NOTES - Surgical Procedures :
Recurring lateral patella dislocation - - Posted by boputnam (boputnam), 23 January 2004
Hey...
I'm new here, and as well, quite ignorant of proper terminology.
Background: I've congenitally defective patellas / knees, whereby the patellas are for-the-most-part "rootless" (they lack the keel), and likewise, the knee lacks the groove. Very evident on Xrays. Mom gave this to me...
I've suffered maybe half-dozen lateral dislocations (R only) over the past 20-yrs. I'm a geologist, and in maybe better-than-average shape, but that doesn't seem to matter. Right position, wrong stress, out it goes. Recently, I had a "double-header" in a weeks-time, and swelling persists after 5-weeks. The greatest pain has been from the medial area - I suppose badly torn from the patella going the opposite direction.
Now in rehab, otherwise going very well, then suddenly last evening, at home, the patella just takes a hocky-puck like movement, and would have dislocated but for the patella brace. Spooked me good, boy-howdy.
So, I'm fairly discouraged. This condition won't be remedied with therapy (might actually worsen with increased calf / lowerleg muscle tone), and the subject of Lateral Release has come-up.
Asking this here is like asking for rain in the rainforest, but: what am I facing with "LR"? Seems very drastic, and irreversible. 
Am I hosed, with no other course of action? I thank-you in advance for whatever you can share. I've read much of this Forum (excellent), but wanted to post my situation for your consideration.
bo.
Posted by anasta5ia (anasta5ia), 23 January 2004
Bo-
I also suffer from constant dislocations. I have undergone a LR as well as 3 TTT's on my right knee. During the last 2, my medial patello femoral ligament was first repaired and then completely reconstructed.
Fortunately the last TTT on my right knee looks like a success. Now I have to get the left one done.
I would just make sure that the OS is doing a LR for the right reasons. A LR will correct tilt of the patella, but many people don't have a problem with the tilt. I would definitely ask him about reconstructing the medial retinaculum/medial patello femoral ligament and also about a TTT so that the source of the dislocations can be addressed.
Good luck....If you have any other questions, feel free to IM me.
-Heather G.
Posted by boputnam (boputnam), 23 January 2004
Hey, Heather...
I don't have any tilt of the patella, at all. They "look" completely normal externally. That's why every OS I've been too are quite perplexed on seeing the Xray. There's almost nothing to keep the patella centered.
TTT has been discussed, but (until I found this wonderful place here, "KneeLand" 
) seemed more drastic. The experiences shared here have cautioned me considerably on the merits of LR.
This clumsy knee brace don't seem so bad, anymore. Yea, it's hot and limiting, but no pain associated. What concerns me, is the inadvertent dislocation - and mine are full, lateral, which I have to remedy myself. No fun at all. Spooky, besides.
I have a great deal of reading here, and look forward to any replies / suggested reading.
bo.
Posted by nmcbride (nmcbride), 23 January 2004
Bo,
I also had recurring dislocation in both my knees. I had a LR to try to rectify this along with medial reefing, unfortunately this didn't work and had to progress onto having 2 TTTs which have worked wonderfully in the respect of keeping the kneecap where it should be, I have trochlear dysplasia (very shallow trochlear) so I would also have full dislocations and have to put back myself - very, very painful 
, not to mention all the ligament damage that is usually done at the time of dislocation. I think you're right to be wary of the LR to correct dislocations, from what I've read here, it doesn't seem to work too well for that condition. If you are offered a TTT I would certainly consider this, I think most people have better luck with TTTs than LR to rectify dislocations. In my case, it was the best thing I could have done. Good luck with whatever you decide.
Natalie.
Posted by Marie (Marie), 23 January 2004
Hi Bo,
I just wanted to echo what has already been said. For me, a LR alone was out of the question, and a Fulkerson TTT (with LR) was performed. It's a bigger surgery, but if your problem is more than the tilt of your patella (i.e. malalignment due to some other cause), it should be considered. My old PT says that LRs alone are rarely performed in Canada.
