The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: ash123 on May 23, 2012, 09:32:26 PM

Title: Dislocated my patella 4 weeks ago
Post by: ash123 on May 23, 2012, 09:32:26 PM
Hi everyone, I'm new to this forum so I just thought I'd say hello. Been searching this forum since my injury for questions and answers regarding my knee.

Basically, I dislocated my right patella 4 weeks ago while playing football, my foot was planted on the floor and I swung around for a volly. I had it put back into place by the paramedics about 30mins after it happened. I arrived at the A&E and went for an X-Ray then had my knee braced up and off I went on crutches home. Had a rough few days with muscle contractions and my quad tensing up, but after atleast 4 days its okay. I've dislocated my left patella before about 3 years ago and never went though all this!

So I went back for a check up and was asked to perform a straight leg raise, I couldn't so the doctor said he thinks I have ruptured my tendons and it's stopping me from lifting my leg up. Bearing in mind that my knee is still really swollen. I was sent for an ultrasound to see if the tendons have been ruptured and if my ligaments were okay, I found out that everything was okay. The doctor then said he thinks that I've fractured my patella.

I can now straighten and extend my knee with ease, I have no pain or tenderness when I touch my patella or surrounding area. I'm due to go for my check up on the 29th of May. I'm just looking to see if anyone has been in this situation because I really don't want to have an operation due to past experiences. Advice and feedback is much appreciated as it's worrying me and is slightly annoying. I've missed out on many lessons which could potentially affect my A-Level grades as I was told not to go to school and to just rest it.

My questions are:
1. I can now raise my leg with a slight bend in off the bed up and down, is this still classed as a straight leg raise?
2. I can bear weight on my leg, but hobble on it if i try to walk, however I find it easier walking in the brace. Is this a sign of a fracture?
3. The X-Ray I Had a few hours of the incident, wouldn't it have shown up on picture if my patella was fractured?
4. Wouldn't a fracture hurt all the time if I moved or touched the area? It doesn't, but I'm just wondering

Thanks alot for reading, I just want some reassurance because my doctor didn't really tell me what was going on and didn't let me ask the question as he rushed me off quickly
Title: Re: Dislocated my patella 4 weeks ago
Post by: lululocket on May 23, 2012, 11:18:01 PM
Hmm, I'm not sure on a lot of these, especially the fracture as I don't know much about it. Dislocations are really horrible. I don't know if you'll need an operation, but I wouldn't worry about it now, and lots of problems are ruled out since your tendons are all fine. Just focus on getting the swelling down and learning about what is making walking difficult if your ligaments are fine.

The good news is that 29th May is quite soon, so you don't have long to wait. You should write down questions to take to your doctor so they can't rush you so much that you forget one.

On question 1, I'm sorry, but if your leg isn't straight, it's not a straight leg raise (SLR)  :( That's okay though, not doing an SLR isn't a major problem right this instant. You just need to know where you are in terms of recovery, and the answer is almost but not quite an SLR.
Question 2, hobbling could be due to muscle weakness or swelling stopping your full range of motion, by itself it doesn't mean that you have a fracture.
Q3, I don't know
Q4, my doctor always says that what he knows about knee pain is that we know almost nothing about knee pain. People have wildly different experiences with the same problems, and the amount of pain you feel is not much help in diagnosing a fracture. So just be glad I guess!

How is your range of motion? How much can you bend it compared to the other leg? And what about extension (you may not have realised that legs actually go a bit backwards, but if you try to do the exercise here, does your heel lift off the bed as much as on your good leg

How much swelling do you have, and how are your muscles holding up? Did your leg get much smaller as the muscles wasted away? Swelling and muscle weakness will contribute to the limping, definitely. I've limped plenty of times after dislocations as my muscles got weak after not being used, but I never had a fracture.

If you have any of your medical notes, you can type them up hear and people may be able to help. What kind of doctor did you see? Was it your GP, someone in A&E, a surgeon, an knee specialist?
Title: Re: Dislocated my patella 4 weeks ago
Post by: ash123 on May 23, 2012, 11:43:59 PM
Thanks for the reply! I've been sticking to the R-I-C-E recovery and after I began to elevate my leg the swelling has begun to go down loads.

I can't lift my leg off the bed when it's straight, but I can straighten it out in the air then go down and up, would that be a straight leg raise?
I haven't been using my quads for a few weeks because I've kept the brace on and my quad seemed to have 'shut down'. It's pretty skinny and flabby compared to my other leg. Since the swelling has begun to go down my motion in my leg has become easier to bend and move about.

About question three, doesn't an X-Ray show bones not fluid so I would be correct to say that it should have shown up on the pictures (Not saying I'm correct, it just seems that it should)

I can bend my leg at a 90degree angle before it gets tight. I've done the exercise and my heel just about comes off the bed whereas my other heel on my left leg comes completely off the bed. My knee is still pretty swollen, it's like I have a budge on the top of my knee when it's straight. My leg has got very small in contrast with my left leg, most of the muscle I believe has turned to fat? It just seems really flabby.

