Kneecap (Patella) Instability and Pain

Kneecap instability or dislocation is a common injury and if experienced, can be very painful. The knee cap or patella is a small bone that sits at the front of the knee and glides up and down a groove (femoral groove) in the thigh bone (femur) as the knee is bent or straightened. 

To allow the kneecap to slide smoothly and easily in the groove, the kneecap has a smooth coating (articular cartilage) on its underside. There are a number of ligaments, muscles and tendons around the kneecap that help to keep the knee stable. It is when the patella comes out of the femoral groove that a patella or kneecap dislocation occurs. Sometimes, the patella will only come partially out of the groove in which case a mild patella dislocation or instability occurs. This feeling of instability is because the muscles and ligaments are unable to keep the patella in the femoral groove.

Given the description of how the kneecap operates, its usage is high and depending upon what activity we are undertaking, at times the impact on this area can be highly stressful, especially when participating in contact sports.

Symptoms of Kneecap Dislocation or Injury

People who have experienced a dislocation of the kneecap often say they feel a sudden pain in their knee, usually following a movement which may have caused them to twist their knee or land heavily, or after a contact injury. Swelling usually occurs and the knee feels very unstable. With a partial dislocation, a tear may have occurred in one of the ligaments or muscles around the knee, which results in a slight displacement, or a feeling that it’s about to dislocate again if the knee cap if literally pushed. Or it may be that you can’t bend or straighten the knee without feeling knee pain. Some people also say that if they straighten their knee, the patella goes back into the femoral groove and appears to have corrected itself.  If, however, the patella does not fall back into place then it should only be moved back into the femoral groove by a Knee Specialist, but either way, specialist medical attention should be sought.

Treatment of Kneecap Dislocation or Instability

It is important to seek medical assistance if you think that you may have damaged the kneecap in some way, even if you feel the kneecap has ‘popped’ back into place. The first important course of action is to apply the simple rule of PRICE (protection, rest, ice, compression and elevation) to limit any further damage occurring.

The treatment of patella dislocations or patella instability should be determined by a Knee Specialist and will be dependent upon severity of the injury. It may be that as well as a medical examination, an X-ray or MRI scan may be necessary as part of the assessment. 

Sometimes patellar instability can be treated through a knee rehabilitation programme, which will include strengthening and flexibility exercises, initially with the assistance of a physiotherapist, the knee can be returned to normal stability and functionalitySurgery may well be necessary to prevent future dislocations. The majority of patellar stabilisations would be in the form of a Medial patello-femoral ligament (MPFL) reconstruction. 

In a number of patients, there are also underlying bony abnormalities and in certain cases these may have to be addressed surgically. . In those individuals who may experience repetitive patella dislocation, it may be that that they have a greater risk for premature wear and tear arthritis (osteoarthritis) of the knee joint.

Consultation Process

If you are experiencing problems with your knee, then a proper consultation with a qualified and experienced Knee Specialist is essential. Mr Guido Geutjens will always take you through a thorough examination and investigation process before providing a diagnosis. Once a diagnosis has been given, and if patella dislocation or instability is confirmed, Mr Geutjens will then discuss with you the correct procedure to ensure a successful recovery from the condition.

  • Q1 What is patellar instability?

    Instability of the patella, or the kneecap, means that the patella is not able to track normally within the femoral groove. The femoral groove is a small groove at the front of the thighbone (femur) where the kneecap glides up and down as the knee is bent and straightened and so maintains the stability of the kneecap stopping it moving from side to side.

  • Q2 Is patellar instability easy to resolve?

    Sometimes, a knee rehabilitation programme under the supervision of your physiotherapist can help resolve the problem. However, surgery to stabilize the patella is often needed, especially in people who experience recurrent dislocations. It is very important to seek the advice of a Knee Surgeon as soon as you think you have a problem so that the problem can be diagnosed accurately.

  • Q3 As an NHS patient, can I request a referral specifically to Mr Geutjens through my GP?

    If you are an NHS patient and your GP needs to make a referral, then you can request a consultation with Mr Geutjens. Ask your GP to look at for Rehabilitation Protocols for more details on how to book an appointment on your behalf.