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Anyone have experience with a recurring dislocated kneecap?

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  • Anyone have experience with a recurring dislocated kneecap?

    Starting around when I was 15 (8 years ago, 23 now) my left kneecap dislocated - slipped off the groove and got stuck to the outside of my knee. I don't believe there was an initial injury that caused it, it just slid out of place as I was kneeling and hurt like HELLoooooooooooo! Ever since then, every year or two it has dislocated again, been equally painful, and remained sore for a while. It happened again last week, and my knee has been particularly painful since then. My kneecap threatens to "jump the track" daily and has just been achey in general.

    Riding can be particularly painful, and I'm just wondering if anyone else has experienced anything like this and how they coped with it? I'm worried that since it is recurring and gets progressively worse each time, they will recommend surgery. Anyone had it? Apparently they cut the ligaments or "loosen them" so that they don't pull the kneecap over to the outside of the knee and "off the track".

    I'm going to a knee doctor tomorrow, keeping my fingers crossed that this can be helped with just physical therapy.

  • #2
    I have this problem, though it doesn't sound quite as severe as yours. It slips occasionally, but not all the way out. It has dislocated 2-3 times, and it does indeed hurt like a mother. I usually grab it instinctively when it happens, just because it hurts so much, and that pops it back in. Straightening your leg will help you pop it back in when it happens.

    There are physical therapy things that can be done. The idea is to strengthen the vastus medialis (the thigh muscle on the inside of your knee) so that it holds the patella in place better. You can do straight leg lifts. Also, the squat thrust machine at the gym with very low weights, and only do the last part of the exercise - Go from 'legs almost straight' to 'legs straight'.

    Honestly, I just run on a semi regular basis and that gives me enough muscle tone to keep it in place. If I slack off, it gets loose again. It first happened in vet school when I was sitting in class for 8 hours a day without a break, and my muscles atrophied. =(

    Good luck!


    • Original Poster

      Ah, yes, my hands immediately shoot down to the offending patella and lock on.. but that has never pushed it back into place, the only thing that does is straightening my leg, which honestly, can be daunting and frightening at the same time, not to mention obviously painful.

      I would have thought that, as a rider, my thigh muscles would be in great shape, but I'd definitely be willing to fully dedicate myself to PT if it would really make a difference. There is no way on earth anyone is going to get me to do any running during the winter, but if I had easy access to a treadmill or elliptical (does elliptical have the same benefits as running?) I would definitely hop on for an hour a day.

      Thanks for the info! I'll have to update tomorrow after the dreaded doctor's visit.. they're all sadists!


      • #4
        Be very careful about overdeveloping your quads--it can make it worse. Work the hamstring a lot. I don't get a full dislocating slip (knock on wood), but my right kneecap does sometimes slide far more than is comfortable. When I did the initial break (dislocation and fracture), my doctor told me at the time to avoid sports like soccer with a lot of lateral movement and to use a brace. I don't run except on a treadmill but because I've had the injury so long I have little/no cartilage and running on pavement hurts a lot. I've never had a problem with treadmills or elipticals hurting it, though I'd favor the latter because it doesn't pound as much. I do dance (and my pro knows to be careful--if/when we get to a higher level of jive, we will not be doing flicks with the left foot as that requires bouncing on the right) and if I have really noticeable pain, I use a soft brace.

        Riding I've found doesn't bother me too much, provided I don't try to point my toe too forward--ie no less than 45 degrees. If I let my foot turn out too far (which is a long, long way for me--I have extreme natural turnout) or try to force it forward, it strains the knee and feels like a lateral pull, which is very unpleasant!

        Yeah, it sounds awful, but I also have found straightening (and pushing down with my heel) will correct/prevent when the patella starts to slip. It hurts, but then it does if it slips out, too!
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        • #5
          Mine dislocated in a riding accident last March and I tore a ligament. No surgery. Instead, I had 30+ sessions of pt, swim 3 times a week, walk, and do about 1.5 hours of exercises daily, or as often as possible. The exercises are designed to strengthen the quad, the aductors, stretch the calf muscles, increase the ROM as much as possible, strengthen the feet and ankles, and get the weight onto the knee in the two different mini-squats. It will not be considered healed until the end of July, or beyond, and then I can add riding into the schedule. The exercises are to be done for life. I am dreading another dislocation, so I am being uber faithful. I wear a Donjoy J brace at the barn.

          The things I will never be able to do again include running, soccer, jumping off of things, ice skating, etc. I love to walk and swim, so I am okay with that. I am hoping to avoid surgery until I need knee replacement.
          "The difference between genius and stupidity is that genius has its limits." Albert Einstein



          • Original Poster

            My knee only hurts while riding when we've been doing a lot of lateral work. We're about to get into more jumping, so I'm interested to see how it holds up to that.

            Running on pavement? Forget about it. I'm also fairly certain my more aggressive skiing/waterskiing days are numbered, if not over. I'm 23, my body is not supposed to be doing this to me yet, dammit!!!


