Synopsis
Separate load-related patellofemoral pain from true lateral dislocation and structural instability, reduce acute dislocation safely, identify osteochondral injury and recurrence risk, and build exercise or surgical pathways around the actual mechanism.
- Patellofemoral pain is anterior or peripatellar load pain during squatting, stairs, running or prolonged sitting without a true dislocation history; instability produces apprehension, subluxation or a documented lateral dislocation.
- Reduce an acute lateral dislocation without delay. BOASt advises against aspirating the associated haemarthrosis routinely.
- After reduction obtain AP, lateral and skyline radiographs, document extensor and neurovascular function and inspect for osteochondral fragment or fracture.
Key red flags
Failure of reduction, absent straight-leg raise, gross tibiofemoral instability or neurovascular abnormality requires urgent orthopaedic assessment and imaging beyond an isolated patellar pathway.
Investigation priorities
Confirm reduction and detect fracture or osteochondral fragment.
Management branches
The patella remains laterally displaced without evidence of tibiofemoral dislocation or fracture preventing reduction.
- Provide analgesia, document neurovascular and extensor status and reduce gently without delay.
- Obtain AP, lateral and skyline radiographs and reassess straight-leg raise and osteochondral tenderness.
Key medicines
Acute reduction analgesiaGive titrated oral, inhaled or intravenous analgesia under the emergency pathway according to pain and reduction conditions; use procedural sedation only with full monitoring and airway-capable staff when simple supported reduction is not tolerated.
Short-course NSAID for rehabilitationUse a licensed topical NSAID or one oral NSAID at the lowest effective adult dose for the shortest period required to support weight bearing and exercise, with gastroprotection when oral treatment and risk justify it.