Q: I keep dislocating my left kneecap. I've tried exercise, taping, yoga, and kinesiotherapy but nothing keeps it from popping out. What's next?
A: You may be a good candidate for surgery but it's best to see an orthopedic surgeon for an evaluation before going down that road. A review of your history, injury, time since the injury, conservative efforts tried, and length of time carrying out conservative care are all important factors in the success (or failure) of nonoperative care.
Studies show that 50 per cent of patients with a first-time patellar dislocation will go on to dislocate it again -- even with conservative care. The way the ligaments and tendons form around the patella, there is often damage to more than just one soft tissue structure.
The tendons and ligaments are interwoven together and then form an enveloping capsule around the patella. A force strong enough to disrupt this connective tissue structure often causes damage to more than one ligament.
Repair can give up to a 70 per cent chance of a good result and return-to-sports. Reconstruction (replacing the torn or damaged ligament with graft tissue rather than repair (reattaching the torn ligament back in place) yields the best results. This is especially true when there are multiple structures involved. A simple single ligamentous tear can be reattached without reconstructing the entire patellofemoral unit.
Reference: Christopher L. Camp, et al. Medial Patellofemoral Ligament Repair for Recurrent Patellar Dislocation. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2248-2254.
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