Dislocated Kneecap, torn medial Patellar Retinaculum Ligament, Cartilage, etc

[comish]

Leave it to me to get the non-standard knee injury. After ER doc's saying I must have broken some bone/ACL/whatever else, the Ortho saying he thought I may have torn my Quad tendon, I found out it was none of the above.

My foray into Gimp Central is due to an apparent knee cap dislocation that has bruised the bone, tore off cartilage from the knee cap, and tore the Medial Patellar Retinaculum Ligament. Now, WTF is the Medial Patellar Retinaculum Ligament??? Apparently I need surgery to fix the busted ligament and remove the cartilage chunks hanging out in the joint.

Can Comish play 20 questions now:

Anyone had this?
Should I get a 2nd opinion?
What was the surgery you had done?
How did it go?
Anything you would change?
How long was the Rehab and what were the milestones?

As in really how long till I can ski, surf, run, and/or bike because until then I'm gonna be putting huge dent in my Cuban rum collection.

Now what does any self respecting injured maggot do, but go buy a brand new pair of skis to motivate me on the rehab. Stoked on the Katanas!!! Fuck that reverse reverse bs.

[Steven S. Dallas]

Ugh, dude, that sucks. I have no idea what that is but I hope I don't have it (MRI is tomorrow). At least you didn't tear your perineum.

[altagirl]

Now what does any self respecting injured maggot do, but go buy a brand new pair of skis to motivate me on the rehab. Stoked on the Katanas!!! Fuck that reverse reverse bs.

I went out and bought a motorcycle after blowing out a knee once. I just had my knee scoped again Tuesday to fix yet another torn meniscus, and this time I'm going to get LASIK, so I'll call that my injury shopping this time around.

Anyway, I have no idea what that medial pateller whatever ligament is. Sounds like some stabilizer for the patella? Sounds like a pain in the ass.

Sorry to hear that. Hope recovery isn't too bad.

[cold_smoke]

Now, WTF is the Medial Patellar Retinaculum Ligament???

That is exactly what I was thinking when I read it. I have never heard of it and have obviously never heard of how they fix it, but please fill us in when you get those details... I figure you got the MRI results (cause who comes up with stuff like that without).

Sounds like your knee injury was a little worse then mine...(last wednesday)... I certainly feel for you man.


DEFINITELY GET A SECOND OPINION.

[comish]

Ok, Have a bit more info.
Apparently the ligament that I actually tore is the Medial patellofemoral ligament. Plan is to go in w/ the scope, clean out the cartilage, and check the situation out. Then the reconstruction is going to be done via an open incision, Yeah! They are going to try and reattach my ligament, but if it can't be done I will be getting an allograft.

Crutches for 4-6 weeks
Jogging at 10 weeksish
Aggressive sports at 4-6 monthsish

Sounds fun

Anyone else had this as I'm drawing a big nothing...

[Joey Bag O' Donuts]

Shit Doug, sorry to hear about the injury. Heal up quick

[Vinman]

sorrry to hear it comish. You should be fine from the patellar dislocation, the bulk of the time will be spent recovering from any cartilage work they have to do.

Once you get to rehab ask about getting in the pool to work on walking etc..

[bigairnbumps]

sorry to here about that - get well soon.

[bdmrad]

I have had TNTC (too numerous to count) dislocation of the left patella since I was 13 due to a shallow trochlear groove (where the patella rides) combined with quad weakness. Avoided surgery until 47 when I completed shreaded the medial retinaculum (really the MPFL -medial patellofemoral ligament.) Had that reconstructed with no further dislocations.

If you have had only one dislocation, it should probably heal OK but you will be prone to recurrent dislocation. It is really important to strengthen your quads, especially the VMO, which atrophies really quickly after and injury.

Here is a link to a board that has lots of info about knne problems. I think if you search for my previous posts (bdmrad) you'll get my take on the problem.

http://www.kneeguru.co.uk/KNEEtalk/index.php

Good luck.

