patellar dislocation--treatment timetable

[JR]

I dislocated my patella about three weeks ago.  I spent 10 days in an immoblizer, then switched to a soft brace.  After two PT sessions and minimal home exercize, I am able to bend my knee only 45 degrees.  Today my Ortho told me this is not good, and he suggested investigative arthroscopy.  Is there something wrong?  Should I be able to bend more?  Thank you for any help!

[Natalie.D]

JR,

I don't think that only 2 PT sessions is enough to get your ROM back, (although maybe I'm wrong, I'm not a doctor), but it took me at least 4 or 5 sessions before I started seeing any significant improvements and that was with working REALLY hard at home too.  I would suggest talking to your OS and your PT first before going ahead with surgery.  To me it seems like early days to be talking about going under the knife, I would have thought they would prefer to do MRIs and x-rays first.  Good luck.

Natalie.

[bdmrad]

Your OS may be concerned about an osteochondral injury that may be impeading ROM. That usually could be detected on plain XRays and would certainly be seen on an MRI.  I personally wouldn't rush to surgery unless  had an extablished surgical lesion. However, I am quite conservative about surgery and a bit of a therapeutic nihilist (I did put up with recurrent dislocations for 35 years before having any surgery).

[JR]

Thanks for your input!  I am going to give it another day or two and see if I can't get up to 70 or 80 degrees.  I am hoping my limited ROM is due more to my lack of intensive PT than any blockage.  I did have an MRI, the results of which were pretty clear.  So I am hesitant to go ahead with surgery.

[LisaL]

JR - I dislocated my patella back in January and the doctor did not make the decision to do a scope until the end of May.   And my MRI back in January showed an avulsion fracture that could possibly have been a displaced osteochondral fracture.

He kept me in PT for 3 months before deciding that it didn't work (I was immobilized for 3 weeks to give the fracture some time to heal).

Progress in PT was slow at first, but I eventually gained back most of my ROM.  I think, for me at least, it was worth it to wait before making the decision to do surgery.  I am having mine done on 7/14.

[LisaL]

Just another follow up on this.  I remember my OS saying very early on that he would not "even think of operating until the knee was working properly".  

I had a lot of swelling initially and very little ROM.  When they scope my knee on 7/14, they are going to do a lateral release, possibly a medial imbrication and a general cleanup.  I would imagine it would be more difficult for them to determine how much to loosen or tighten when the ROM is not there.

Well that's my 2 cents for what it's worth.

Good luck!

[JR]

LisaL,

My OS said the reason he wants to operate is that he thinks there may be some blockage preventing me from bending.  But I am up to about 70 degrees, comfortably.  Given my clean MRI (just a contusion), I think I'l give PT some more time.

Thanks for your advice, and good luck with your scope!

[laurG]

hi JR
i am surprised at how fast your doctor suggested arthroscopy.  My patella has dislocated 10 times and it took about the 6th time for my doctor to realize there was a big problem.  now however because of the damage to my knee i need full patella realignment surgery.  i would suggest giving the PT some more time aswell, however if it does occur again do not put off the arthroscopic surgery.