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Author Topic: Patellar redislocation worries.  (Read 4016 times)

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Offline Daniel4

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Patellar redislocation worries.
« on: April 29, 2012, 02:22:50 PM »
Last monday i dislocated my patella. I twisted my knee badly. It relocated itself as i stepped back in shock. I had little pain and could walk on it thereafter. I went to ER, got an xray( no tendon/ligament damage) and am now in an immobilising bandage. I have to visit a specialist next friday. The paramedics however asked if this was the first time it occured, and also told me it could happen again in the future.  I am a college student and i am incredibly worried that it may happen at a terrible time such as a lab session or in a club. Does anyone know the chances and how to avoid it happening in the future? I heard that leg workouts on the quad help significantly aswell as PT

Offline colleenery

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Re: Patellar redislocation worries.
« Reply #1 on: April 30, 2012, 08:10:31 PM »
Hi Daniel,

Sorry to hear you had a dislocation, I had one in December and they are no fun. I don't have statistics for you, but yes you are much more likely to have a dislocation once you've already had one.  From the boards I have read on this site it seems people have had to suffer with many repeat dislocations and some seem to have characteristics that lead to this like Q angle knees. But my story is like yours, I had a minor dislocation of the patella in high school, then eleven years later (this past december) I had a more serious dislocation.

I would encourage you not to worry, not just yet at least. While you are wearing the brace your knee is stable. Once you are able to talk to the specialist he/she will be able to look at your knees and talk to you specifically about your situation. The specialist will also likely refer you to physical therapy, and the PT person can show you exercises you can do to strengthen your knee and avoid a repeat situation.

I hope you heal quickly!

-Colleen

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #2 on: May 04, 2012, 11:33:18 AM »
Hey,

thanks for the reply
Went to the specialist. Took off my bandage(same as cast but lighter). Patella he said was pretty stable and very similar to my uninjured one. He told me that i could walk out unaided and i did, so that was cool. Wearing a brace now for 2 weeks with some light excercises, then have to go through PT.

Daniel

Offline aaa

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Re: Patellar redislocation worries.
« Reply #3 on: May 04, 2012, 12:31:50 PM »
Stick with the rehab, you'll need to get the entire leg strong again, not just the quads.  The hip strength is key, it helps keep the leg stable so the femur doesn't rotate under the kneecap, basically it will help with keeping the kneecap more stable.

I'm kind of surprised the paramedic told you it could happen again right after you got injured.  Ok, it is true, but still.  I think the worst thing someone could do after an injury is walk up to you and say 'it could happen again' ...
They should be giving you some confidence that rehabilitation and strengthening can prevent future incidents.

You want to give rehab a consistent effort initially, but don't over do it.  It may take some months to get strong again, and keep hope that it will be fine.

Do you have to do a lot of walking around now, as your in school?  That might be something to talk about with your PT or Doctor about how much movement is safe early on while your knee is healing. 

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #4 on: May 04, 2012, 03:53:24 PM »
PT said to walk but take it easy and slowly.As with heavier steps sometimes I sense the knee trying to give way or stop the step.
I have a question regarding the brace, when I am standing it is perfectly comfortable but when I sit or lie down for a while my knee starts getting very painful. Is this normal?

Offline allyd

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Re: Patellar redislocation worries.
« Reply #5 on: May 04, 2012, 04:45:36 PM »
In regards to if it will happen again… there is not a crystal ball for these things. It’s possible, but not definite – realistically, they won’t (and shouldn't) label it ‘chronic’ until it DOES happens again. Generally it’s said most patients will respond w/ conservative treatment (PT, RICE, Bracing, etc). Keep in mind these boards are not filled with ‘most’ people. You are doing all the right things it sounds like. So, do your rehab and just give it time… you’ll be back on your feet soon enough hopefully.

As for the brace… I have a collection at home, and can’t stand a single one of them. Generally, the only time after injury I’d wear them is if I was up and moving – so if you are just sitting or lying around and that’s when it bothers you, possibly take it off? I wouldn’t think you’d risk anything by not having it on then. Every doctor, patient, PT, etc seems to have a different opinion on bracing, and what works or is necessary. First and foremost, follow the advice of your PT and/or Doctor.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #6 on: May 05, 2012, 11:29:33 PM »
Fell today but no damage done to knee thanks to the brace. Keeping up with excercises and finding walking more comfortable, although i am still finding it hard to put full weight on the leg in anticipation. Knee can bend well enough to a sitting position right now, but i try not to overdo it.

As for the above post, i believe the irish medical system has the worst bedside manner. Paramedics first question was "is this the first time as its usually serious the first time".

Offline lululocket

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Re: Patellar redislocation worries.
« Reply #7 on: May 06, 2012, 03:23:57 PM »
Hey Daniel,

First of all, so sorry to hear this has happened - I've been through it a few times and it really is horrible. In fact, it's difficult for other people to understand just how bad, but rest assured that you have similar people here.