I saw the Orthapaedic doctor on the NHS.
Title: Re: Dislocated my patella 4 weeks ago
Post by: allyd on May 23, 2012, 11:58:49 PM
I'm also not sure about the fracture either. But would simply think it would have shown on xray? As lululocket says, if there's a bend, it's not a SLR. But your capability to do this has nothing to do with whether you need an operation or not. It simply means your quad muscles have shut down or weakened some, which with the trauma and swelling of the dislocation, is not that suprising. They'll come back (as you can already see, your SLR's have improved since your first attempt)

Its sort of a wait and see approach. Don't over-react, but don't under-react either. Your doctor will likely treat conservatively, which is normal and what you should expect with a first time dislocation. Treatment focus will likely be simply strengthening your knee/hips/core - You may want to ask for a referal to a PT/Physio from your doctor when you see him next week?

For what its worth: I dislocated my left kneecap multiple times when I was a teenager. I'm 29 now, I've never had surgery on it, or even let a doctor take a serious look at it. My right knee on the other hand... sometimes things just get to unstable. I'm a walking example of both extremes of this injury. :)  
Title: Re: Dislocated my patella 4 weeks ago
Post by: ash123 on May 24, 2012, 12:08:26 AM
I wasn't told that I had any fracture when I had my X-Rays taken they just said my patella had gone back in as it should.

If I ask to move on to Physiotherapy what if I actually have fractured it. If you did fracture a patella surely you wouldn't be able to bend it as it would cause loads of stress on the joint. It's just bugging me that I have to wait, when I dislocated my left knee I didn't wait coming up 5 weeks to start physio as I am doing with my right.

I am 16 coming up 17 in July, I dislocated my left knee when I was 14 and that was far more painful than when I did it this time. I daren't actually put that much weight on my knee when walking because I think it might redislocate.

It's just very frustrating, Thanks for the reply though
Title: Re: Dislocated my patella 4 weeks ago
Post by: allyd on May 24, 2012, 01:07:23 AM
When my Mom fractured her patella a few years back - she was still able to bend it and do all kinds of non-weightbearing stuff. Her OS just wanted her braced up when walking, etc to as you say reduce the stress on the joint. Hers was evident on an xray though and they just kept xraying it every few weeks until it was gone. But defnitely not my area of knee expertise...  :) I'd guess this is why your OS is holding you back if he suspects a fracture?

I guess my suggestion of Physio was in the event there's not a fracture. Your concerns are all good questions to write down and ask your doctor.
Title: Re: Dislocated my patella 4 weeks ago
Post by: ash123 on May 24, 2012, 01:14:02 AM
That's reassuring, I just don't like waiting as I'd rather know now instead of searching all over the web about it. I hope I haven't fractured it I really hope I haven't!

If anyone else has fractured their patella before symptoms would be appreciated and the length of recovery.
Title: Re: Dislocated my patella 4 weeks ago
Post by: ash123 on May 25, 2012, 12:15:00 AM
Sorry for asking again, are you able to bend your knee painfree if the patella is fractured?
Title: Re: Dislocated my patella 4 weeks ago
Post by: lululocket on May 25, 2012, 11:51:34 AM
Hey ash,

We'd love to reassure you. The problem is, there is no way that we could tell you it's definitely not fractured! The person who has the most information is your doctor, who says it might be. Not that it is, so please don't get stressed out about it, just that it might be.

You're right, an xray would normally be the way to check for a fracture, but after a dislocation you can have bone bruising where the bone would have energy lines through it, which might disguise a fracture. Or the xray may have been poor quality (out of focus and therefore fuzzy), meaning a fracture line wouldn't come out cleanly enough to really see it.

Also, as others say, sometimes people can have fractures and not so much pain. And, you may well still be able to bend your knee pain free after a fracture, especially if it was a little hairline fracture that didn't even show up on an xray very well. So at the moment, we just don't know. That's okay! You're seeing the doctor again really soon who will be able to examine it properly and tell you far more in person than anybody here can because we're not looking at your knee.

Also, to reassure you a bit, bear in mind that the muscle loss you've described would cause problems even if there is no fracture. It may be that your knee itself is fine, but the lack of muscles are actually causing all of your current symptoms, including being worried about redislocating, because I bet it feels all weak and wobbly after all that muscle loss. It sounds like you've had no physiotherapy at all - is that right? In which case, even a totally normal undamaged knee braced for a few weeks would end up pretty weak and wobbly, with an unhappy owner! So given your treatment, the symptoms would be normal.

In the short term, I think you should just wait to see your doctor and get more information. Hopefully he'll do another xray if he really thinks that it is fractured. What kind of doctor is he?

If you're frustrated by the four day wait then start doing some quad sets as they are prescribed almost no matter what else is going on. They will be the first baby step back towards getting strong muscles. If your doctor says there is no fracture and no ligament damage then see if you can get referred for physiotherapy like allyd says, and with a bit of time and lots of work on exercises, you should recover really well. Another important question is to ask him why he thinks your knee dislocated in the first place. Understanding this will help you to make sure it doesn't happen again.

Best of luck and post back when you get more news.
Title: Re: Dislocated my patella 4 weeks ago
Post by: ash123 on May 25, 2012, 11:53:27 PM

Would you say it could be a displaced fracture? My knee cap looks normal, but there's still a little swelling. If it was displaced would I be able to bend it etc?

I can now perform a straight leg raise without any pain, although it feels tight on my muscles. I have had no physio for 4 weeks my muscles have certainly shrunk and are very weak, would starting these exercises affect my kneecap if it turns out to be fractured?

Thanks for all the information, it's very reassuring!