|
Q:
My 13 year-old daughter dislocated her knee two weeks ago. Her leg has been in an immobilizer since then. We have a follow-up appointment this week and would like to know what to expect. What kind of therapy will she do and for how long?
Answered by
David Golden M.D.
|
|
A:
Every case of dislocation is different. The dislocation to which you refer is a patella dislocation. It is initially treated by keeping the knee straight for an extended period of time (up to six weeks) to allow healing of the torn ligaments (patello-femoral ligaments). The cause can be multi-factorial. A trauma may cause it and the knee may not require any additional treatment beyond immobilization and subsequent therapy. Once therapy is started, special attention is given to strengthening the quadriceps musculature. If the cause of the dislocation is because of malalignment of the knee, or because of a bony abnormality, the specific problem may need to be addressed surgically. It is not possible to know, without a detailed history and physical exam, what the cause was for the dislocation. Be sure to ask your treating orthopedist what the cause and subsequent treatment will be for the dislocation.
|
| |
Q:
I have had recurrent dislocation of my left patella. I have seen a doctor who told me to have an operation (lateral release), but I prefer to do physical therapy. Is that enough?
Answered by
David Golden M.D.
|
|
A:
Physical therapy may not be enough to treat the recurrent problem of patellar dislocation. There is more than one type of procedure to address the problem if it requires surgery. Some surgeons perform lateral releases, while others lengthen those ligaments rather than totally release them. The purpose of the surgery is to “unteather” the patella from the tight ligaments on the lateral or outside part of the knee. Those tight ligaments may be pulling the patella laterally and causing the dislocations. Recurrent dislocations often require surgical intervention to prevent future dislocations. Repetitive dislocations can harm the undersurface of the patella and damage the surface of the knee.
|
| |
Q:
After dislocating my knee several times I went to an orthopedic surgeon. He recommended a lateral release. What is this? What should I expect?
Answered by
David Golden M.D.
|
|
A:
A lateral release is an operation that cuts the ligaments that bind the patella from the lateral side of the knee. They are normally present in everyone, but occasionally they are tight, or there is a mal-alignment of the knee that causes them to pull the patella laterally and cause dislocation. Releasing those ligaments allows the patella to center itself better in the knee and track down the middle of the knee, rather than be pulled to the lateral side and risk dislocation. There are different procedures performed. Some surgeons lengthen the ligaments, while others release them completely. Either manner seeks to release the tight lateral pull from those ligaments. The recovery time varies. Soreness from the procedure can last a few months and time to return to activity depends on the extent of the release. The knee can swell with activity for 6-12 weeks following the procedure. Be sure to talk with your surgeon about reasonable recovery time.
|
| |
Q:
Are there any new procedures to treat patellar subluxation and if so, how successful are they?
Answered by
David Golden M.D.
|
|
A:
There are new procedures attempted often to try to improve the surgical techniques for treating patellar dislocation. Every new technique requires controlled studies before they are widely accepted. The surgical procedures for patellar subluxation vary, but they are all variations of the same theme. The tight ligaments pull the patella laterally and cause subluxation or dislocation. These are released or lengthened to correct the problem. Ask your surgeon what type of operation is planned and what the recovery time will be.
|
| |
Q:
About one year ago, I dislocated my knee. I haven’t had much pain, just weakness, but now I seem to have more pain with it. Are there any exercises I can do at home?
Answered by
David Golden M.D.
|
|
A:
There are some exercises that may help. Be sure to see your physical therapist so they may show you the proper techniques. There is a specific part of the quadriceps muscle called the vastus medialis oblique (VMO). It is located on the medial aspect of the knee and is felt to counteract the pull of the lateral ligaments that may contribute to subluxation or dislocation. Strengthening the VMO helps to align the patella better and prevent dislocation problems.
|
| |
Q:
I am going in for a lateral release next week, how long does a typical recovery take and what does it entail?
Answered by
David Golden M.D.
|
|
A:
Recovery time varies considerably from patient to patient. You will likely be able to bear weight but it may be limited for protective reasons. Swelling may be present for many weeks following the operation. That does not always mean pain is associated with it. Be sure to ask you surgeon what type of lateral release is planned (complete or lengthening) and discuss the estimated recovery plan.
|
| |
| Go back to previous page |
| |
|
If you need more information, you may submit a question to the doctor.
|
