How long for a subluxation to heal??? Desperately needing advice!!!

[pumped4life82]

Hello, I'm new to the forum. I subluxed my left knee about 3 weeks ago doing lunges on a bosu ball with a personal trainer at my gym, and after doing tons of icing and taking it easy, I honestly see little to no improvement. I've already seen 3 doctors (and had an ultrasound), and I was told the same thing by alll- that I didn't tear anything, that my patella just partially popped out of place due to my joint laxity (I'm hypermobile), and that all I can do is physio to strengthen the VMO's. Right now my knee is still swollen (not drastically, but enough to notice a difference between my good knee and my bad one), I cannot fully bend or straighten my leg out (off by about 10-15 degrees either way, due to the pain and swelling), and I cannot walk around for more than 15-20 min at a time before my knee starts to throb, causing me to limp badly.

I've already gone to my family doctor twice, and even got a referral for an MRI (he didn't think it was necessary, but I insisted), but it's not scheduled til December. In the meantime, I don't know what to do; the physio exercises I've been given are simple enough, and do seem to help with strengthening the surrounding muscles, but it's not helping with the pain or swelling; actually, if anything, I'd say the patella "bump" (basically, the lower half of my knee) looks even puffier since I started doing these exercises. Even with wearing a generic knee brace, my knee was killing me while I was at the mall today. What seems to hurt the most is if I'm standing upright and unintentionally start "lock out" my leg (causing the back of my knee jut out slightly)...when I do this, the pain is enough to almost make me fall over. But my PT and doctor keep telling me everything I'm experiencing is "normal" and that it just takes a very long time to recover from a subluxation (months, even).

Can anyone please tell me...is what I'm describing typical after a subluxation (when it's the first one, too)? Another reason why I'm so doubtful of what my doctor is telling me is because I literally just finished recovering from shoulder surgery (after 33 dislocations in 7 years), and during those 7 years, I was continuously told the same thing about my shoulder that I'm being told about my knee now (that there was no damage, nothing torn, and nothing that could be fixed outside of physio). I don't want surgery again, but I need to know if what I'm living with right now is normal and will be only temporary, or if I should be seeking a 2nd or even a 3rd opinion. I'm normally an active gym goer, and between my shoulder and my knee, have been on layoff now for 8 months. I just wanna know what I should expect for a realistic timeframe, assuming I didn't actually tear anything. Any help would be greatly appreciated, thanks so much!!!

[crankerchick]

Hi there, sorry to hear about your knee injury, especially on top of already being off from activities due to the shoulder.

I've had a few subluxations like this, where the kneecap went out and my leg buckled. It definitely took a few weeks for my knee to feel normal again. The last time it happened like this I ended up taking I believe 3 or 4 weeks off of sport, and even when I went back, the knee was still sore after for a few more weeks. The major swelling subsided after a few days but the residual, lingering swelling took weeks to go away. My ROM was never affected too badly that I can remember, but I definitely had the pain locking the leg in extension like you describe. It was also painful if the knee was twisted or any kind of torquing motion on it. Not to mention the areas medial and lateral to the patella were sore.

I think everyone is different in terms of healing and pain level so it is really hard to compare. But for a first time subluxation, physical therapy is often the way to go.

That said, I was always told by multiple doctors that it was something to live with and to just keep my leg muscles strong so I can understand where you are coming from. It ended up being the case for me that there really was an explanation for my instability and pain and it just took having the right doctor to diagnose it.

I would say continue on with your strengthening and healing but if you aren't satisfied with the diagnosis, seek more opinions. The treatment course you are on is a good one regardless of if there is something fundamentally wrong in the knee or not, and if there is, time will tell.

[pumped4life82]

Hi there, sorry to hear about your knee injury, especially on top of already being off from activities due to the shoulder.

I've had a few subluxations like this, where the kneecap went out and my leg buckled. It definitely took a few weeks for my knee to feel normal again. The last time it happened like this I ended up taking I believe 3 or 4 weeks off of sport, and even when I went back, the knee was still sore after for a few more weeks. The major swelling subsided after a few days but the residual, lingering swelling took weeks to go away. My ROM was never affected too badly that I can remember, but I definitely had the pain locking the leg in extension like you describe. It was also painful if the knee was twisted or any kind of torquing motion on it. Not to mention the areas medial and lateral to the patella were sore.

I think everyone is different in terms of healing and pain level so it is really hard to compare. But for a first time subluxation, physical therapy is often the way to go.

That said, I was always told by multiple doctors that it was something to live with and to just keep my leg muscles strong so I can understand where you are coming from. It ended up being the case for me that there really was an explanation for my instability and pain and it just took having the right doctor to diagnose it.

