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Author Topic: First patella dislocation (traumatic), have a few questions...  (Read 9052 times)

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Offline Katiekorn

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Hi everyone, this is my first time posting after a month of reading many of the topics on here.

My story:

I'm 24, female, and have never had any knee problems. About 6 weeks ago, I was roller blading and wasnt able to stop while going fairly fast (I was going downhill). I tried to grab a pole to slow me down, but it turned out to be made of fiberglass and just shattered into pieces. So I crouched down and prepared to crash lower to the ground. The lower part of my left leg went left, while the rest of me went straight with all the momentum behind it. I felft the twist, the point of where it would not twist anymore, and then my patella went laterally. I ended up landing on my other knee (which is fine) and while laying on the ground, pulling as hard as I could, pulled my patella back into its groove (I didn't know straightening the left would achieve the same goal, but after reading the many posts here, now know)

I could walk after about 5 minutes of sitting there and cursing, but went home and iced it. By that night, my leg felt like it was going out with each step, and was so swollen I couldn't even see my knee cap. So I went to the Dr. the next day, which referred me to the OS. They took about 2 or 3 different x-rays.† OS said that there was no fracture, but he wasnít able to manipulate my leg as I was too tense because of the pain and swelling. So he gave me a brace locked in extension and told me to come back in 5 days,† that I could put weight on it as tolerated, and to take those days off of work. He also told me to tense up the muscles a couple times a day to avoid the atrophying.

5 days later I went back in and he took different x-rays of both knees, confirmed there werenít and bone chips visible, and also said that anatomy was good (no shallow groves, etc) and told me to keep the brace on for 4 weeks and to start PT after that, and that I could return to work as tolerated, and to do straight leg raises and hold as many times a day as I could. At 4 weeks I went back for my appointment. Knee still swollen, but kneecap is actually visible on the lateral side, the medial side is still just a ball. He said to start bending it at home and I didnít have to wear the brace at home. But to wear it at work (he unlocked it for complete flexion though). PT appointment made for 1 week later.

So fast forward to now:

I had my first PT appointment 3 days ago, at which time she compared it to the right one, showed me how to do exercises to strengthen it, and things to help me get more flexion, as right now it is veeeery stiff.

So I did my exercises and ROM, and this morning when I woke up itís visibly more swollen, warm to the touch, and painful.
So my questions are:

1.   Do I continue to do the exercises and work through it, or do† I ice and elevate and wait for the swelling to subside (which is what I have been doing) enough to where it isnít so uncomfortable?

2.   Is it normal for it to still be so swolllen almost 6 weeks after initial injury?

3.   Where does the pain and swelling stem from on the medial side? Is it just from the ligament being stretched and tissues being torn that aggravates it? I would think the lateral side would hurt more, but it doesnít.

4.   Is there anything I can do to speed up my recovery time?

I am a veterinary technician, so am on my feet all day, lifting dogs, and I am limited right now on the many things I canít do. I think work is starting to become impatient, and I donít/canít afford to lose my job.

I appreciate any responses in advance, and sorry this post is so long.

~Katie
† † † † †


















Offline shelly86

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Re: First patella dislocation (traumatic), have a few questions...
« Reply #1 on: May 09, 2011, 10:03:31 AM »
Hi, Sorry to hear about your patella dislocation, it is the worst pain ever  :( . I am a 25 year old female and have patella dislocations on both knees since i was 11.  You will find a lot of useful information on here regarding patella dislocations but one thing to remember is everyones recovery from them is different.

THe knee always seems to be worse after physio but just keep trying to do the exercise as you dont want your knee to not being able to bend at all (i dislocated mine again in August 10 and still cannot bend it - im waiting on surgery). When you are relaxing, then keep it elevated and put ice on it, the swelling will go down in time.

My knee is still swollen and I done mine 8 months ago. As for the swelling on the medial side, im not entirely sure why the swelling and pain seems to be here but I think it could be due to the stretching of all the muscles.