What do you mean that your "knee lacks the groove"? Can you tell where the proper tracking groove is supposed to be?
Definitely read http://www.patellapain.com/ (under the "surgery" link). I also just received Dr. Grelsamer's book "What your doctor may not tell you about knee pain and surgery" which is good, but doesn't delve as much into the topic of dislocating knees (although I'd still say it's worth reading). It does, however, tell you how to find the better OSs out there, and gives good advice re: making sure you're having the right procedure(s) done.
Marie
Posted by boputnam (boputnam), 25 January 2004
Hi, Natalie and Marie...
Thanks to you both for taking time to reply.
Quote:originally posted by Natalie
I think most people have better luck with TTTs than LR to rectify dislocations. |
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I think this is the most impactual quote, thus far. Thanks. I cringed reading of your having to reposition the patella yourself - me too, each of the 5-times this has occurred over the past 20-years. But, even though it is excrutiating, there is simply no-way to not do so. And, what I've come to realize this time, is the ligament damage must be quite extreme with pain and swelling persisting (and a subluxation) into the 5th week.
Quote:originally posted by Marie
What do you mean that your "knee lacks the groove"? Can you tell where the proper tracking groove is supposed to be? |
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Xrays show a poorly developed trochlear groove, both knees same. And, over the years, I have felt (and seen) either patella slip into the groove as I rise from a sitting position. It is audible, and others can feel it if they cup the patella. Disappointingly, with the recent troubles to my right knee, the left has lately increased this behavior to the point of being uncomfortable (and certainly unsettling).
Everyone here has given me a great deal to go on. Thanks. You have encouraged further reading and research. It's great. My PT is quite intrigued (accustomed to dealing with damage and sports injury, but not so much to a congenital condition that won't remedy with therapy) he has brought-in quite a few papers.
More reading and PT to do. Thanks, for all the thoughtful replies. I'm going to try and get on a free bicycle today, and cruise around the neighborhood. Thoughts of downhill skiing seems like I have someone else's memories. Slowly, slowly...
Posted by Helena (Helena KTF), 25 January 2004
on 01/25/04 at 19:19:25, boputnam wrote: Xrays show a poorly developed trochlear groove, both knees same. And, over the years, I have felt (and seen) either patella slip into the groove as I rise from a sitting position. It is audible, and others can feel it if they cup the patella. Disappointingly, with the recent troubles to my right knee, the left has lately increased this behavior to the point of being uncomfortable (and certainly unsettling).
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Bo,
same problem here! Left knee had lateral release to correct tilt but didn't stop the dislocations, even got worse! TTT has stopped them but kneecap still subluxes due to trochlear dysplasia (poorly grooves). R knee gives LOUD crack every time I get from flexion to extension, and that's the kneecap snapping in the groove! L knee cracks all the time.
I would suggest a TTT, as a LR (as said) only correct patellar tilt and is frequently done for other than good reasons (and then fails, explains high failure rates!!!!). One of our OS does a LR on everyone with CMP!!! He won't touch me!
Recovering from a TTT isn't something easy, but it hasn't been as bad as I thought, after reading all the posts here. I recovered quick and am still active (well I try! 
)
Good luck!! ~Helena
Posted by boputnam (boputnam), 26 January 2004
I stumbled into this, today, thanks to the wonderful plethora of Links on this site!
Quote:from: http://www.patellapain.com/surgery.htm#tibial%20tuberosity
The concept of displacing the tibial tuberosity to affect patellar tracking goes back to the 19th century. The Swiss Roux described displacing the patellar tendon in 1888 (see below). He was also one of the first to publish the observation that patellar dislocation is a problem that occurs near extension (slight flexion). People do not dislocate their patella going up and down stairs, but they readily dislocate with social dancing. |
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I realize the conditions of many here are quite different than are mine, but this describes me (sadly...) perfectly. I am at greatest risk when it is least intuitively obvious...
