The SPECIALIST'S OFFICE => The patello-femoral joint => Topic started by: crystallinegreen on September 13, 2015, 12:31:38 AM

Title: patella dislocation - what to expect and return to work
Post by: crystallinegreen on September 13, 2015, 12:31:38 AM
Hi guys, I'm really glad I found this forum! I would be really grateful for some advice.

I'm 27 years old (female) and dislocated my kneecap for the first time 4 weeks ago whilst on honeymoon in the Caribbean (timing, doh!  :(). I'm not sure exactly what happened - I didn't hit my knee on anything, I was just turning to sit down in a restaurant, felt a 'clunk' in my hip/down my thigh, collapsed in pain and my kneecap was not where it used to be. It was a full lateral dislocation, relocated by medic at local emergency department after about an hour as did not occur spontaneously - not sure if that's relevant to outcome. They took x-rays and said there was no fracture however said that a ligament was completely torn - medic's English was limited but pointing to the inside of my knee, I guess it was MPFL? There was no other imaging besides x-ray however. They suggested a full leg cast but I was concerned this would be an issue for flying home, so I was given a removable splint/brace to wear and told to consult an orthopedic surgeon when back in UK. I was assessed again in A&E when back in UK a few weeks ago - I say assessed - knee wasn't really examined, I was just asked to attempt bending my knee which was proving difficult so told not to bother and return for an appointment at the acute knee clinic - but 'not to expect much'?. X-rays were repeated however and confirmed no fracture. 4 weeks from injury and my appointment at the knee clinic is coming up on Wednesday. I'm feeling a little anxious by now as I've little idea about the injury and no idea what to expect. Having read up a little I think I probably have some predisposing issues, I've always been a little 'knock kneed' and I have some hyperflexible joints, my legs can bow backwards a little when stood for long periods. I work as a mental health nurse in an area with high levels of violence and aggression and need to be able to restrain in order to be deemed fit to return to my post. I'm concerned about this as transferring people who're resistive entails a lot of unpredictable twisting when stood with feet planted, and often requires dropping quite forcefully to the knee. A long period on sick would be particularly problematic right now as husband is facing redundancy.  :-\ Can anybody give me any advice as to what kind of time frame is likely for recovery and what to expect from this? Am I likely to be able to return to my work any time soon? Anybody here return to full activity following dislocation? How have you managed return to work?
Title: Re: patella dislocation - what to expect and return to work
Post by: dsj11 on September 13, 2015, 06:31:09 PM
Hi, welcome!

So sorry to hear about your recent dislocation. Hope you still were able to enjoy your honeymoon!

If you haven't gotten an MRI, I would suggest it. This will allow your doctor to see any anatomical issues, the extent of the MPFL tear, TT-TG distance, condyle damage, loose bodies etc. Most people who dislocate do have predisposing issues as you pointed out (e.g., 85%+ have some degree of trochlear dysplasia).

Dislocations can happen in odd ways, so yours is not out of the ordinary. I have dislocated mine in a number of ways, for example: playing soccer, slowly jogging backwards, even slightly catching my foot on a chair. I've had at least 4 subluxations and 1 full dislocation (similar to you, it came out laterally - mine for about 30 mins). After every event, I was able to return to normal activities gradually over a couple of weeks. However, my activities just involved commuting to a major city and walking a lot. I don't think I engaged in physical activities for at least 6-8 weeks after each event; physical therapy helped me a lot to recover. And yes, I absolutely regained full activity following all of my dislocations. Post-dislocations I was still able to run 5-10 miles on weekends without any pain. Since this is your first dislocation, it's likely that you can just do some physical therapy and wear a patella stabilizer brace for now - but push your doc for concrete suggestions and long-term prognosis.

Lastly, this may sound like a simple suggestion, but take some time to write down your specific questions for your doctor (e.g., your work activities, having to go down on your knee, etc.). I've found it easy to get overwhelmed when I'm not prepared for an appointment and have lots of questions.
Title: Re: patella dislocation - what to expect and return to work
Post by: dsj11 on September 13, 2015, 06:34:33 PM
By the way, I too was very anxious when this all started happening. I think this article provides a good overview of the condition and its treatments:

Title: Re: patella dislocation - what to expect and return to work
Post by: crystallinegreen on September 13, 2015, 09:38:46 PM
Thank you so much for your response! It's reassuring to hear you've returned to running despite your knee troubles. I found the article really helpful, I had no idea until now how very complicated the knee structures are! Certainly helps to have some idea what I'm dealing with. Great advice about making a list of questions for the doc, my mind always draws a blank in these situations, so I'll be sure to do that and ask about MRI and physio as well if not offered.
Title: Re: patella dislocation - what to expect and return to work
Post by: dsj11 on September 15, 2015, 05:23:10 PM
No problem. Let us know how everything goes and when you're able to return to work. Interested to hear about your recovery!
Title: Re: patella dislocation - what to expect and return to work
Post by: kchan808 on September 17, 2015, 08:44:34 PM
I have also dislocated my left knee over 12 times. It has been a year since my surgery I had mpfl and arthroscopic trochleoplasty. Prior to the surgery I was doing activities etc only thing that kept me uncomfortable was ice skating. After each dislocation I would say 2-3 week for the swelling to go away and maybe 1-2 months to get back to normal. I have had a lateral release done which did not help about 11 years ago. I would not have even thought about having the mpfl or trochleoplasty but my most recent dislocation set me back big time. Couldnt run couldn't jump. I knew something was off. MRI showed nothing was torn such as acl etc. But it did show that I had a shallow groove. No orthopedics from the USA mentioned a torn mpfl. Im pretty sure I tore that thing back when I was 10 years old. I would say solutions for dislocating has come a long away from when I got the lateral release done back then. Hope you recover and don't need surgery. I would recommend wearing a compression sleeve on both legs just to keep everything tight. I have tried many braces that claim to prevent the dislocation but it only made it worse. Good luck