Question - Patella dislocation

by GMG
(Greensboro,NC)

My son is an active 15 yr old soccer player (year round) w/ large boned & musclar legs who has grown about 4 inches since July and is very flat footed (uses prescription inserts ).


He initially injured his knee in a 3 v 3 game, felt a pop w/ pain on August 2nd. No contact, but happened while shifting/cutting w/ the ball. After 10 min. stretching etc, went back to playing. The knee was a little sore, but otherwise he said he was fine. On 9/17 it happened again in a high school game. Again, no contact, but could not return.

Orthopedist diagnosed a knee sprain. X-rays looked fine. After 4 weeks of rest and some re-hab he began playing again and injured the knee again on 10/14 in another HS game. It happened when he tackled the ball vs another player. Again felt a pop. MRI was performed this time and showed he has dislocated the patella. No other damage (ACL, MCL, cartilage, etc) except bruising. The right knee cap is loose, more so than left.

His doctor has recommended surgery to "loosen" one side and tighten the other side of the patella. My son wants to return to playing competitive soccer again as soon as possible.

Is this the best course of action? Are their any negatives? Will the "modifications" bother him later in life?

Also, when could he be expected to be able to return to competition?

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Nov 03, 2008
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patella surgery
by: Bart - SII

The procedure your physician is recommending sounds like a combination of a lateral release and a medial reefing or realignment procedure. The lateral release loosens the tight outside structures and the medial reefing or re-alignment will tighten the medial structures.

Because this injury has happened several times, he obviously has patellar instability. That is likely to continue to be a problem with sports. A lateral release by itself would likely not completely fix the problem, as it can make the patella more unstable. But along with the medial reefing or realignment procedure, this could be successful.

Surgery may be able to be avoided if he goes through more rehabilitation, especially if it focuses on improving his hip and core strength, balance, and control. Also, because of his recent growth spurts, an aggressive flexibility program would be of benefit as he likely has tightness throughout the lower body. And it may be worthwhile to look into more aggressive posting in his orthotics to counteract the flat feet and the effects this will have on his knee.

Talk with your doctor about the specifics of the surgery and the likely outcomes. Recovery from the dual procedure I describe above is likely 3-5 months.

Bart

May 22, 2009
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Been There
by: Pastor Chad

I had a lateral release/medial reefing done when I was in my early 20s. For me, it was a bust, but that was likely more the result of a bad surgeon than the actual procedure. Make certain that you have done your research not only about the procedure, but more importantly, the one performing it! Usually, this should be done in stages...start with the lateral release, then rehab and see how it goes. Do the reefing if it is necessary only. I had the addition of a patellar tendon relocation, which destroyed itself weeks after the surgery. I had no post-op treatment, so make certain you get good after care as well...physio, regular check-ups, etc. A good surgeon will get you some excellent rehab training, and a bad one will tell you "just get as much exercise as you can." It is a long road back to where you were, but if it works, it is very much worthwhile.

Jun 25, 2009
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Upcoming Surgery
by: Josie

I am having both procedures on June 30 and I must add I am very anxious. Major Insomnia! I injured myself on May 22 while doing bootcamp and have postponed my surgery 4 times since my initial visit with the surgeon. Basically I sheared off a piece of cartlidge when my patella popped out. It was the most painful experience I have ever had. I have seen 2 ortho surgeons and have done my research on lateral releases and medial reefings and have read positive and negative stories. The negative one freak me out. As the day approaches I find myself loosing my mind because I am afraid that my knee will never function the way in used to. I am just wondering if i should have the loose body removed only and avoid the dual surgery altogether. Any advice is greatly appreciated.

Jul 05, 2009
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don't worry about the surgery
by: SAL

I just had patella realignment surgery on my left knee on 6-30-09. I had a nerve block so I did not experience pain until almost 2 days later. After 2 days I had my drain tube removed from my knee(which did not hurt)but ever since I have had shooting and stabbing pains in my knee and when I move sometimes my kneecap feels very unstable and sore and it scares me. Im also a little worried because my right knee gets sharp pains when I use my crutches. I think the most painful part thus far was figuring out how to get into my car to get to the dr's office 2 days after the surgery.

Jul 05, 2009
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Followup from my sons surgery
by: GMG

The issue with cartledge damage was why my son went forward with the surgery. He had no damage at that point but his Dr. said it could happen if he continues to dislocate the patell. Said it could even chip bone.

My son had the patella release with the ligament "tightening" in November 08. Everything was good until the pain block wore off. First night was tough, but he did not wake me to give him pain meds. After that it was OK. The bath/shower thimg was tricky. Missed about 4 days of school. He was on crutches for 6 weeks in a brace that locked his movement. First 2 weeks it was locket at ~ 70 degrees. Then he was given about 30 degrees of movement and gradually increased until the 6 week mark when the brace was discarded with the crutches (yea!). PT started after 2 weeks. He could not even lift his leg an inch at first when laying down. PT was twice a week and at first involved muscle stimulation. PT continued for 4 months when he had about ~85% % stength. He started soccer again in March 09 wearing a J-brace. By then his flexability was more than most people but not as much as the non-injured leg. Limited practice and a lot of icing after each. Swelling occured and would go back down with icing. He started playing (club soccer) w/ contact (games & scrimmage) again in April 09. In early May the DR. pulled fluid off and gave him a very small dose of cortizone. Things went better with swelling. The DR. wanted him to focus just on soccer w/ no gym, backyard basketball and no strngth training. (It's hard to hold a 15 yr back). By the season end (May) he was about 85% as a player compared to pre-injury, but part of that is endurance. Now in July we went to a physical trainer who evaluated his stength and movement. He will start next week to improve strength and flexability as he still favors the non-injured leg. The Dr. has released him completely and expects it will be late fall before all strength returns including muscle size. He does have a clicking sound occaisonly in the knee, but the Dr. says that is of no concern and is either scar tissue or cartlidge. This occured b4 the surgery as well. Overall, things have gone well and NO MORE dislocations (he had 3 last fall). Our Dr. was a knee specialist who came very highly recommended.

