Growing Pains in the Knees

Knee troubles are not uncommon in children, particularly those engaged in active sports. One specific concern that warrants attention is known as “patellar instability.”

The Intricacies of Patellar Instability

Our knees are truly remarkable, intricate joints, with the patella, or kneecap, playing a pivotal role in ensuring their smooth operation. Visualise the patella as a key player on a team, working in harmony with the quadriceps tendon and its neighbouring components to facilitate knee movement and maintain stability. However, there are occasions when the patella seems to misbehave, resulting in discomfort. Think of it as if the patella has a desire to venture away from its designated location.

This phenomenon can occur for various reasons, ranging from developmental factors to accidental injuries. In some instances, it might appear as though the patella is unstable, even though it isn’t entirely detached from its usual position. Nevertheless, it necessitates attention, often involving physical therapy or, in rare cases, surgical intervention.

In more severe cases, the patella can suddenly “pop out” from its customary position, often triggered by a sudden impact, such as a collision during a game of football. Usually, it manages to return to its rightful place on its own, but occasionally, a trip to the emergency room is warranted.

In other scenarios, the kneecap may dislocate without any obvious injury, typically occurring due to irregularities in the knee’s structures, encompassing both soft tissues and bones.

Understanding the Underlying Causes and Vulnerable Groups

The causes of patellar instability are often multifaceted, particularly in instances of developmental or congenital patellar instability.

The Potential Consequences of Patellar Instability

Much like other joint issues, patellar instability can result in harm to the knee’s moving parts, including the delicate cartilage. When a child’s knee is in pain, they may begin to shy away from activities they once enjoyed, like sports or dancing. This can have a far-reaching impact on their overall well-being, affecting both their physical and mental health.

Diagnosing Patellar Instability

The initial step in identifying patellar instability entails a comprehensive examination by a medical professional. They will inquire about the symptoms and closely observe how the patella behaves when it should be securely in place. If a child appears apprehensive about having their kneecap examined, it serves as a significant indicator.

In certain cases, X-rays are employed to evaluate the alignment of the lower limb and the patella’s fit within its groove. For a more detailed evaluation, MRI scans may be utilised to detect any issues within the soft tissues or cartilage.

Navigating the Treatment Landscape

The preferred approach in addressing patellar instability is to commence with non-surgical methods. This encompasses physiotherapy and tailored exercises designed to fortify the muscles around the knee. The ultimate objective is to prevent the patella from further deterioration and, ideally, forestall the need for surgical intervention.

If non-surgical treatments prove to be ineffective and the instability causes substantial distress, surgery may become a viable option. There exists a range of surgical procedures tailored to specific circumstances. Some focus on the repair of soft tissues, while others necessitate alterations to the bone structure.

Patellar instability is a relatively common issue encountered by growing children. It can manifest for a variety of reasons and potentially lead to knee-related difficulties. Medical professionals are equipped to assess the symptoms and employ diagnostic tests like X-rays and MRI scans to formulate the most suitable course of action. Initially, non-surgical approaches, such as targeted exercises, are explored, with surgery considered if deemed necessary.

Kneecap dislocation, also known as patellar dislocation, is a relatively common orthopaedic injury, particularly among young individuals and athletes. It occurs when the kneecap (patella) moves out of its normal position within the groove at the end of the thigh bone (femur).

Here’s a more detailed look at kneecap dislocation:


Traumatic Injury: The most frequent cause of patellar dislocation is a direct blow or force applied to the knee during physical activities or accidents. This can happen during sports, falls, or collisions, especially in high-impact sports like football, soccer, or basketball.

Anatomical Factors: Some individuals may have underlying anatomical issues that make their kneecaps more prone to dislocation. These can include a shallow groove in the femur (trochlear dysplasia), a high-riding kneecap (patella alta), or other structural abnormalities.

Muscle Imbalance: Weakness or imbalance in the muscles around the knee, particularly the quadriceps, can contribute to patellar instability.


Pain: Intense pain is often experienced at the time of dislocation and may continue afterward.

Swelling: The knee may become swollen due to the injury.

Visible Deformity: In many cases, the kneecap can be visibly out of place, which is a tell-tale sign of dislocation.

Limited Range of Motion: The ability to move the knee may be restricted.

Instability: A feeling of knee instability or giving way is common.


Reduction: The immediate treatment for patellar dislocation is a procedure called reduction. This involves manually putting the kneecap back into its proper position within the groove. This is often done by a healthcare professional, such as an orthopaedic surgeon or an emergency room physician.

Immobilisation: After reduction, the knee is usually immobilised with a brace or a cast to prevent further movement and allow the injured structures to heal.

Physical Therapy: Physical therapy plays a crucial role in the recovery process. It helps strengthen the muscles around the knee, improve stability, and reduce the risk of future dislocations.

Surgery: In some cases, especially if there are underlying structural issues or recurrent dislocations, surgical intervention may be recommended. Surgical procedures can include realignment of the patella, soft tissue repair, or addressing any anatomical abnormalities.

Recovery: Recovery from a patellar dislocation can vary depending on the severity of the injury and whether surgery was needed. It often involves a period of rest, followed by gradual rehabilitation and strengthening exercises. Returning to sports or physical activities should be done cautiously and under the guidance of a healthcare professional to prevent reinjury.

Preventative measures, such as proper warm-ups, strengthening exercises, and protective gear, can help reduce the risk of patellar dislocation, especially for individuals involved in sports or activities that place stress on the knee joint.

This article “Understanding Patellar Instability in Children: When Kids’ Kneecaps Go Rogue”  does not provide medical advice and is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor for all medical advice. 


Meet Dr Peter Smith, a leading Orthopaedic Surgeon operating from the Mediclinic Milnerton in Cape Town, Western Cape. His practice is situated in the heart of this seaside town.  Dr Peter Smith not only offers patients the full spectrum of professional orthopaedic treatments, but specialises in total knee replacement, total hip replacement, sports injuries and the latest arthroscopic surgery techniques and computer guided surgery. He gained extensive experience in the latest arthroplasty techniques during his stay of 6 years in Australia where he performed more than a hundred primary and revision hip and knee replacements cases in a year.

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