There are two kinds of people who dislocate or have sublaxations - first there are those with abnormal anatomy (i.e. knee is the wrong shape in some way). Before my treatments, if you hit my leg with medium force, you could dislocate the kneecap, even though on a normal person that kind of impact wouldn't be a problem. In that way, the first dislocation uncovered that I had a problem, and in general I was more likely than a normal person to dislocate. The dislocation itself didn't cause the problem though, my knee was already the wrong shape.

The second kind of people who dislocate have normal knee anatomy, but get something hit really hard. That can do some damage, stretching out or snapping a ligament, or loosening some muscles as the kneecap goes into the wrong place. Because everything gets loosened up/torn, they sometimes can end up 'more likely to dislocate again' as your fine medical staff put it.
Here's a little explanation http://www.kneeguru.co.uk/KNEEnotes/node/1798

If a specialist has seen your knee and says it is 'pretty stable', you probably don't have any weird shapes in your knee, it's probably normal anatomy, and just a lot of force that caused the dislocation. However, there are a lot of things that combine to make a knee abnormal enough to dislocate frequently, so there's not just one test for it.

It's great that there is no ligament damage! If you really do have normal anatomy, and you didn't bust any ligaments, then you can work on strengthening certain muscles to make the knee more stable, and dramatically reduce the chance of it ever happening again. Normal anatomy means that although if you do no work the weak muscles make you susceptible to dislocation, if you get them back up to strength then only a big force will be able to dislocate your knee, not a medium force. If you have bones in the wrong place like me, then no matter how strong you make your muscles, you still end up susceptible to dislocation, so it's an important distinction.

So, to strengthening - Did you dislocate laterally (the kneecap went away from the midline of the body) or medially (kneecap went towards the midline of the body)? Most people go laterally, because your four 'quad' muscles are arranged so that one pulls medially (inwards) and three pull laterally, so it's easy to break the one than the three, and end up going laterally. In that case, the muscle you need to strengthen is your VMO - http://www.kneeguru.co.uk/KNEEnotes/vastus-medialis-obliquus.

Your physiotherapist will give you appropriate exercises, but really you need to understand your own knee, so that you know if it's ever getting weak in the future, and then you can take action to strengthen it and have a good chance of never having this problem again.

Short term - get the swelling down, get weaned of the brace with your physio's help, try and build up strength slowly and avoid twisting type activities until you're confident of good muscle strength again, which may take a few months.

Best of luck, and let us know of any more questions,
Lulu

2003 RK dislocation
multiple sublaxations (10+), both knees
2007 LK dislocation
03/2010 TTT on RK
03/2012 TTT on LK

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #8 on: May 12, 2012, 01:50:22 AM »
Hey.


Just one or two questions.

I can walk with only one crutch now but sometimes when i put too much weight on the leg i get a sharp pain up the back of my thigh/knee to the rightof the leg(dislocated my left kneecap),should this be a worry?

I notice that the "Lateral J" brace kinda seems to hold my patella up. The padded "J" shape lies slightly under the patella, am i wearing it correctly?(the physio put it on for me)

My OS said i would only need it for 2 weeks. Yet i think i will need more time with it...i feel i should be weaned off it rather than having it taken away in one day?

Finally, i see you can buy these braces privately online or in medical stores, lets say when im back in college would i be able to use one i bought privately during the day so i wont dislocate, say during a lab session or during excercise?

Thanks in adavance and for the replies,
Daniel


Offline aaa

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Re: Patellar redislocation worries.
« Reply #9 on: May 12, 2012, 03:06:13 AM »
Hi Daniel,

Just some terminology so I don't confuse things - as this is your left knee / kneecap - lateral would mean to the left away from your body, medial would mean towards the right hand.

I'm not really understanding where the pain is happening, but if it is near the border of the medial side of the kneecap, than I would think that is normal.  You might also get a bit of pain at the top of the patella on the lateral side, or even under the lateral side of the kneecap generally.

There are several stabilizing ligaments on the medial (and lateral) sides of the kneecap.   Usually, the kneecap tracks outwards, and almost always in a dislocation it is in the lateral direction.  That is why the medial ligaments are important to keep the kneecap stable.

With a full dislocation, typically there is some damage to the medial structures, and as they are healing there will be some associated pain.  The goal is to allow the structures to heal and also build up strength so the kneecap will be stable again.

You definitely want to be careful not to strain things too much, and avoid the kneecap from tracking laterally.  It might feel a bit unstable as you heal for the initial weeks, but the goal is for maltracking to settle down after a round or two of PT and once the swelling subsides.  In many cases, PT and also rest is enough.

I never liked knee braces.  I understand what you mean about the J brace lifting up the patella.  I always hated those braces because they seemed to push my kneecap up and strain my patella tendon.  I would say ask your PT about possibility of taping the kneecap instead of a brace, McConnell taping sometimes provides relief. 

