What should I do after a knee dislocation?

You’ve probably heard of a dislocation, but you may be unsure what this actually means, and what recovery looks like. Here we explore all of this, and explain how we at First Line Physio can help!

A knee dislocation is a serious and uncommon injury where the shinbone (tibia) is moved out of place compared to the thighbone (femur). It usually happens from high-impact trauma and can damage the ligaments, blood vessels, and nerves around the knee. It is important to get medical help right away because it can cause problems like blocked blood flow to the lower leg.

What causes a knee dislocation?

These injuries can happen from high-impact events like car accidents or falling from a height. Playing contact sports or activities that involve quick direction changes or hard landings can also cause the knee to dislocate.

There are many common mechanisms of injury for knee dislocations, including getting hit directly on the knee, or if the knee is bent backward too far or twisted suddenly. Knee dislocations can also occur without much trauma, if there is a history of instability of the knee, unusual knee structure or weak thigh muscles. Conditions that affect the stability of the joints such as Ellis–van Creveld syndrome, Larsen syndrome, and Ehlers–Danlos syndrome can also lead to high risk of knee dislocations.

What are the different types of knee dislocation?

Anterior Dislocation

These occur when the shinbone (tibia) moves forward compared to the thighbone (femur), which tends to be a hyperextension injury. This is the most common type, accounting for 30-50% of all knee dislocations. The posterior capsule, the posterior cruciate ligament (PCL) and sometimes the anterior cruciate ligament (ACL) can be injured during an anterior knee dislocation. Peroneal nerve injuries are the most common in anterior knee dislocations.

Posterior Dislocation

These happen when the tibia moves backward in it’s relationship to the femur, such as a dashboard injury or a fall on a flexed knee. These have the highest rate of injury to the blood vessels at the back of the knee, such as the popliteal artery. Injury to this artery occurs in 20% of posterior knee dislocations. These can also be accompanied by ligament, meniscus, vein and nerve injuries.

Lateral or medial dislocations

In lateral and medial dislocations, it is the patella (kneecap) that moves our of its groove and to the side of the knee. This can happen laterally (towards the outside), or medially (towards the inside). This can happen when the patella is forced out of the trochlear groove by a sudden twist or impact, such as a blow to the knee. The kneecap can move partially (subluxation) or completely (dislocation) out of the groove. 

The dislocation can lock the knee and pull the ligaments out of place, which can sometimes tear them. The dislocated kneecap can sometimes correct itself, but it's usually painful and debilitating until it's fixed.

Rotatory dislocation

This is a complex injury that occurs when the femur shifts in relation to the tibia in a combination of anterior, posterior, and lateral directions. These dislocations are caused by indirect rotational forces, such as when the body rotates in the opposite direction of a planted foot. They can be caused by severe trauma, such as falls from a great height, motor vehicle collisions, or being hit by a car while walking. Minor trauma, such as tripping while walking or playing sports, can also cause rotatory knee dislocations. 

There are four types of rotatory knee dislocations, named after the direction. The most common type is posterolateral rotatory dislocation, where the tibia rotates around the femur while the PCL remains intact. A dimple on the inner side of the knee can indicate a posterolateral dislocation. 

Knee dislocations can also be classified as open or closed, and reducible or irreducible. 

What are the symptoms of a knee dislocation?

Knee injury symptoms can include:

• Sharp pain around the kneecap

• Swelling which happens quickly after injury due to bleeding inside the joint

• A noticeable misalignment if the kneecap is pushed to the side

• Feeling of the knee being unstable and like it might “give out”

• Difficulty with bending or straightening the knee

• Injury may be associated with a pop

How can physiotherapy help knee dislocations?

Physiotherapy is crucial for recovering from a knee dislocation. It helps with pain and swelling management using methods like ice therapy and electrical stimulation.

Exercises are gradually introduced to improve knee movement and strengthen the thigh muscles (quadriceps and hamstrings).

The training also focuses on making the knee more stable and improving balance to prevent future injuries. Functional exercises are included to help you return to your normal activities as quickly as possible.

When should I start physiotherapy after a knee dislocation?

This will depend on the severity and the type of the knee dislocation. All injuries should be managed individually and there is no “one size fits all approach”. Most knee dislocation recovery plans will include an initial medical management phase, and then a rehabilitation phase.

Recovery after severe knee dislocation:

Initial medical management phase: After the knee is realigned (usually in an emergency department) and stabilised, it might be kept still with a cast or brace, especially if there are serious ligament injuries. This phase usually starts within a few hours to weeks after the injury, and may include surgery if needed.

Rehabilitation Phase: Physiotherapy typically begins a few weeks after injury or surgery, depending on how well the surgery went and the stability of the knee. During this phase, the focus is on getting the knee moving again, strengthening it, and improving stability. This recovery process can take several months.

Recovery after patella dislocation:

Initial medical management phase: Once the kneecap is put back in its place, the knee might be kept still with a brace or cast to help it heal.

Rehabilitation Phase: Physiotherapy usually starts soon after the initial medical treatment. It focuses on reducing pain and swelling and keeping the knee flexible.

As you progress, exercises will be introduced to strengthen the thigh and hip muscles and improve balance to help prevent the kneecap from dislocating again.

How can we at First Line Physio help with treatment?  

At our clinic, our physiotherapists are committed to helping you recover from a knee dislocation with a personalised and thorough approach. We begin with a detailed assessment to understand your injury and create a treatment plan just for you.

We focus on managing pain with techniques like electrical stimulation and acupuncture. We also help you adjust activities that might cause pain and design a specific exercise programme to strengthen and stabilize your knee. Hands-on therapies, such as massage and joint mobilisation, are used to improve movement and reduce pain. We teach you the right techniques and track your progress during rehabilitation, making changes to your plan as needed.

After recovery, we guide you on how to keep your knee healthy and prevent future injuries. Our skilled physiotherapists are dedicated to providing top-notch care, ensuring you recover well and return to a good quality of life.

This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. If any of the exercises cause pain during or after the exercise, discontinue and consult a physiotherapist.

If you would like to get in touch please visit our contact page.