Thanks for the replies - its a long history - here's some details:
First dislocation age 12 (am 34 now), subsequent dislocations led to TTT, VMO advancement and LR at age 15. Knee never really felt right after surgery, I was never able to run on it again - rehab after surgery took around 2 years. Life did return to some sort of normality, then age 18 dislocations started again. Next 10 years spent seeing different OS's, no one wanted to do another surgery, periodic rounds of physio, and perhaps 3 dislocations a year. Every (public) OS would say 'if it dislocates when you run dont run, if it dislocates when you play sports dont play sports etc...', activities limited, no sports, nothing that involved running. Cycled for cardio exercise but knee would occasionally dislocate while standing on pedals. Over time dislocations became less severe but more frequent, reached a point where I would just pop the kneecap back into place and continue whatever I was doing. I was able to dance, wear high heels, and get around ok but I could never ever run and avoided anything that might cause problems such as hill walking (because of uneven ground) or anything like tennis, badminton (because of pivoting etc).
Late 20's, dislocations became more frequent, eventually had a big dislocation almost 3 years ago and immediately felt unstable afterwards, knee swelled up and I made a private OS appointment with the OS who is allegedly the 'best' in Ireland. He told me he wouldnt consider a surgery as the muscles in my leg were so badly atrophied from what he considered was years of disuse. At this stage I was on crutches as my knee was so badly swollen that I couldnt weight bear on it. Sent me off to physio and told me not to come back unless I wanted a surgery (Im not clear on how I was supposed to make that decision but thats what happened). Attended physio for a year and a half, diligently performed exercises, quads, calf muscles, glutes, lower back - all weak. After the big dislocation I was dislocating every 3 or 4 days. After a year and a half I was dislocating perhaps every 2/3 weeks but it was becoming harder and harder to walk and really there was so little improvement that I felt I was wasting my time. From the big dislocation to the next OS appointment I had perhaps 120 dislocations in a year and a half.
Tracked down original OS who had performed the surgery 19 years ago. Saw him for the first time last June (2007). He orderedMRI, did manual examination, stated all ligaments were intact but that VMO was invisible. There is a
meniscus tear but he said there is no way he is fixing that until the muscles are strong as it will only introduce more muscle dysfunction. Told me to stop wasting time with the physio practice I was with(they totally ignored VMO) and sent me to new physio and told me to get an e-stim machine - which I did. New physio took one look at my leg and said that she didnt think she could help!!??!! But on OS orders began physio program using exercises designed to engage VMO supplemented with e-stim and isokinetic testing every 4 weeks. Next OS appointment in August, he told me he hadnt said before but was worried my VMO was paralysed but now could see that it was flickering the tiniest bit when I contracted VERY hard. Told me in his opinion I had a lot of hard work ahead and that I would rehab the leg in 6 months to a year. Said he didnt want to see me again unless isokinetic tests showed no change or things got worse.
In late September I woke up one day with shooting pains in VMO - have been able to engage it ever since. It went from nothing in June to perhaps half the size of good side now.
Physio is despairing of me now. Isokinetic tests do show slow improvement in quad strength but I cannot shake the 'feeling' that my kneecap is trying to dislocate when I walk. I can extend my leg without feeling unstable when it is loaded with weights but when its weightless it feels loose and unstable. As a consequence I have not been able to walk properly for almost 3 years now and unless I break this hurdle Im not going to progress. As you can imagine Im in a lot of pain and feel very frustrated frequently.
The exercises Im now doing are as follows - all exercises are performed using 30 lb weight (except where stated), 15 reps, 3 times a day:
- Squats against a gym ball
- 1 leg squats against gym ball
- Sit on gym ball and use bad leg to roll back and forth
- Calf stretches/Quad stretches
- Lunges
- Step downs
- SLRs - foot straight (25lb)
- SLRs - foot turned out 10 degrees to engage vmo (25lb)
- Partial leg extensions (not extending to absolutely straight to avoid stress on joint)
- 2 different sets of hip exercises -
dont know the names, lying on stomach raising leg behind me, and lying on side raising leg up like scissors) - both 15lb weight
I also do 30 mins on treadmill (but it is just 30 mins of torture feeling like Im going to dislocate) and two 20 minutes sessions of e-stim each day.
I dedicate over 2 hours of time every day trying to rehab this leg but I just feel Im going nowhere as long as I cant get those muscles to engage without resistance.
Isokinetic test in June showed I could exert 29 pounds per square inch force with right leg, last test was early Dec showed I could exert 46 pounds per square inch - so my quads are definitely getting stronger.
Have not had a dislocation in 15 weeks now - but any and all walking has been very torturous.
Sorry for such a long post - wanted to provide a detailed history.
Thanks all!