Patellar Dislocation in Children

Patellar dislocation in children is a condition in which the kneecap shifts out of place, usually after a sudden twisting movement or an unbalanced landing. It may present with pain, swelling, and a feeling of the knee giving way; even if the kneecap quickly returns to its place, the problem may persist. Early evaluation and proper treatment are important to reduce the risk of recurrence and to preserve knee function. Regular follow-up and an appropriate exercise program help ensure a safe return to daily activities and sports.

What Is Patellar Dislocation in Children?

Patellar dislocation in children is an injury that occurs when the kneecap at the front of the knee shifts outward from its groove on the thigh bone. In children and adolescents, it typically develops after a sudden twisting motion, an awkward landing after a jump, or forced movement of the knee in one direction. In some cases, the kneecap returns to its place spontaneously and the episode is brief; however, soft tissue injury, joint swelling, and pain may still occur. Although it may initially appear to be a simple sprain, this condition can have a tendency to recur if not properly evaluated.

Patellar dislocation in children may occur only once and resolve completely, or it may become a recurrent problem if underlying anatomical predispositions are present. Therefore, the pediatric orthopedic approach aims to clarify the cause of the episode, identify associated injuries, and create a treatment plan appropriate for the child’s age, activity level, and growth process. Especially in children who actively participate in sports, proper rehabilitation and a safe return-to-sport plan are essential to preserve knee function and reduce the risk of recurrence.

Is Patellar Dislocation the Same as Patellar Subluxation?

In everyday language, patellar subluxation and patellar dislocation in children are often used interchangeably, but they do not always describe the same condition. A true dislocation refers to the kneecap clearly moving out of its groove toward the outside. Subluxation, on the other hand, refers to the kneecap partially deviating from its normal track during movement, creating a brief sensation of slipping or instability. Some children clearly describe that the kneecap came out of place, while others report that the knee gave way momentarily or did not feel stable.

Clinically, these two conditions can be considered parts of a spectrum. When the kneecap completely dislocates and then returns, the child usually remembers it as a sudden painful and frightening event. In cases of subluxation, there may not be a full dislocation, but repeated micro-instability over time can strain the cartilage surfaces and reduce sports performance.

For this reason, in a child presenting with complaints of patellar dislocation in children, a detailed history should be taken and the patellar tracking, ligament balance, and joint stability should be carefully evaluated during examination.

What Causes Patellar Dislocation in Children?

Patellar dislocation in children usually results from a combination of trauma and anatomical predispositions. A strong direct impact alone can dislocate the kneecap; however, a more common scenario in children involves a sudden twisting movement that creates a force pulling the kneecap outward. Sudden contraction of the thigh muscles, changing direction while the knee is slightly bent, and the foot being fixed to the ground can facilitate this mechanism. In some children, the first dislocation occurs after a clear traumatic event, and afterward the kneecap may dislocate more easily.

Underlying predispositions may affect the path the kneecap follows, making it more prone to shifting outward. Children with ligamentous laxity may have reduced joint stability. Knee alignment, hip and ankle axis, the strength of the soft tissues that keep the kneecap centered, and the balance of the thigh muscles all play a role. Therefore, when evaluating patellar dislocation in children, not only the event itself but also the overall alignment of the lower extremity should be considered.

Do Sports Injuries Cause Patellar Dislocation?

Sports injuries are among the most common triggers of patellar dislocation in children. The risk increases in sports involving sudden direction changes, jumping, and contact, such as football, basketball, volleyball, and handball. Quickly changing direction while running, contact with another player, or landing awkwardly can increase outward forces on the kneecap. Insufficient flexibility, poor muscle control, and fatigue may also raise the risk of injury.

In athletic children, an important point is not only treating the dislocation episode but also restoring muscle control and balance to prevent recurrence. If the muscles around the knee weaken after the first event or if the child alters walking patterns to protect the knee, patellar tracking may further deteriorate. Therefore, rehabilitation after patellar dislocation in children is a fundamental part of a safe return to sports and should not be limited to rest alone.

What Are the Anatomical Predispositions?

Anatomical predispositions can significantly influence the risk of patellar dislocation in children. A structurally shallow groove in which the kneecap sits, outward deviation of the patellar tracking path, and weakness of the ligaments that hold the kneecap on the inner side can increase susceptibility. In some children, the kneecap may sit higher than normal, which can delay proper engagement with the groove during knee bending. This may make displacement easier, especially during sudden movements.

Lower extremity alignment is also important. Knees that angle inward, rotational tendencies originating from the hip, and ankle-arch support problems may affect patellar tracking. Children with ligament laxity may have more difficulty maintaining joint control. Each of these factors alone may not be decisive; however, when combined, the likelihood of patellar dislocation in children increases and the risk of recurrence becomes higher. During pediatric orthopedic examination, these predispositions are evaluated individually and the treatment plan is shaped accordingly.

What Are the Symptoms of Patellar Dislocation in Children?

Patellar dislocation in children usually begins with sudden and severe pain. The child may feel that something has shifted out of place at the front of the knee, may be unable to bend the knee, or may avoid bearing weight. Rapid swelling can develop, often due to fluid accumulation or bleeding within the joint. In some children, the kneecap may be visibly displaced to the outer side; in others, it may return quickly to its position, and no obvious deformity may be noticed externally.

After the event, there may be a feeling of instability, insecurity, difficulty going up or down stairs, and a sensation that the kneecap might slip again. Tenderness around the kneecap and pain on the inner side due to ligament injury may be present. patellar dislocation in children may cause the child to avoid walking or to limp. If these symptoms do not completely resolve within a few days, or if locking sensation or significant movement restriction persists, a detailed evaluation is necessary.