A 34-year-old woman presented to the emergency department with acute left knee pain after her 14-kg toddler jumped on her knee while she was sitting with her knees fully extended. On physical examination, a sharp bony prominence was seen anteriorly over the left knee, accompanied by mild skin tenting (Figs. 1, 2). The medial aspect of the left patella was wedged between the femoral condyles, with the articular surface facing posterolaterally. An x-ray of the left knee was reported as demonstrating mild suprapatellar effusion, with no fracture or dislocation identified (Figs. 3, 4). Reduction was performed under procedural sedation using intravenous propofol. The patella was grasped at its superior and inferior poles using the thumb and index finger of both hands, with both thumbs positioned medially and the index fingers positioned laterally. Lateral translational force was applied from the wedged medial aspect while external rotational torque was simultaneously applied to disengage the patella. In combination with gentle flexion of the knee, this maneuver resulted in successful reduction. Vertical patellar dislocation is a rare form of intra-articular dislocation in which the patella rotates about its vertical axis, resulting in one side of the patella becoming wedged between the trochlear groove or the femoral condyles. Most cases result from direct trauma, although spontaneous atraumatic cases have been reported [1]. Unlike the more common extra-articular lateral dislocations, vertical dislocations are more difficult to reduce [2]. The orientation of the dislocation can be determined by palpation to identify the smooth articular surface of the patella. A skyline-view radiograph can be helpful for identifying vertical patellar dislocation [3], but performing this view may not be feasible because knee flexion is often limited by pain. A skyline view was initially ordered for our patient, but it was not performed by the radiographers. Reduction in an incorrect direction can result in worsening pain and additional soft tissue injury, potentially involving the quadriceps muscles, quadriceps femoris tendon, patellofemoral ligaments, and patellar retinaculum. Repeated attempts at reduction in difficult cases may lead to osteochondral trauma and may also erode patient confidence in the treating clinician. In some cases, reduction under general anesthesia, or even open reduction, may be required [4].