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Author Topic: Dislocated Kneecap - 1st Time  (Read 4435 times)

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Offline MacAttack

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Dislocated Kneecap - 1st Time
« on: July 19, 2010, 09:31:33 PM »
Hi.
I'm 37, had ok knees which have been sprained and somewhat loose for years, but no really serious injuries until now.

I dislocated or subluxed my kneecap playing basketball when turning to follow someone down the court.
I had x-rays and MRI.  The dr said I tore the ligaments that hold the kneecap in place, chipped a bone, and did some bruising.
He said he thinks I'll be ok with just physical therapy, so I'm doing that and supposed to check back in 4 weeks.

What's bothering me is that most of the threads I read here seem to say I will not be ok with just physical therapy.
It seems like most who've dislocated have one problem after another and end up having surgery, and then still have problems.

I'm extremely active and hike every weekend, so this is just driving me crazy, and I have to fight off feeling depressed every day.
What are the chances I can just be normal again?  I don't care about basketball; I just want to be able to hike and walk and ride a bike and play golf and wade in a trout stream.
Does anyone out there get close to normal again and have no problems if they are strict with physical therapy?

Offline Silkncardcrafts

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Re: Dislocated Kneecap - 1st Time
« Reply #1 on: July 20, 2010, 11:35:27 AM »
Hi there,

If I was you I would be getting another opinion from a patello-femoral specialist. It just doesn't sound right to me.

I've had patella instability for a long time and the only thing that fixed mine was surgery, but having said that everyone is different.

Good luck !
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline fraud_ninja

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Re: Dislocated Kneecap - 1st Time
« Reply #2 on: July 20, 2010, 01:39:51 PM »
Physical Therapy is almost always the first course of treatment with a first time kneecap dislocation/subluxation.  Did your kneecap come all the way out of place and remain stuck there?  That would be a dislocation.  If it partially came out of place but when back in place on its own, then that is a subluxation. 

Honestly, starting with physical therapy is a good place to begin.  I read somewhere that only 20% or so of people who have a first time dislocation become chronic dislocaters.

Surgery can fix chronic dislocations, but its not without its risks.  Your always better to avoid surgery if you can.  There are lots of people who suffer from a single dislocation, do physical therapy, and then never have another problem with their knees.  Please keep in mind that a message board such as this one is not a good representation of the general population.  People who do not have chronic problems are not likely to be posting on a message board, they are out enjoying their knees.

12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline crankerchick

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Re: Dislocated Kneecap - 1st Time
« Reply #3 on: July 20, 2010, 03:44:18 PM »
Well no one knows the future so its tough to say if this will be the only incident or not. But conservative treatment should always be the first course of action, so work hard at the PT and see where it gets you. If you have any underlying structural problems, then the odds of recurrence are probably higher, but if this was just an isolated case of subluxation/dislocation in an otherwise healthy knee then it certainly makes good sense to pursue PT to strengthen the muscles around the knee and hip and expect a good outcome.

Either way, even with a recurrence, you aren't doomed to a life of instability. If the instability persists, it will be important to find a doctor well-versed in the patello-femoral joint that can get to the root cause of the instability and suggest the best approach to fixing it. The key is finding a qualified patella doc to get to the root cause.

Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline MacAttack

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Re: Dislocated Kneecap - 1st Time
« Reply #4 on: July 20, 2010, 09:40:16 PM »
How do I find a Patello-Femoral specialist?

I've searched google for a doctor or physical therapist that specializes in this area, but I can't find anything.

My kneecap didn't stick out of place, so I guess it was a subluxation.
I have no idea if the dr is good or not.  I actually went to 2 doctors to see if they said the same thing.
They both said go to physical therapy and check back in a few weeks.

The 2nd dr did an MRI, and did an x-ray where I laid down with my knees draped over a board at about a 45 degree angle. 
I already had x-rays from the emergency room, but he said that angle was one they missed.

He mentioned something about my Q-Angle.  He didn't act very worried about it.  Just said "I think you'll be ok with physical therapy".

Offline crankerchick

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Re: Dislocated Kneecap - 1st Time
« Reply #5 on: July 20, 2010, 10:05:51 PM »
Well, you want to at least be dealing with an orthopod that specializes in knees. There aren't "patello-femoral specialists" like, it's printed as such on their fancy business cards. A true patella specialist is probably hard to come by.

At this point, it sounds the like the one that ordered the MRI and "sunrise" view x-ray is more on the right track then the first one.

I still think your best bet is to get some good physio to start and see where that leaves you, but I applaud your desire to educate yourself on the topic and seek out doctors to get opinions from. What state are you in? We might be able to suggest someone near you to see for an opinion.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline MacAttack

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Re: Dislocated Kneecap - 1st Time
« Reply #6 on: July 21, 2010, 01:50:37 AM »
I'm in Beaverton, Oregon (suburb of Portland).

I'm going to physio now twice a week, but while I have that going on
I'd thought I'd try to find out if there was a doctor around here that
was more knowledgeable on kneecap problems.

Also if there is a physical therapist who has some extra knowledge in regards
to kneecap dislocations/subluxations that would be nice to know too.

I have no idea if my dr is good, and I have no idea if my physical therapist is good.

Thanks.

Offline MacAttack

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Re: Dislocated Kneecap - 1st Time
« Reply #7 on: July 21, 2010, 03:41:50 AM »
I had another question:

Is there a way I can tell if the tracking of my kneecap is off, or if there is something functionally wrong with my kneecap which would cause it to dislocate?

I was just standing up flexing my quads, and I notice my kneecap if anything is pulled more to the inside, but mostly straight.  I think I read somewhere that people with kneecap tracking problems can flex their quads and their kneecap will get pulled toward the outside of the leg.


Offline Silkncardcrafts

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Re: Dislocated Kneecap - 1st Time
« Reply #8 on: July 21, 2010, 11:48:40 AM »
As a sports trainer and allied health assistant I would be encouraging you to see an Orthopaedic Surgeon that specialises in patella instability. I particularly don't like the fact that the surgeon has suggested that you have torn the ligaments holding your knee cap together.

They really should be doing scans now rather than waiting to determine the best course of treatment.

Physiotherapy is a good place to start.

Good luck.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline aaa

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Re: Dislocated Kneecap - 1st Time
« Reply #9 on: July 25, 2010, 02:19:00 AM »
hope you will do well with physio.  in many cases, physiotherapy will be sufficient to restore the knee function.

Try to get your quads strong again and don't over think it, of course within the guidelines given by your physiotherapist.

If you come back to your surgeon without giving physiotherapy a good effort, he's likely just to send you back and do more physio ..