Posted by bdmrad (bdmrad), 27 January 2004
I would be extremely cautious about a lateral release as the first procedure for patellar subluxation. In my limited experience, this is offered my "arthroscopic wand wizards" as a less invasive outpatient first step. Unless you have clear cut lateral tilt and tight lateral structures, the LR is not likely to help. I advise that you find someone who is "on a mission from God" about patellofemoral disease. Those names are all over this website. Also Google the International Patellofemoral Study Group.
Try is get the one best surgery that is for you done by someone with the experience. Your run of the mill Sports Medicine OS may not be that person.
Posted by boputnam (boputnam), 27 January 2004
on 01/27/04 at 13:33:17, bdmrad wrote:| Google the International Patellofemoral Study Group. Try is get the one best surgery that is for you done by someone with the experience. Your run of the mill Sports Medicine OS may not be that person. |
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Truly exellent suggestions, in particular IPSG. Thank you. The more I learn about my congenital (i.e., non-sports nor accident related) conditions, the more I realize they require a different approach.
I will also share: www.sciencedirect.com go to "Journals" and "The Knee". Asbstracts are free; articles pricey (but less than surgery!). . Two excellent articles in Volume 10, Issue 3, Pages 215-220, and 221-227 (September 2003).
Posted by Laura945 (Laura945), 24 February 2004
I suppose it depends in part why this is happening.
My right knee starting dislocating when I was 14 (I'm now 43), not from an injury, but a congenital weakness in the tendon. It dislocated 5 times in 3-1/2 years, the last the night before I checked into the hospital for a patella realignment (MUCH more invasive than a lateral release). I was off my feet for 7 weeks. No more dislocations, but my cartilage has been disintegrating ever since.
I had a lateral release on my left knee 4 years later, to prevent it from dislocating. Re-hab was much shorter, and although it's not perfect, it's a million times better than the right.
My suggestion would be to go for it. The procedure is minimally invasive, and what you could be facing if you don't is a lot worse.
Posted by bdmrad (bdmrad), 25 February 2004
I agree that it is important to understand WHY one is dislocating and that the best remedy is based on an thorough assessment
Laura945 - you may have damaged your cartilage with your several dislocations, and maybe not as a consequence of surgery. I had had numerous dislocations due to patella alta and shallow trochlear groove with no damage for 35 years. I almost signed on for the LR because it was "less invasive" but the more I thought about it the more illogical it sounded for MY problem and anatomy. Instead I had a bigger procedure, reconstruction of medial patellofemoral ligament. I was full weight bearing within two days and back to work taking call within a week. I think the ultimate solution would have been TTT combined with MPFL recon ( a la Drez et al.) but I really did not want six weeks of non weight bearing. The MPFL recon seemed a reasonable compromise. The surgeon I used has a series of 40 or so patients who had MPFL recon in the setting of trochlear dysplasia and had excellent results in all but two. I'm 4 months out and doing well.
I just want to re-emphasise to the readers that an accurate diagnosis by thorough examination is crucial for the selection of the proper treatment, surgical or nonsurgical. I don't think that most Sports Medicine surgeons are well versed in the treatment of PF disease. There seem to be plenty of "tales of woe" on this chat board about the lateral release.
Posted by boputnam (boputnam), 25 February 2004
I've been absent here recently - but have been busy on researching my ailment.
Independently (but certainly not ignorant of all the experiences wonderfully shared here...) through weeks of research and discussion I've determined that there may indeed be times when LR is indicated. However, it seems an extreme remedy and can itself produce unintended consequences by materially altering the biomechanics of the knee joint.
As Arendt et al (2002*) reported in their comprehensive summation of available research, most diagnoses are done after the event and therefore may be influenced by how the PFL presents post-event.
Alteration of the structure and mechanics of the PFL is, IMO, very aggressive. Pre-surgical measurement to determine amount of LR indicated, or degrees of movement in a TTT procedure, cannot be measured with great precision / reproducibility. The outcome seems highly variable.