            • #7
              I had the same type of thing, which led to dislocating the knee joint repeatedly. Talk about pain, not to mention the nausea when one looks down and realizes your foot is pointing in a direction not normally allowed!
              What I ended up with was reconstructive surgery; I do NOT recommend this unless there is no other do-able option. Seriously, request attempting PT or any other options before going for anything other than orthoscopic surgery. I had a horrid recovery, lots of PT (6 months worth), and my knee still "attempts" to dislocate: all the pain, fear, and nausea as before, but now the knee (or kneecap) can't actually dislocate (well, unless I rip the tendons and displace a couple fancy pins first).
              Oh, but according to the surgeon and phsical therapist, I have an impressively high tolerance for pain and am considered "a success story" by both.
              Now I have arthritis in that knee, too, and to top it off, holding my leg position for longer than about 45 minutes means I can't walk on that leg when I dismount and have to hop around like an idiot: like I said, avoid surgery if possible.


              • #8
                I agree--be leery of surgery unless you HAVE to (like, are unable to walk without it). Among the people I know (higher than average, as dancers and skaters tend to destroy their knees faster than 'normal' people) who've had their knee or hip done in any way, it's about fifty-fifty whether it helped at all. And none would really have been able to come back at their best (though again, 'retirement' age is a little younger--my Rhythm pro retired from pro competition at 28 when his knees were starting to go. He's a success story in that he can still work and compete in pro-am, which is somewhat less demanding on the body.) I basically won't consider it unless/until the knee or hip, which is out of alignment on the same side (that is probably a riding injury, not related to how I did the knee--my friend who's a PT thinks it probably came from a fall that hit my right...glute...harder than my left and shoved that side of the pelvis up and forward) needs to be replaced completely. I'd like to at least hit forty before that happens.

                Though I have to laugh at 'foot pointing the wrong way." I suspect my natural build saved me a bit, as the only "wrong" on mine would be pigeon-toeing more than 45 degrees--I can turn either foot OUT 180 degrees! I don't do 'toes forward' while riding, and there's a reason no trainer's ever let me have spurs. And yes, I was born that way, no ballet until I was much too old to develop anything. Said friend the PT told his wife, who was shocked at my extreme variant on fifth position and asked "but you're not doing that from the hip!", "Honey, if she wasn't turned out from the hip, her leg would be broken." I can probably push my knees out a little more before the kneecap slips than people who aren't wonky-jointed.
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                • #9
                  I had a Tibial Tubercle Transfer just over a year ago. My kneecap did not dislocate but rode way to the outside and had started swelling in the last five months before surgery. It was a longgg time chronic problem getting worse.
                  It was not a light decision, but hopefully, that will be it for my knee, no total knee which was probably going to be a possibility at some point.
                  Dr. basically broke the tibia and realigned it and cleaned up the knee arthroscopically as well, the kneecap now tracks where it is supposed to. I'd say it was worth it (for a while I wasn't sure!).
                  It's just really sad how quickly muscle is lost and how hard it is to rebuild, especially the older one gets. Sigh.
                  We're spending our money on horses and bourbon. The rest we're just wasting.


                  • Original Poster

                    Well.. I had my ortho visit. Apparently he saw much more than he did last time because he immediately ordered an MRI for tomorrow morning.

                    He thinks there are two possible scenarios:

                    1 - There was a trauma to the inside of the knee that damaged the tendons that are supposed to hold the patella in place and keep it from dislocating,

                    2 - My knee is wonky and my patella sits more to the outside than it should, which would mean going in and basically restructuring the knee.

                    There is much more to these two scenarios than I've shared here, and I may not have given either a fair description, but this is really all I know at this point. He put me in a special brace that should help to prevent the patella from dislocating, but I've got my MRI tomorrow and then I will see him within the week to hear what the images have to say.

                    Today has been an awful day altogether, so I'm really hoping this isn't as serious as it seems to be, even though he said that he's leaning toward scenario #2 for me.

                    Fingers crossed, everyone?


                    • #11
                      Keeping my fingers crossed for you. And don't be afraid to get a second opinion if the treatment options are aggressive. Remember that if you ask a person with a scalpel in their hand for an opinion, they're likely to give you a surgical option. Another doctor might recommend non-surgical options like PT. Hope things go well for you,


                      • #12
                        Me, too. Started as a teenager, 30 years ago.

                        Mine didn't get progressively worse. It happened a few times a year at the beginning and then tapered off in my late-20s. Now, in my 40s, I can't remember the last time it happened. Surgery was recommended but they also basically said that if it wasn't debilitating (i.e, I wasn't making my living playing pro football), just to be careful and live with it. It hurt like hades whenever it happened but it wasn't a life threatening problem worth the risk of surgery.

                        The worst thing that happened was when my horse spooked and spun really hard, dislocating my knee when I was riding. Not fun. Thank goodness it only ever happened the once.

                        I find I need to be careful with my weight. I don't need a scale because I know when my knee starts giving me grief, it's time to lay off the cookies.

                        My daughter has recently started having the same problem. She has a knee brace she uses while dancing or riding.

                        Good luck!


                        • #13
                          Wishing for the best results today!
                          We're spending our money on horses and bourbon. The rest we're just wasting.