are reliable as far as stabilizing the kneecap, but return to sports results are widely variable. Some published medical data show return to sports at about 55% and others as high as 85%. Some of the key factors in successful return to sports are normalized function as measured on specific tests, and near-normal strength when compared to the normal knee. It may take more than 8 months after surgery to achieve these milestones.
Kneecap dislocations typically happen in younger athletes, often adolescents or early teenagers, and girls are affected more often than boys. Reasons for repeated dislocations can include a stretched or torn ligament that stabilizes the kneecap, and sometimes bone alignment issues. If surgery is needed, the ligament and bone issues are addressed.
This is not an easy rehab. Immediately after the surgery you’ll typically be in a long leg brace with the knee locked out straight, and you’ll be on crutches. Motion and strength are then gradually built into your rehab process, and finally you’ll progress to sport specific activity.
Most orthopedic surgeons will typically list a six-month goal of return to sports, and you’ll see this timeline often listed on medical websites too. But recently published data suggests that adolescents and young teenagers will typically take closer to eight or nine months to normalize strength and function.
Athletes who wait until strength and function are normalized will have a more successful return to sport than those who return too soon. We also believe that the chance of having another dislocation is reduced if you wait to return to sport until strength and function has fully returned. This published review shows that with the right type of surgery and proper rehab, about 85% of athletes can expect to return to their desired level of sports participation.
The techniques for surgery to stabilize a dislocating patella have improved considerably over the last 25 years. With the improved techniques and especially with the improved outcomes, we tend to recommend surgery for repeated kneecap dislocations. If you have surgery you should expect to work very hard in your rehab, and if you do, you should also expect an excellent outcome.