I would say continue on with your strengthening and healing but if you aren't satisfied with the diagnosis, seek more opinions. The treatment course you are on is a good one regardless of if there is something fundamentally wrong in the knee or not, and if there is, time will tell.

Hi crankerchick, thanks very much for the reply!

Question, though- in your 2nd last paragraph, you said "It ended up being the case for me that there really was an explanation for my instability and pain and it just took having the right doctor to diagnose it." What was that explanation that was found? I don't think you mentioned it in your response. Was anything torn? Or are you also loose jointed like me?

Also, are you able to run, do squats, or just kneel in general with your knee as it is? And if you are, how long was it before you could do that again after your first subluxation??

[tiahp95]

hey
i've disloacted my knee cap 7 times and i'm 15,
usually it takes around 3-4 weeks for recovery, and my advice is- let it heal completely, usually what happens to me is when its just about healed it dislocates again (mine dislocated when i twist)
i've recently been told that i need surgery, so i'll be on crutches for my year eleven semi formal, so yeah dont keep doing it because it ruins your life..

[crankerchick]

Hi crankerchick, thanks very much for the reply!

Question, though- in your 2nd last paragraph, you said "It ended up being the case for me that there really was an explanation for my instability and pain and it just took having the right doctor to diagnose it." What was that explanation that was found? I don't think you mentioned it in your response. Was anything torn? Or are you also loose jointed like me?

Also, are you able to run, do squats, or just kneel in general with your knee as it is? And if you are, how long was it before you could do that again after your first subluxation??

Generally speaking, if something tears, it is as a result of the dislocation, not the cause. In my case, I have a few structural deformities working against me to contribute to the instability. I have femoral anteversion and tibial torsion which just means my femurs twist inward excessively and the tibias twist outward excessively. It's not really visible to the eye for me as it is with some people, but CT scan shows it to be the case. This creates a joint behind the kneecap that is out of alignment, pulling the patella long for the ride. I also have patella alta which just means my kneecap sits high in the trochlear groove. My kneecaps also have a tilt and my trochlear groove is shallow.

The second surgery in my signature is what I had done to address the excess torsions on the femur and tibia as well as the patella alta. I've only had this done on my left leg, as it has always been the worse of the two.

There are a lot of reasons for why a patella might dislocate recurrently. For someone experiencing repeated dislocations or subluxations or pain due to malalignment, it is very important to find a doctor that looks at all of the reasons for the problem, rather than just treating the symptoms or consequences of the problem. For someone that has dislocated just once, conservative treatment seems to be the best course, especially in someone that has otherwise normal anatomy.

If something tore in the knee, it would mostly likely be the medial patello-femoral ligament. In an otherwise healthy knee, the need to reconstruct that ligament should be investigated only after a solid course of physical therapy has failed. And even still, the tearing of said ligament is generally the result of the dislocations, not the root cause. These are tricky problems.

[crankerchick]

I forgot your second question. Yes I was able to run squat kneel jump all of that after my subluxations. It usually just took a few weeks to feel comfortable and strong enough to resume those activities.

Since my surgery, I can kneel jump and squat, but I'm still working on running.

[The KNEEguru]

tiahp95
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KNEEguru

[pumped4life82]

Generally speaking, if something tears, it is as a result of the dislocation, not the cause. In my case, I have a few structural deformities working against me to contribute to the instability. I have femoral anteversion and tibial torsion which just means my femurs twist inward excessively and the tibias twist outward excessively. It's not really visible to the eye for me as it is with some people, but CT scan shows it to be the case. This creates a joint behind the kneecap that is out of alignment, pulling the patella long for the ride. I also have patella alta which just means my kneecap sits high in the trochlear groove. My kneecaps also have a tilt and my trochlear groove is shallow.

The second surgery in my signature is what I had done to address the excess torsions on the femur and tibia as well as the patella alta. I've only had this done on my left leg, as it has always been the worse of the two.

There are a lot of reasons for why a patella might dislocate recurrently. For someone experiencing repeated dislocations or subluxations or pain due to malalignment, it is very important to find a doctor that looks at all of the reasons for the problem, rather than just treating the symptoms or consequences of the problem. For someone that has dislocated just once, conservative treatment seems to be the best course, especially in someone that has otherwise normal anatomy.

If something tore in the knee, it would mostly likely be the medial patello-femoral ligament. In an otherwise healthy knee, the need to reconstruct that ligament should be investigated only after a solid course of physical therapy has failed. And even still, the tearing of said ligament is generally the result of the dislocations, not the root cause. These are tricky problems.

