Patellar Dislocation - Conflicting Opinions/Recommendations??
by Tracy Schrupp
(Gillette, WY, USA)
15 Days ago I dislocated my knee cap playing basketball. I ran off a screen a little too close and hit knees with my screener. It was extremely painful and I got a good look at my knee cap completely off the lateral side...I managed to get it back in after a couple of minutes after I pushed it in.
On that same knee I have (what I believe after reading up on my knee anatomy and injuries) a subluxation of the patella, about a year ago, snowboarding. I fell directly on my knee and it went about half way out...not excruciating pain, just experienced weirdness and it also popped back into place after I straightened my knee. It was tender from the impact but not painful for about 2 months afterwards.
After this dislocation I got on board with the RICE and did not extend my knee fully or more then about 50 degrees. I went and visited a friend 4 days after my initial injury that also runs a physical therapy place; he did a manual examination, tested for bone chips and such and deduced that I did not have a tear in either of my ACL, MCL or LCL or any bone fragments or breaks. His suggestion was to get full extension and to start up on physical therapy right away.
The next day I started on all sorts of exercises that would strengthen my muscles, balance and a week out, I did a "T" test even! It ached and such and was sore, but I honestly did not have much pain and in my mind, I did not have a problem, so I needed to do these things to make sure I wouldn't dislocate again.
In the mean time, I had another friend that is an athletic trainer who wanted me to see an orthopedic surgeon and believed the therapy was too aggressive. She arranged it with her surgeon she works with daily and 12 days out of my injury he examined my knee(s) and by the bruising, swelling, soreness areas, and obvious laxity, deduced that I possibly have a slight tear and/or stretched out Medial Patellomenical Ligament (MPML) He wants me to have no more than 45 degrees of flexion, very conservative rehab exercises, and to wear a patellar supportive brace at all times for at least 4-6 weeks.
Obviously these are two very extreme differences in opinions. You might be able to see my dilemma that I am in and so I need a 3rd opinion.
My views on wearing a brace 24-7 do not agree with the Dr. but I see his point on trying to have this ligament scar over and heal itself without surgery, so I do not become a chronic patella dislocater. But, I also agree with strengthening your muscles to compensate for this lax ligament (Isn't it common knowledge that once these ligaments are stretched to a certain point they will not go back and muscle strengthening and/or surgery is the alternative to not being able to play basketball anymore?)
Should I get an MRI now or wait for my 4-6 weeks, and what should I do about the brace and the rehab? HELP ME PLEASE!!!
Thanks for hearing my sob story, if you have any suggestions and or recommendations I would greatly appreciate them!!