It is not obvious to me that releasing the lateral tension on the PFL is remedying the symptom, or the problem - I fear the former, and that is not compelling to me (for the condition I suffer). Conversely, I am compelled to rebuild the MPFL and help / enable it to do it's designed task - that of proper tracking of the patella. My case may be more benign and different than many here - that is, it is not accident-related, per se. And, I have not yet decided upon surgery. I am continuing remedial physical therapy and feel I have much more to learn through research.
My plan may fail, but I find I can wear a patella-stabilizing brace with little discomfort (Breg airmesh model) and am +85% functional (the remaining 15% dificiency relates to persisting swelling from my Dec. 2003 event).
I value, and look forward to continuing dialogue here.
* - Arendt, E.A., D.C. Fithian and E Cohen: Current concepts of lateral patella dislocation, in Clinics in Sports Medicine, Vol.21, p499-519.
Posted by nmcbride (nmcbride), 25 February 2004
Hi Bo,
My story is somewhat similar to yours. My dislocations are due to genetic defect, ie, trochlear dysplasia. I spent 18 years of constant physio appointments, taping, bracing, later a lateral release which obviously failed as it was done for the wrong reasons, a further few years of constant, intensive physio, taping, bracing, and nothing worked. I was then put forward for the TTT (Elmslie Trillat) and I was desperate, was sick to death of dislocating every 8 weeks or so, I was no sooner over a dislocation and was started to mend and it would go again, usually when I was out dancing or running around with my kids and dogs, so I went ahead with it. I had my first TTT 7 years ago and then went on to have the other knee done just last year. For me it has been the only thing that has worked and I have never looked back. I hope you can get by with exercise and bracing but if it does come to having surgery, hopefully you will be as lucky as I've been with the outcome. Sure, I get all the usual aches and pain, ie chondromalacia etc but things are still miles better than they were when I was living in constant fear of dislocating at any time. Very best of luck with whatever happens. Keep us informed of any other research you come across, always interested to hear of new things.
Natalie.
Posted by hmaxwell (Heather M.), 28 February 2004
Bo,
I'm afraid mine is one of the cautionary tales out there. I will be fair and say that my lateral release did exactly what it was intended: it stopped the subluxations and dislocations in their tracks (so to speak). Unfortunately, it did so much more that my knee is ten times worse now than it was before!
I have one of those rare, unanticipated consequences (massive joint bleed post-op, followed by even more massive internal adhesions) that have led to a further four procedures with no end in sight.
When a lateral release for my other knee was strongly recommended by no less than three surgeons, I not-so-politely declined. There is no way I'm going to do that again. I think that it is indeed logical to start with the smallest and least invasive procedure--but that has to be appropriate for the set of symptoms you present with! And the alteration of the mechanics is not nearly as benign as many surgeons would make it out to be. Plus, the follow-up work is critical, and in these days of HMOs and drive through PT that is not likely to happen!
It sounds like you're on the right track--find someone whose mission in life is the proper treatment of genetically mal-aligned knees. Lateral releases do seem to have their place, but not when they are done lightly or as an after-though prior to disengaging the scope.
So while I do know of two people who, anecdotally, are happy with their lateral releases, I know of so many more who wish they'd never had it done! And for some, it seems that the 'less invasive' lateral release actually starts a cascading process of inflammation and scarring that keep the knee from ever reaching homeostasis again. I fear I have one of those knees, but am working toward forcing it to settle!
Hope you find your answers.
Heather
Posted by sneal7171 (sneal7171), 16 April 2004
Good Morning Everyone!
While I could have posted this message numerous places on this board, I find that I have a lot in common with most who have posted here.
A lil about my story.. I've had recurring dislocation in my r.knee since age 9. After numerous years in PT..and countless dislocations later.. at 25 (May 2000) I had a distal TTT. Can I just say that was the worst pain ever! After being in the hospital for 4 days, I go home and 3 days later my tibia fractures..so back to the hospital to have a second screw put in. 
