(See also Overview of Dislocations and Patellar Dislocations.)
Indications
Contraindications
Complications
Equipment
Additional Considerations
Positioning
Step-by-Step Description of Procedure
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Do a pre-procedure neurovascular examination, including posterior tibial and dorsalis pedis pulses, capillary refill time (normally < 2 seconds).
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Analgesia is usually unnecessary. Patients with significant pain or anxiety may be offered procedural sedation and anesthesia (PSA).
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Cradle the affected lower leg in one arm.
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Slightly flex the hip (relaxes quadriceps tension).
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Gently extend the lower leg. The patella may reduce spontaneously.
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If the patella has not reduced, use your other hand to apply gentle force to the outermost edge of the displaced patella, and push the patella back to its normal location between the femoral condyles.
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Successful reduction may be accompanied by a perceptible “clunk.”
Aftercare
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Successful reduction is preliminarily confirmed by visible restoration of a normal knee contour and by decreased pain.
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Immediately immobilize the knee in full extension with a knee immobilizer or splint. The immobilizer should be worn for 3weeks.
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Repeat the neurovascular examination.
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Do post-procedure x-rays to confirm proper reduction and identify any coexisting fractures.
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Arrange orthopedic follow-up.