[bdmrad]

Just read your second post. FYI, I had a MPFL reconstruction with an allograft as first and only surgery. Sounds like you have good orthopod since they usually want to do a scope and lateral release which never made any sense to me. Treating medial instability by inducing lateral instability(which is what my first orthopod recommended) sounded crazy. I ended researching the heck out of it and went out of state to find a surgeon with a lot of experience performing the procedure. Though not a new operation, it is still not common. They more frequently do a tibial tubercle transfer/lateral release which is a technically easier procedure with a longer track record.

[comish]

bdmrad,

Thanks man. Appreciate the insight. Nice to hear from someone that has had this done.

[bdmrad]

Hey comish,
This is a good link with concise info about MPFL.

http://www.orthosupersite.com/view.asp?rid=23017

[SPREAD EAGLE]

Not sure if this is the same thing. It has been a few years

I dislocated my left knee (medial portion) and had to have surgery to fix a new anchor to my Femur. Your potential surgery sounds very similar. This was a doosy as it was 6 weeks non-weight bearing and required me to use crutches and I could put NO pressure on it. Other people in the Rehab were walking with their ACL injuries 5-10 days post op. but I just laid there stretching hoping to bend the knee from 45 to 55 deg. and so on with lots of pain.

Now, this was Winter/Spring of '05 and I have had a full recovery since. My knee cap area is twice the size of my right knee but I feel that the surgery was done well and my new knee is BOMBER.

It is funny how when a person is injured they often wonder if they will ever be the same....WELL SNAP OUT OF IT BECAUSE YOU WILL. Don't let yourself think overly negative thoughts because the human body has a will to survive. I wanted to slap myself for thinking anything but positive reinforcements because once I started true re-hab, weight bearing and all It was on!!!. PT will get you through the experience and drive you to knew heights.

Positive vibes and a speedy recovery. I will dig through my records for terminology if you need to find out more about what happened to me.

[comish]

SE,

Thanks mang. How long till you were walking? biking, jogging, other sports?

Definitely sounds similar. I'm pretty psyched actually to get the surgery done and get on with it!

I think the ligament part will go well, a little nervous about what they will find cartilage wise and am just hoping for the best on that front since not a whole lot can be done there. Bring on the rehab!

[Long duc dong]

Best of luck. Hope the surgery goes well and you are back on it in no time.

[comish]

Had surgery last Wednesday night. Reattached my Pattelafemoral Ligament and had a lateral release and cleaned out a chunk of cartilage that was supposedly behind the knee. Dr. said it all went well (surprise surprise). Immobilized for a week and then starting ROM exercises and rehab. Thank god for cell phones, laptops, and DVR's so can do most things from my new office, the sofa.

Supposedly 4-6 months until doing sports again.

Anyone else had this, rehabbed it, etc as there doesn't seem to be too many cases out there. Seems like most people that have had this had chronic knee cap instability rather than the acute dislocation from ski accident ala me.

[Arty50]

While I can't offer any advice, I just want to say GOOD LUCK, SIR. Here's wishing you a perfect recovery, and I can't wait to see you out on the hill again next year.

[Storm11]

I've never had my PF Ligament blow, but I have had all the rest. 1st surgery when I was 11 after my first dislocation, which broke a piece of bone and lots of cartilage off my knee cap. Had my 2nd surgery 9 years later to go in and clean up further rough cartilage and scar tissue, plus they did a lateral release to try and get my knee cap back in track (I have a pretty severe J curve). They wanted to do something that sounds similar to your reattachment as a corrective measure, but I never really considered it an option.

I have chronic dislocations, so my case is probably quite different than yours. Ever since the first surgery my knee has a catch about 1/3 of the way through my ROM, which I've been told is probably permanent cartilage damage, so hopefully you're better off in that department because it SUCKS while skiing.

The lateral release helped a small amount, but really the best thing for me has been keeping my quads as strong as possible (DO YOUR PT!) along with patellar stabalizing knee braces.

