A kneecap can be knocked out of the groove when the knee is hit from the side.

A kneecap can also slide out of the groove during normal movement or when there is twisting motion or a sudden turn.

Kneecap subluxation or dislocation may occur more than once. The first few times it happens will be painful, and you will be unable to walk.

If subluxations continue to occur and are not treated, you may feel less pain when they happen. However, there may be more damage to your knee joint each time it happens.

You may have had a knee x-ray or an MRI to make sure your kneecap bone did not break and there was no damage to the cartilage or tendons (other tissues in your knee joint). An MRI can also identify risk factors on why your kneecap is unstable.

If tests show that you do not have damage:

• Your knee may be placed in a brace, splint, or cast for several weeks.
• You may need to use crutches at first so that you do not put too much weight on your knee.
• You will need to follow up with your primary care provider or a bone doctor (orthopedic surgeon).
• You may need physical therapy to work on strengthening and conditioning.
• Most people can return to activities within 6 to 8 weeks.

If your kneecap is damaged or unstable, you may need surgery to repair or stabilize it. Your health care provider will most often refer you to an orthopedic surgeon.

Sit with your knee raised above heart level at least 4 times a day. This will help reduce swelling and muscle atrophy.

Ice your knee. Make an ice pack by putting ice cubes in a plastic bag and wrapping a cloth around it. Do not put ice directly on your skin.

• For the first day of injury, apply the ice pack every hour for 10 to 15 minutes.
• After the first day, ice the area every 3 to 4 hours for 2 or 3 days or until the pain goes away.

Pain medicines such as acetaminophen, ibuprofen (Advil, Motrin, and others), or naproxen (Aleve, Naprosyn, and others) may help ease pain and swelling.

• Be sure to take these only as directed. Carefully read the warnings on the label before you take them.
• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.

You will need to change your activity while you are wearing a splint or brace. Your provider will advise you about:

• How much weight you can place on your knee
• When you can remove the splint or brace
• Bicycling instead of running while you heal, especially if your usual activity is running

Many exercises can help stretch and strengthen the muscles around your knee, thigh, and hip. Your provider may show these to you or may have you work with a physical therapist to learn them. It is OK to move and bend your knee with the exercises.

Before returning to sports or strenuous activity, your injured leg should be as strong as your uninjured leg. You should also be able to:

• Run and jump on your injured leg without pain
• Fully straighten and bend your injured knee without pain
• Jog and sprint straight ahead without limping or feeling pain
• Be able to do 45- and 90-degree cuts when running

Contact your provider if:

• Your knee feels unstable.
• Your kneecap is out of place and it can't be put back in place.
• You have trouble lifting your leg on your own.
• Pain or swelling returns after having gone away.
• Your injury does not seem to be getting better with time.
• Your knee catches and locks and it is painful.

Patellar subluxation - aftercare; Patellofemoral subluxation - aftercare; Kneecap subluxation - aftercare

Miller RH, Azar FM. Knee injuries. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 45.

Sherman SL, Hinkel BB, Farr J. Patellar instability. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 105.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.