Keep up with the physio and exercises at home which will make recovery alot quicker.

Michelle.

Offline Lottiefox

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Re: First patella dislocation (traumatic), have a few questions...
« Reply #2 on: May 09, 2011, 05:03:42 PM »
Hi there

I don't have any first hand experience of patella dislocations, although mine are worn out through years of maltracking.

What is your current ROM? You say its stiff, how far can you manage to bend it? Do you have full extension? I know they've done X-rays but has your OS checked for any ligament damage? The patella is tethered by various structures and the medial patella femoral ligament MPFL takes a big stretch when you have a traumatic dislocation, especially at speed downhill! I would imagine your doc has checked this for any ruptures or tears, but if it has been damaged then that can contribute to the swelling on the medial side. The lateral side probably took less damage as thats where the kneecap ended up, whereas the medial side got all the stretching force. As I say I'm no expert though!

I think PT often makes things worse afterwards - but so long as the knee settles down then you need to keep doing the exercises to prevent the muscles weakening and to help your ROM. Ice and elevate afterwards, with the knee higher than the heart if possible. Are you taking any anti-inflams to help the swelling reduce? What kind of exercises are PT getting you to do? Do they hurt at the time? Taking a painkiller prior to PT can help you relax and do a bit more at the time.

Patella dislocations are a big thing, although people often imagine them to be simple and for you to back to 100% rapidly. You sound focused and with the right PT and determination you should heal well, but it can be a slow and frustrating process. I'd see how things go over the next couple of weeks, and perhaps keep a record of how you're doing as days blend into one after a while and a coherent diary really helps your OS if you don't make the progress you want to.

Good luck

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Katiekorn

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Re: First patella dislocation (traumatic), have a few questions...
« Reply #3 on: May 10, 2011, 02:06:30 AM »
Lottie,

My current ROM, with me lying on my back and bringing my leg to my butt, itís 65. But there is a bicycle at my gym and while relaxing I can get to what I think is 90 (I can get quite a few revolutions in and Iím not on the tips of my toes either)

I donít think I have 100% extension, because the straight leg raises I do have a lag, and with the quad sets I canít get my heel off the ground as I can with the ďgood leg.Ē But I donít know if my VMO is currently awake.

My OS manipulated my leg a couple different ways, said he was pretty sure my ACL was intact, and didnít think I had any ligament damage. He said the swelling was probably blood from tissues being torn on the medial side.

Iíve been taking advil (about 400-600mg) twice a day, but I sometimes have to decrease it to once daily or less more often, as it starts to upset my stomach even after eating.

PT gave me quad sets, SLRís after, Heel slides while lying on the ground, and then to try them without the sheet. Another is to lift my heel to my butt, while standing, and hold.  Also with the knee bent while sitting on a chair to dig my heel into the ground back towards me to strengthen my hamstrings. Each exercise is supposed to be held for 10 seconds, and repeated 10 times, twice daily. And she said while Iím on the bicycle to try making the revolutions with just my left leg (the bad one). With the ROM exercises, it can be a little painful, but more so is a feeling of pressure. Quad sets are definitely painful (again on the medial side) and the SLRís even more so, but itís not intolerable (unless itís really swollen). 

Yes, it has been frustrating, and I really feel for everyone here that have so many ongoing knee problems, as I donít think I would ever be stoic or patient enough to handle them as so many here have. Thanks for your encouragement, I really appreciate your input, and will start with the diary, I didnít even think about doing something like that. : )

Michelle,

Yes, very painful. The only thing Iíve experienced that was worse than that was when I burned myself with boiling water in 4th grade. Everything else (broken big toe, fractured index finger, and broken collar bone) havenít been as painful, although still did hurt.

Well Iím glad I asked about the physio then, because otherwise I would probably just keep icing it, lol. 8 months of dealing with swelling and no flexion, seems so intolerable. What surgery are you having, and when? I condone you on your patience, and hope all goes well with your surgery.
















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