Not so bad, start PT..which wasn't fun but tolerable. Move out of the state (6 weeks post op) before PT is finished and fail to find time to keep up with the exercises which keeps me on crutches for about another month. The March of 03 I dislocate again. Talk about serious depression! Find a doctor who prescribes PT which I am completely sick of and then 2 months later (May 03) decides to do a scope to clean-up and correct some locking up and popping. So that was surgery #3 and surgeon #2.
Now, with both knees suffering from arthritis and the r. knee still severable unstable.. I am seeing the team physician for the Dallas Mavericks. (I live in Dallas) 
Going on the assumption he works on multi-million dollar knees and has fellowshiped under the great Dr. Hughston.. I am trusting that this next set up surgical procedures I am facing on 5/27/04 are going to correct the problem for good!
In May 2004( what is it about the month of May and knee surgeries for me...lol) I am having a Proximal Patellar Realignment, Synovectomy and a Lateral Release. I've searched this board high and low and see nothing concerning PPR or Synovectomys. Can anyone tell me what they know about those procedures? Is there another name for the PPR? 
My patella is so unstable that I still cannot do straight leg raises without my knee feeling like it's going to pop out of place. With full extension you can feel moving out of its groove. Very scary and makes it hard to work on quad exercises.. which I desparately need to be doing before this next surgery as I basically have no quads as it is.. 
And one last thing.. cause I know I've rambled enough.. but has anyone had any uncontrollable crying experiences pre/op? I don't know if I stay upset because I know what I'm about to go through again or what.. but I seriously cry all the time.. (and I'm a big girl) but this is really stressful..not just physically but mentally and emotionally and financially as well.
Thank God for insurance! and thank you all for your time and any response you can offer.
Posted by boputnam (boputnam), 16 April 2004
Hey, "sneal7171"...
Your situation, and serial complications are unique, to my experience.
Only thing I have to say, is, my research on LR was not encouraging. In many cases it seemed to exacerbate things, and in many instances the result was an end to lateral luxation, but the beginning of medial luxation. My view, and I'm not a doctor only an MSc in earth sciences, I don't like the idea of releasing a part (i.e., one side) of the patella restraint. This leaves un-opposed (or at least less-opposed) the tension from the MPFL, and makes little/no (bio)mechanical sense. What engineer would recommend releasing tension on half of a device, and expect improved performance?
I posted on this Thread in February a reference to a wonderful article by Arent* - you should read this. Arent forwarded me a copy, gratis. Maybe I could scan it and email it to those interested...? In short, Arent's researching of the literature among her other findings, finds little support for LR in the case studies - the outcome of the procedure has (very) poor success rates.
My OS dismissed the Arent article as a "book report" and not fundamental research, without having read it - and he's recommending LR (no, I am not...). It may be he - like many other OS's - are put-off by patients becoming knowledgable. I guess we then ask too many good questions. I've found that OS's are keen to deal with you so long as they can calendarize your surgery - if you solicit input and counsel their interests in your condition quicky fades... This is not good for us.
Sorry - not meaning to be discouraging - I've been very disheartened by the poor understanding of our condition on the PT field.
* - Arendt, E.A., D.C. Fithian and E Cohen: Current concepts of lateral patella dislocation, in Clinics in Sports Medicine, Vol.21, p499-519.
Posted by hmaxwell (Heather M.), 16 April 2004
For sneal--here's a link that explains about proximal vs. distal realignments.
This is a quote from the link: Quote: Surgical procedures have been arbitrarily divided into proximal and distal procedures. All seek to somehow transform a tilted and/or lateral-tracking patella into a less tilted, centrally tracking patella. Proximal re-alignments involve surgical manipulation of the lateral retinaculum, the medial retinaculum, the vastus lateralis, the vastus medialis obliquus and any combination thereof. Like balancing a marionette, it is a question of tightening certain "strings" and giving others more slack. The term distal re-alignment denotes (by convention) a transfer of the tibial tuberosity. Certain procedures fall into neither category: prosthetic re-surfacing of the patella or trochlea for example.