[The Best]

Hey Comish... I actually just had an MPFL recon on the 14th, this is actually my second surgery on the same knee in less than a year.. last may i dislocated and broke my patellar and damaged the cartilage. so in may they put my knee cap back together, and just recently they had to reconstruct my MPFL so i could assure i would be able to ski next winter without dislocating my knee again..... i was hoping you could tell me when you're rehab process is looking like. Im actually getting my staples taken out tomorrow (mon 25th) so hopefully the doctor will have something productive to tell me! hope everything is going well man..

[comish]

So I'm typing while hooked up to my "make the knee bend" machine. I had surgery on the 14th as well... I got my MTKB machine last friday and have gone from 18 defrees flexion to 36 this morning which has me feeling pretty good. Dr. said he wants 90 degrees by the 6th, but then again, he told the tech dude to start my knee at 45 degrees to start which wasn't happening. For the most part pain is gone. Occasionally get some where the brace rubs the incision or the area where they reattached the MPFL to my patella. Knee still a bit swollen, but WAY better than even 2 weeks after my dislocation when it looked more like a head than a knee. Supposedly going to start physical therapy after next visit on the 6th. I got my stitches out last Thursday or 7 days post-op.

They ended up doing a MPFL recon and a lateral release and cleaning out some cartilage during my surgery.

You get one of these MTKB machines??? I highly recommend it although its painfully boring. Thank god for having just got a DVR recently, a good Lakers team, and lots of good Premiership soccer on FSC...

Share your rehab as you go. Will be interesting to see the different tacks the docs take. I assume you had full movement, walking, etc of your knee before surgery, right? That will definitely be different as I had been immobilized for 2.5 weeks before surgery and then another week post.

[comish]

Arty, thanks for the thoughts. Hope to make some turns with ya next year.

[The Best]

yeah they actually didnt give me a knee bending machine.. although my brother had the same surgery with the same doctor a few years ago and got one, so im not really sure why i didnt get one. but i was told to start bending it on my own, so im trying to do that. What has your doctor said about weight bearing and wearing the brace... also im curious what his instructions were about showering ( i know that sounds weird) but im wondering if showers or baths or what's the best means. I was mistaking and my appointment is tomorrow so i'll be sure to ask my doctor these questions but im curious as to what other doctors say as well. Also whats your physical therapy looking like? and whats your timetable for walking? and then back to normal?

[comish]

MMKB machine rocks. Its has helped me immensely. He said putting weight on the bad knee was fine. Not full weight, but I couldn't do that now anyway. I keep the brace on 24/7 and it sounds like that is going to be the case for a while... He said something like 4-6 weeks on crutches. Maybe jogging at 10 weeks and "normal" sports at 4-6 months. He didn't say anything about showering. I wasn't supposed to get it too wet at first, but not it doesn't matter. I have water proof bandages on and the thing is mostly closed up so he didn't give me any special instructions there. I think shower is initially better from a not getting the wounds wet perspective, but a little treacherous because of the lack of support so I'm basically on one leg the whole time with very little weight on the bad knee. Starting physical therapy in 2 weeks which would be 3 weeks post-op. This may be assuming I get to 90 degrees flexion by then. At first I thought that was crazy talk since I was at a whopping 18 degrees, but I'm around 38-40 degrees tonight so I seem to be making some pretty good progress on this machine. Highly recommend the machine. Its doing it way faster than I could have just sorta moving it on my own.

Post up what your dr. says. What flexion do you think you think you have now? I supposed you had good flexion pre surgery where as I had 0 so maybe thats the reason.

[The Best]

so i went to see my doctor yesterday and he removed my staples, I sitll dont have a knee bending machine, but my flexion is at about 45 so thats pretty good. I start physical therapy as soon as i can get an appointment so hopefully next week sometime. The doctor gave me the same kinda timetable as to when i'll be walking and when i'll be back to normal activity...my doctor gave me this other machine before surgery to use after my surgery that im still using and its called 'game ready' its essentially a machine you fill with ice and water, and it cycles it through a seperate brace you put on. It did wonders to help the swelling, although im still a bit bruised from my surgery. My doc also told me i dont need to wear the brace when i sleep.. which is kinda nice..

[comish]

What was your flexion before surgery?