One problem with McConnell taping is it can irritate the skin after a while.  I tried several braces, but they didn't work like the taping did.  The closest I could get was simply using a tensor like wrap and just wrapping it going towards the medial direction tight enough to keep the kneecap more medially.  It also allowed me to bend the knee a bit more freely.

Best of luck.


Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #10 on: May 14, 2012, 01:55:23 AM »
Thank you for all the replies.

Having less pain now, and yes it dislocated lateral and the pain was medial.
I am still terrified of walking without the brace however as i do walk with a limp at times. And when i put weight on the leg when the leg straightens, it feels like "over-straightens" and i get sharp feeling of knee giving way...would this lead to a dislocation without the brace?

How permanent a measure is bracing/taping typically? I mean, after the PT clinic takes the brace away can i use my own or my own tape, or should i be confidient that i am strong enough?

My PT is aiming to strengthen my hips,glutes and my quads(Especially VMO) and has suggested that after i get strong enough during PT that i continue work outs myself at the unviersity gym.

Thanks in advance again
« Last Edit: May 14, 2012, 01:57:17 PM by Daniel4 »

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #11 on: May 18, 2012, 01:43:58 PM »
Specialist wants me to lose the patella support but i dont want to yet. I have it off when i am not walking but i am afraid to move/bend the knee while it is off. its been roughly 4 weeks since the dislocation. Will it be ok to bend it without the stabilzer?
« Last Edit: May 18, 2012, 02:15:52 PM by Daniel4 »

Offline aaa

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Re: Patellar redislocation worries.
« Reply #12 on: May 18, 2012, 02:59:42 PM »
Hi Daniel,

Its a difficult situation to be in ... I've been there.

My advice - you want to be careful in and around the kneecap, avoid it giving way.

If you are walking without the brace and getting sharp pains / giving way, I might not be quite ready yet, but I think you'll get there.  Be clear with your PT about how things are feeling, and describe to them exactly whats going on when you walk.

I would get into a pool and try to walk there (but be careful actually getting in to the pool!! :) ), focusing on even exageratting the heel strike and follow through the balls of your feet.  When walking in the pool you can also hold a floatation device out in front of you to keep your balance (like a noodle or kickboard).  The pool is also a great place to work ROM and do a bit of hip work.

Establishing gait can be tough, it will take a bit of time.  Bracing / taping would hopefully be a short-term measure, typically it is short-term. 

« Last Edit: May 18, 2012, 03:01:35 PM by yb »

Offline Daniel4

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Re: Patellar redislocation worries.
« Reply #13 on: May 18, 2012, 11:48:59 PM »
thanks yb.

PT has finally been arranged 2 weeks late...my knee is out of the brace while sit etc, and im doing the excercises and walking quite a bit(with the brace). PT course is scheduled to  be 6-8 with a follow-up to see if i respond or if a surgical method is necessary(PT will do for this case though as they told me that surgery is only used in chronic conditions of severe sublaxation on daily basis).

The brace is mostly physiocological at this stage as without it i am afraid to move/bend my knee. Although i did walk a 15 minute walk without it in the hospital today. The main issue is I am too unsure to put a large bend in the knee without the brace, although the doctor has told me that normal bending without twisting force should be ok.

PT is aiming to get the brace off as soon as possible(which will be a good thing) and to give me gait training to wak without the crutch.


Offline aaa

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Re: Patellar redislocation worries.
« Reply #14 on: May 19, 2012, 03:00:34 PM »
Hi Daniel,

Bending the knee, in theory, should be safer since as the knee is bending the kneecap comes to rely more on the femoral groove which the kneecap glides within, to provide stability. 

From about 0 - 30 degrees, e.g. doing a mini-squat, the ligaments (such as MPFL) play more of a role in stabilizing the kneecap.

I don't think you should worry to much about using the knee with it bent more, but let pain be your guide as well.  There is 'good' pain and 'bad' pain.  Good pain is like the pain after a workout, the muscles are sore.  Bad pain is that feeling like something is being over-strained or pulled apart, or feeling of a lot of pressure under the lateral part of the kneecap, this should be avoided.

You may get way they call a 'movie sign' , sitting in a chair for a long time might cause you a bit of irritation under the kneecap.  This is usually normal at least for the first little while.  It should subside over time.   Its best to stretch out a little and also ice / elevate the leg if you need to, to manage the pain/inflammation.

I think the best way to build up confidence in the knee is trying to do movements in the pool.  Start in the deep end, and then progress to the shallow end.  Then try on land.

One thing about the pool is when a lot of other people are around its harder to balance because the movement of the water can really throw you off, and its a different sensation all together in the water.  It takes a bit of getting used to.  I liked to use a floatation device to help balance.