Kneecap and Front Knee Problems  

The knee is the largest joint in the body and is vital to movement. Its exterior cover, the kneecap (patella), connects all the muscles of the thigh to the shinbone (tibia), allowing you to bend or straighten your leg as you walk, run, sit or stand. To view all the information on kneecap and front knee problems please view the following: non-surgical treatment, surgical treatment, and frequently asked questions.

The kneecap does this normally because it fits into a groove or notch in the thighbone. If the groove is uneven or too shallow, however, the kneecap can slide out of place, resulting in complete or partial dislocation. A sharp blow or a fall could also cause the kneecap to slip or "pop" out of place.

Symptoms

• Knee buckles and cannot support your weight.
• Kneecap slips off to the side.
• Pain in the front of the knee occurs during activity.
• Stiffness is experienced.
• Creaking or cracking sounds are noticed during movement.
• Swelling occurs.

Diagnosis

Your doctor may ask you to walk around or to straighten or bend your knee. He or she may carefully examine the area around the kneecap, take measurements to determine if the bones are out of alignment, feel the thigh muscles to see if they are weak and check for other reasons for pain, such as a tear in the cartilage or ligaments of the knee.(See above.) The doctor may also order x-rays to see if the kneecap is fitting in the groove properly.

Treatment options: Non-surgical and surgical

Non-surgical

If the kneecap has been completely dislocated, it may pop back simultaneously. If it does not, the doctor may apply gentle force to push it back in place. This is called reduction.

If the kneecap is only partially off track (subluxated), your doctor may recommend exercises, such as cycling, to help strengthen your thigh muscles in order to keep your kneecap in proper alignment. A stabilizing brace may also be prescribed.

Surgical

Many times dislocation damages the underside of the kneecap or end of the thighbone. This can lead to additional pain and arthritis. Arthroscopic surgery, involving a small incision, can correct this problem. (Click here.)

Chronic instability can often be corrected surgically, too. In this case, the doctor can realign and tighten tendons to keep the kneecap in its groove or release tissues that pull it off track. (Click here.)

Frequently Asked Questions  

•  How soon can I expect relief from pain?

With RICE (rest, ice, compression and leg elevation), you should feel more comfortable within a week or two.

•  How soon can I resume daily activities like driving a car?

The initial goal is to achieve maximum protection to help avoid further injury. With an exercise program designed specifically for your situation, you may achieve normal functions in one to three months.

•  When will I be able to resume recreational athletic activities, like running, swimming, tennis or golf?

Unfortunately, there is no quick cure for knee injury, but if you adhere to your prescribed physical therapy program, you may expect gradual improvement. The ultimate goal is to be able to resume strenuous activities in two to four months. Professional athletes may need more intense rehabilitation.

Note: Sources of this information include the American Academy of Orthopaedic Surgeons (www.aaos.org) and the American Physical Therapy Association ( www.apta.org ).