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Author Topic: Another knee injury  (Read 1240 times)

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Offline inmodulo

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Another knee injury
« on: February 01, 2004, 06:33:27 PM »
Hi My name is Stuart. I am sitting here with my leg in a lightweight plaster after a fantastic game of rugby. Early november I had a minor tear in my MCL and also a dislocated kneecap (Tackleing people bigger than you is definitely bad for your health). Whilst I had no treatment other than anti inflamitries, an elasticated bandage and a week off work, it was explained to that it was only a minor injury and should fix itself. On saturday ( My 4th game since the newyear) I was again flattened and my knee dislocated again. This time at the A&E I could not have a full set of X-rays done due to my quadracept ( apparantly oversized due to rugby in comparison with the back muscle) pulling my kneecap out and over every time a bent my knee ( during the 3 hours I was there it dislocated about 10 times. I have to go back next week to have the cast removed and the knee re-examined, and I am terrified on what it could be. This was heightened after reading some of the horror stories here. My questions are these: My doctor said best case was the cast would be reaplied and my patella stabiliesed for a further 2 weeks but was very reticent to mention any other options, What are the probable causes? and does anyone know proabable recovery times?

Thanks in anticipation
Stuart

Offline ATsoccergirl

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Re: Another knee injury
« Reply #1 on: February 01, 2004, 07:13:07 PM »
Stuart-

Stories like yours make me cringe.  Casting is hardly ever indicated for knee injuries.  It has been shown through years of research to be extremely detrimentral to the overall recovery process.  Early, controlled motion is really the best way to achieve a complete recovery.  In terms of knee-cap dislocations I use a very aggressive protocal as allowed by our orthopedic surgeon.  Early and aggressive ROM and strengthening combined with biofeedback and proprioceptive work has given us great results, even in when it's in somebody whom this may be their second traumatic dislocation.  I would caution that we take a very different approach to those who chronically dislocate due to structural problems.  

In terms of probable causes, you could have some damage remaining from your first dislocation such as a stretch medial retinaculum or scarring on the lateral retinaculum.  You may also have a muscular imbalance between the vastus medialis and vastus lateralis which combined with damaged from the previous dislocation would make it easier for it to dislocate again.  If the VL is overdeveloped it can put an additional lateral force on the patella.  The quad to hamstring muscle ratio is based on strength and has very little to do with knee cap tracking, so the doctors saying that this resulted because your quad was overdeveloped as compared to the hamstring is pure nonsense.  You may also have some structural problems would would need to be addressed.  

For now, you can be doing isometric quad sets which will help retard some of the atrophy which will result from casting.  You can also aggressively exercise your uninjured leg, this will also help prevent excessive atrophy.  If you plan on returning to sports it's also important to maintain your cardiovascular fitness.  You can try biking with one leg or try finding an upper body ergometer.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline Leentje

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Re: Another knee injury
« Reply #2 on: February 01, 2004, 07:21:57 PM »
I had a ful leg cast for 6 weeks following my patellar dislocations... after cast removal I had agressive PT!!!!Our OSs still give patients a cast following a patellar dislocation, lenght depends on whether they did a reduction or not.

Don't compare me with you... I have no femoral grooves and lateral tracking patellas which dislocate/sublux alot! Originally caused by trauma, now spontaniously. Everyone is different, so don't panic and follow your OSs orders!

Good luck!
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline inmodulo

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Re: Another knee injury
« Reply #3 on: February 01, 2004, 07:24:19 PM »
Atsoccergirl

Thanks for the promt and full repsonce. I have to go and see the hospital's physio on tuesday (though I think it only an introduction into the proper use of cruches) and I will take along your e-mail, At the moment I am unable to put any wheight on the leg without geeling the kneecap press against the side of the cast ( the cast by the way is ankle to upper thigh), so you can understand how reticent I would be to actually exersie it bit I will keep the other excersised as you suggested.

Offline ATsoccergirl

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Re: Another knee injury
« Reply #4 on: February 01, 2004, 07:27:42 PM »
Stuart-

I should have explained the first exercise better.  You simply need to tighten your quad and hold if for a couple of seconds then relax.  It's NWB and will help a lot.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline inmodulo

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Re: Another knee injury
« Reply #5 on: February 01, 2004, 07:35:36 PM »
Helena,

WOw this forum is amazing, I was half expecting to come back tommorow and not see a reply. Its nice to see someone else who has had the same action taken as me ( even though our situations may be different).  By the way when you had your intitial incident how long did it take you before you went back to work? THe OS said at least a week but due to being out of sickleave, that will cost me a fortune

Stuatr

Offline Leentje

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Re: Another knee injury
« Reply #6 on: February 01, 2004, 09:40:54 PM »
Stuart

Dunno anymore how long it took to heal...  :P It was 13 years ago... I was 13 @ the time (I trun 27 next week) and dislocated after a fall on some ice. I was in an open cast for 2 weeks NWB and then in a closed synthetic cast for 4 weeks WB. I stayed home for 2 weeks!!!!!!!! Didn't use crutches, I just hopped around @ home!!! When I returned to school my teachers picked me up and returned me home :-[ My mom can't drive and my dad was working everyday! I can't remember how long before I could go back to gym class... Seems a long time heh! I am a fast healer and never had problems with getting ROM back! Could do stairs pretty soon, my PT's office was in the bassment so I had to go up&downstairs @ every appt! Not easy but a good exercise! Stairs never have been a problem, even not when I was NWB on crutches after my last surgery (TTT open knee realignment).

Just be positive, do the quad exercises AT says and Keep The Faith! You should heal just fine!

~Helena
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation