knee cap dislocation, i'm new here and would like some help please : )

[sable81]

ok here goes..... i dislocated my left knee cap 14 weeks ago now and although it is alot better now, it still is not 100 percent, my knee looks alot different to how it did before, it looks swollen and abnormal when i stand up and i cannot get my leg to straighten all the way back, i have problems with both knees, and have dislocated the other one before as well, i was told i have small high positioned knee caps and also have a shallower groove that it sits in...what i'm asking for is just some opinions really on what other people think i can do to help it, i've been doing all the exercises my physio has told me to do to help strengthen my knee again, which has helped alot as i'm now able to walk pretty much pain free as long as i'm not on my feet for ages, it's uncomfortable more when i stand still and above my knee it looks like there is a lump, which my physio said could be my quads just tightening up to protect the knee, i've been doing so many exercises, and stetches for my hamstrings, i go to the gym and swim pretty much everyday, i just want to get more opinions cos i'm so frustrated with it, and i'm returning to work next week.

please, please help lol

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[smshaffe]

knee cap dislocation is a complicated topic with no one clear treatment or answer. it can happen for a plethora of reasons. who told you why it dislocates? did they see an x-ray or other imaging or do extensive testing to figure out why? honestly, this problem can be effected by foot/ankle alignment, knee alignment, hip flexibility/strength, and a variety of other sources. no one can tell you what to do without a thorough and appropriate evaluation. and, at that, many professionals may not be able to do so. in some cases surgical correction is the only way to fix a knee cap dislocation but surgical techniques are extremely varies and not guaranteed to work. find a good physio.

[sable81]

im under the care of the nhs, and have been since it happened and i was taken to a&e, i've seen an orthopeadic surgeon, and have a physiotherapist who i see every week and have one hour gym sessions with him, the knee dislocated when i lifted my leg up to move my foot off the bottom step of a ladder, there were no twisting actions involved it just popped out, it's the first time it's happened with this knee, but a couple of months before i was getting pain at the botom of my knee and wasnt able to kneel down, i know my other leg is misalined as i've been told this by a surgeon, when i straighten that leg to get my knee to sit facing straight up my ankle and foot point out to the right hand side, but the leg i'm having the trouble with now, is not misalined like that.

i know what your saying about it being hard to give advice without seeing the patient, but i'm so frustrated with it.

[smshaffe]

did the other knee cap dislocate before? how old are you? do you get pain every day? if so with what activity or position?

if you dislocated that easily (no twist etc) then it is likely that you have underlying boney deformity. this can be slight, moderate, or severe in terms of the changes and cannot be fully verified without x-ray, MRI, CT scan or some other test to visualize the bones. there are so many possible problems here that it is impossible to give good advice without doing a thorough evaluation. is say this not only a physio that has studied orthopedics extensively but as a patellar dislocation patient myself. i have dislocated each patella dozens of times and had a corrective surgery on the left knee. i enjoy treating this diagnosis both because it can be challenging and because it is a personal topic for me. unfortunately, there isn't really any good research on how best to treat this problem. this is probably mostly a result of the fact that there are so many reasons why a knee cap can dislocate. how do you study/treat something that is so variable? the answer is that you can only do a very thorough ankle, knee, hip, and low back evaluation, find the individual problems for each patient, and treat what can be treated. all of that having been said there can be lots of things that aren't even treatable such as underlying boney shape.

on a general note: lots of people that get pain between the knee cap and femur are helped greatly by a quad stretch (lie on stomach, pull heel to the butt for example). they typically also benefit from strengthening the hip and knee muscles, stretching the calf and the structures on the lateral side of the thigh, and correction of flat feet if present (among many other possible options).

ask any question you want but i assure you there are no easy answers

[sable81]

ok thanks fo your advice, i see that there really is no definate answer, i will just have to ride it out and see how it goes.

i'm 27 and have dislocated the other knee as well, my sister has problems with both knees too, and has had operations on both, and my dad has problems with his knees and also had operations in the past, i do get pain everyday, and have the giving way where i can feel the kneecap slip a little bit and then lock back in,although this doesn't happen everyday, i've been doing lots of different exercises to correct posture and improve my balance, stretch my hamstrings build up my quad area, i was told that for it to dislocate so easy must have been the weakness in my surrounding muscles, and not so much the abnormality in my knee.

would the fact that i cannot get my leg to starighten up comfortably, and push the knee back be due to the fact that my hamstrings are tight? even though i do hamstring stretches everyday?

my physio seems to be reluctant in getting a second opinion, even though he says i may need one pretty much everytime i see him, i dunno if this is just an nhs thing because of resources and waiting times.

anyway thanks for your help.

[smshaffe]

sounds like you may have a family predisposition to this. it could be a genetic thing, maybe bone shape etc. but, is it the same problem everyone has? the same knee cap dislocation? there are lots of knee problems and it is hard to say that just because you all have a knee problem it is all the same one.

if you dislocate that frequently it is not likely a knee muscle weakness problem. the muscles don't hold the knee cap in place. that happens by the "passive structures" such as bone and ligament. the biggest issue is usually the depth of the groove on the femur that the patella slides in and out of. many, many people have weak muscles and their knee caps don't dislocation. in fact, strengthening the surround muscles only helps a little bit. it is becoming an old idea these days for this sort of problem. in fact, i bet you haven't gotten too much better (less frequent dislocation with the same level of activity participation) since you began stretching the hamstring and strengthening the quad.

what kind of operation did your sister have and did it help her problem? is that the same problem you have? i ask the same questions about your dad?

you asked: "would the fact that i cannot get my leg to starighten up comfortably, and push the knee back be due to the fact that my hamstrings are tight? even though i do hamstring stretches everyday?" no. what position are you doing this in? sitting with your legs straight in front of you? standing? is the knee cap literally getting stuck out on the outside of your knee as opposed to being in the front? typically most knee caps slide back in very easily when they are dislocated.

you said: "my physio seems to be reluctant in getting a second opinion, even though he says i may need one pretty much everytime i see him, i dunno if this is just an nhs thing because of resources and waiting times." sounds like your physio isn't good at making a solid decision and sticking to it. are you getting better? if not, you should get a second option (doctor, physio, or otherwise). i don't know anything about the nhs.