Jul 21, 2009
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painful therapy
by: SAL

Wow! I was told the phy therapy would be bad but it's really painful. I started last week and my knee is very stiff. My therapist said I should have been doing some sort of exercises during the first week but my doctor didn't tell me to do anything. My therapist keeps telling me I have to stop being afraid to move my knee or I may have to get a 2nd surgery in the future to be able to bend my knee. Any suggestions to help work through the pain?

Jul 21, 2009
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recovery
by:

Your physical theropy should include muscle stimulation of the quads. At home my son would lay on the couch and just try to lift the leg. He could not even move it at first. Just try to get those quadracepts to fire/tighten a bit. Also, at home move your foot up and down while laying flat (not moving the leg). It does not sound like much, but it was all he could do for at least the first two weeks. It is a slow process, but requires work. Our Doctor explained that the quadracept muscles will not fire at first due to the body's natural reaction to the trama of the surgery. The phy. theropist and you must fool those muscles into firing to speed the recovery process.

Jul 23, 2009
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Thanks for the info
by: SAL

My therapy sessions went from 45 mins twice last week to 2 hrs each session this week. I just came from a therapy session about an hour ago and today was still hard but a little better than last week. The therapist said i'm making progress, last week I was able to bend my knee at 22 degrees and as of today I measured at 55 degrees. It's encouraging to hear that your son made it through and he is doing well. I will remain motivated knowing that your 15 yr old did not give up so there's no excuse for me as a 32 yr old to give up either.

Jan 04, 2010
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re injury after surgery anyone?
by: amster52

i had a lateral release/patella realignment on my left knee in October 2004 (age 15), and the right knee in March 2005 (age 16). Since my surgeries, i have dislocated my right knee cap 3 times. This has resulted in very limited range of motion, and the inability to squat. My left knee has developed a very loud click accompanied by a wobbly patella when i go up stairs. i cant sit, stand or even lay in the same position for an extended period of time before stiffness sets in. Both provide constant medium range pain, and the promise intense pain with one wrong move...and I'm only 20 years old! Ive played sports for years (obviously were the initial injuries occurred), and continue to play volleyball in the summer months. I love to hike and bike ride. At this point i can do none of these activities, or will do so worrying every second if this will be end all of my "fixed" knee. I have recently started considering having yet another surgery to fix the damage that has been done since my previous. I feel as if i have no other options. I live in fear of patella removal, or permanent loss of knee usage. Has anyone else been through re injury after surgery? I just don't know what to do...

Jan 10, 2010
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patellar realignment surgery
by: Anonymous

Hi Everyone! So glad I found this site. I am a 32 female who has played sports my whole life. My knee started to discloate when I was 8 years old and probably has dislocated over 100 times since then. When the knee cap would pop out I would always fall but would be fine.. a little pain but nothing serious. This last time about 4 months ago it went out and I never fully recovered. Just had my patellar realignment surgery on December 7th with 3 screws in my tendon. I have to say I was not prepared for this. I am only at a 55 degree bend.. cannot stand on it yet without it tightening up almost feeling like it is going to lock. I have no quad muscle and such atrophy.. still working on getting that muscle to fire. No luck yet. I keep getting that feeling that my knee is going to pop out of its socket.
It is so scary! any thoughts from anyone?? Is this a normal feeling?

Jan 10, 2010
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You will be fine
by: Anonymous

When my son had his done (a release and realignment) he was on crutches for ~ 6 weeks. The knee was locked at a max of 70 degrees. Quads would not fire at first. Could not even lift his leg an inch laying on his back. Rehab at 6 weeks to about 4 months. He was playing soccer again at about 6-7 months. Be patient and do exactly what the docter says. Rehab/physical theropy is important.

Aug 12, 2010
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RE: re injury after surgery
by: Anonymous

I have had three lateral release surgeries and 1 patella realignment surgery on my left knee. After the lateral release surgeries, my knee would be fine for up to a year and a half or so and then I would start dislocating the patella again (either from sports or a fall). For the patella realignment surgery, they also reshaped the back of my patella due the the groove that had been worn into it from constantly dislocating it. I have been fine for almost 10 years now and still go biking, hiking, and running quite regularly. I've only just recently started having problems with it being sore again and am thinking of having the screws removed...

Apr 19, 2012
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knee realignment surgery??success sport NEW
by: sdarce

hey guys suppose be getting this knee realighnment surgery done 21 years old 3 dislocations to my right knee which is now maligned with cartilige damage..cant really run and constant pain with locking of the knee met several specialists and physios to no avail ,but now going doing this surgery last option was told probably shoud retire from sport as in my 40's nd 50's knee replacement will be needed and the likes but not worried about that!!I want to know how surgery went success or not?my dream is to get back I am fairly talented would do anyting to play sport again life hardly worth living if cant particapte in sport being such a fit young lad!!!

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