Hi again, thanks for the info. Well, so far I haven't been diagnosed with anything beyond joint hypermobility, but I also haven't had any extensive testing, either. So far it's only been the one subluxation, but of course, I wanna keep it limited to just that. I've been off work again all of this week, resting my knee and doing my physio exercises, and it's starting to feel better, thankfully. At physio today, my PT commented that my knee cap feels quite a bit more stable than it did last week, and the swelling has gone a lot, too (possibly due to the new anti-inflammatories I was given a few days). He was able to bend my leg fully, and straightening it was only off by a few degrees. However, standing upright, I still can't completely hyperextend and lock out my leg without pain, but he said that should improve after a few more weeks of physio. It's just frustrating though, cuz my knee still starts to ache if I'm walking for more than 20-30 minutes at a time. Basically, I just wanna know if this is normal (being almost 4 weeks since it came out), and if it should improve. But it sounds like it should, based on what you're telling me.

I'm also trying to get a timeline for how long I should expect to be out of the gym because of this, but I know it's too early to predict at this point.

[gerine9903]

I am hypermobile and have suffered from subluxations/dislocations in both of my knees.  My underlying factor is a small patella, hypermobility, loose ligaments, and just about every other reason for malalignment (increased Q angle, foot pronation).  Usually an orthopedist and physical therapist do not do much after the first dislocation.  But you are at increased risk of a recurrent dislocation.  In my experience, I did dislocated afterwards and even in braces my knee would try to but the brace would prevent it.  The MRI probably will not show much.  Loose bodies, cartilage damage.  I'm not sure if it shows the medial patellofemoral ligament or not, but that is concern.  The MPFL must fail for the subluxation.  I just had a MPFL reconstruction in May.  Years ago I had a lateral release for malalignment but it is not holding up well.  The MPFL is supposed to be the method that gives the best results. 

For the conservative route, find out what likely caused the subluxation.  If it is malalignement, they will tell you that strength is the key.  If you ever question the orthopedist, have a heart to heart with the physical therapist and don't be scared of a second opinion.

[crankerchick]

I think here is some confusion over subluxation versus dislocation. Subluxation is when the patella leaves the groove momentarily but goes back on its own. Dislocation is when the patella leaves the groove and stays and must be reset manually. A patella that hangs over the edge of the groove is also often called a subluxed patella.

The MPFL need not fail in the case of a subluxation. It has most likely failed in a dislocation.

The method that gives the best results is the procedure that addresses that individuals root problem(s).

It stands to reason that reconstructing a ligament that was torn as a consequence of a dislocation doesn't necessarily fix the underlying problem but only repairs what was a consequence of the problem.

Flexibility and strengthening should always be a focus, but it won't correct a bony malalignment obviously.

Pumped, i think your recovery from the initial subluxation isn't anything abnormal so far. Everybody recovers at their own pace. If you are going to commit to conservative treatment to start, then you will have to give it more than 4 weeks to have an effect. Your OS and PT are the best ones to help you really feel as if your treatment course is working, but you'll have to see it through to the finish.

Your doctor is the best indicator for how long before you will be allowed to do things, but what exactly in the gym are you trying to get back to? Maybe you aren't going to be deep squatting just yet, but it seems like there should be no reason why you can't strength train and stationary bike (very important!) now. The bike would be the first thing my doctor would have put you on.

[pumped4life82]

Hi, thanks for the replies everyone (been very busy lately, and haven't had much chance to reply back yet).

Anyways, it's been about 5 and a half weeks, and I'm still getting intermittent pain when walking, as well as constant residual swelling (more so when the pain starts up again). Still attending physio twice a week, which has continued to help with strength, but really doesn't seem to be doing anything for the pain and inflammation I still have.

I'm very new to knee injuries, so right now I really have no idea what to believe. My PT has maintained his position that he doesn't believe I've torn anything (and if I did, he thinks it's extremely minor, and nothing that would require surgery). His reason for this is simply because my ROM is near perfect, and my knee doesn't catch or lock up on me when walking. And I'm glad; but that doesn't change the fact that my knee still hurts (often badly enough to make me limp), and the last bit of swelling just won't go away.

I actually find it very bizarre; there are days when my knee actually feels really good. As in, I can walk virtually pain-free (and without the knee brace), and even jog for short distances with little to no discomfort. And then there are days (like today) where as soon as I get up and put any weight on my leg, my knee immediately starts to throb and I have no choice but to limp. At that point, I usually go off work for another few days and just rest my knee, icing it and keeping it elevated. And after a few days, it feels "normal" again.

Anyone who's experienced any ligament and/or cartilage tears or damage, does this sound like a tear or like any kind of internal damage that needs to be scoped? Or is this typical when healing from a subluxation that (let's assume) didn't cause any tears or serious damage, and just stretched/strained the ligaments?

I'm also tempted to go to my doctor for a cortisone shot to help with the swelling; gonna keep my leg up for the next day or two first, and see how it feels after.