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There is also a lot of information on this site about whether to do LR's or not, and when they are appropriate. It's a great resource, though it is a bit technical. The doctor who wrote the page is one of the best PFS specialists around.
http://www.patellapain.com/surgery.htm
Heather
Posted by bdmrad (bdmrad), 17 April 2004
This topic (PF disease) is very complex. It is not as straightforward as gallstones or even meniscal tears. Chronic PF pain is a totally different beast than recurrent subluxation even the same operations are offered for both. Finding a physician with a specific interest in PF disease can be difficult. I had also consulted an OS who takes care of NBA team players who recommended an initial LR and thermal plication. He felt that it had about 50% chance of taking care of my problem of recurent dislocations, but I got the feeling he thought I would eventually end up with a distal realignment such as a Fulkerson. I had been scheduled for the LR but talked to another OS (pediatric OS who said I needed a distal realignment - Insall) and became sufficiently confused that I cancelled surgery and began extensive reading of the medical literature which eventually led me to the concept of MFPL reconstruction. I am six months post-op and still think I made the right decision but I may never know if I would have done better with a TTT or both. If I had been younger, I might have opted for TTT with MPFL reconstruction which addresses both the propensity to dislocate as well as repair the damge done by the multiple dislocations.
I agree with boputman that the OS community as a whole is poorly informed about this complex issue, but this is understandable. Chronic knee pain is like chronic low back pain- many operations can be done and pain can be alleviated to some degree but it is unlikely that the individual will ever be pain-free. It takes a special person to deal with this sort of chronic problem. Everybody would like a "quick fix" and it is more gratifying to take care of problems where the "quick fix" works - like gallstones or meniscal tears.
Posted by boputnam (boputnam), 18 April 2004
Hey, bdmrad...
Long time, no chat. I'm anxious to know how you're progressing.
In the interim since we "talked" and you were so helpful, I've elected to do nothing. And, it has made me question something I'd like your thoughts on: IMO, I do not think immediately PT after a lateral luxation is indicated. The damage to the MPFL was the area of most acute pain for me, and was hair-raising painful during PT.
The MPFL is not a muscle, so PT cannot be helping much, if at all. PT does rebuild the atrophied quad, but does nothing for the ligament. I believe PT actually delays the healing of the MPFL. This is only my opinion and I am not an MD, but since halting PT, and going into a more subdued use, the MPFL has begun to feel better and now is offering better tracking.
I wonder if in my case, after two complete lateral luxations within the period of 1 week I should have been put in cast - or at least a brace - to restrict flexing of the knee. The MPFL seemed to need a period of limited flex to enable it to rebuild. I believe this is evidenced by prolonged fluid build-up (over two-months) which may have been "renewed" by PT-related trauma to the MPFL.
I am pretty cross at all the PT's and OS that would not listen to me. I believe the two-months of therapy I worked hard on was for naugt.
Thoughts?
Posted by bdmrad (bdmrad), 18 April 2004
Hey Bo,
I had dislocated innumerable times and never did any rehab. My body just took care of itself. Once the effusion subsided, I could resume normal activities - until my last episode last February. I've probably never had much of a MPFL. One of the anatomical studie I read showed that this structure can be anywhere from 3 millimeters to 3 centimeters thick. I think that people with patella alta have a particularly thin MPFL; therefore, they have the anatomical predisposition to sublux (increased Q angle, trochlear dysplasia,etc) as well as a deficient tether.
I think that if I had had my typical dislocation, I would not have needed surgery; however, that time last Feb was a prolonged and more violent dislocation due to the circmstances. I had an osteochondral fracture and bone bruise of my lateral femur. My OS thinks that the slight change in my femoral configuration is what tipped me over and completely destabilized my patella.
I really had no choice but to have some surgery since I had gotten to the point where I had to wear the Breg PTO just to walk around the house. But the surgery is no picnic. I had been more functional pre-op with the brace than I currently am, but I am optimistic that I will get back to baseline eventually. I am figuring on at least 18 months to two years before I feel "normal."
I think you would be wise to avoid any surgery especially the LR. Work on your VMO and avoid things that cause you to dislocate. I found that activities that put my knee into full extension with twisting caused dislocations. As long as I kept my knee flexed I could do any crazy snowsports I wanted. I was able to snowboard this winter, 4 1/2 months post-op.
Posted by Helena (Helena KTF), 18 April 2004
on 04/18/04 at 01:14:18, boputnam wrote:Hey, bdmrad...
Long time, no chat. I'm anxious to know how you're progressing.
In the interim since we "talked" and you were so helpful, I've elected to do nothing. And, it has made me question something I'd like your thoughts on: IMO, I do not think immediately PT after a lateral luxation is indicated. The damage to the MPFL was the area of most acute pain for me, and was hair-raising painful during PT.
The MPFL is not a muscle, so PT cannot be helping much, if at all. PT does rebuild the atrophied quad, but does nothing for the ligament. I believe PT actually delays the healing of the MPFL. This is only my opinion and I am not an MD, but since halting PT, and going into a more subdued use, the MPFL has begun to feel better and now is offering better tracking.
I wonder if in my case, after two complete lateral luxations within the period of 1 week I should have been put in cast - or at least a brace - to restrict flexing of the knee. The MPFL seemed to need a period of limited flex to enable it to rebuild. I believe this is evidenced by prolonged fluid build-up (over two-months) which may have been "renewed" by PT-related trauma to the MPFL.
I am pretty cross at all the PT's and OS that would not listen to me. I believe the two-months of therapy I worked hard on was for naugt.
Thoughts? |
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After a luxation (or dislocation) the leg should be in an immobilizer (pref. cast) 3-4 weeks to let the ligaments heal. Isometric exercises are allowed (such as SLR). If you don't give the surrounding ligaments the time to heal, you'll probably have future problems and have recurrent dislocations. This not only with the kneecap, but with every joint. A dislocation is always likely to happen again (if not treated well or if congenital).
I am not an MD but work in the medical field and have had recurrent dislocations myself, which are congenital AND not treated properly by my previous OS.
Take care!
Posted by bdmrad (bdmrad), 18 April 2004
Helena KTF may be correct. That would be the conservative course but I would not fret too much if you were not immobilized. The MFPL is not weight bearing and is only under tension in end extension. As I have noted before, I was allowed full weightbearing day one post op MPFL reconstruction because its function is fairly passive. I know that some surgeons put people in a cast after that operation. It just goes to show that there are few absolutes in medicine. If you look long enough you can find an authoritative opinion that will validate your own about just about anything.
Posted by boputnam (boputnam), 19 April 2004
Hey, Helena and bdmrad...
Thanks, to both for the insight.
I concur. I hope that what "damage" might have been done by premature PT, will rectify itself in patience. I was obvious to me the MPFL was not benefitting from the PT, while the quad and calf were - however, as I predicted/knew, the strengthening of the latter worsen my patella tracking. Nasty business, this...
I wish we could get the awareness out that treatment of muscles and ligaments is not alike. There is a rush to PT to sustain/recover mobility - but ligament tears should be treated more like a hair-line fracture, for lack of a better analogy.
bdmrad - you're 100% correct on the risk being increased at/near full extension. My research confirms that risk is greatest at 0 to 15% flexion - in that range the patella can slip out of the trochear groove, laterally. Biomechanically, this is the shortest distance between the femur and tibia. Obvious, but ouch. In the late 1800's this condition was called "ball room dancing knee" - for that exact reason. Semi-straight positions, while rotating are the worst.
But, I feel we've not done much for newbie "sneal7171" who revitalized this Thread. Feeling like Dorothy - "does anyone have anything to bring her better hopes?"
bo.
Updated Fri Jan 9 2009
