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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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What's the fastest way to recover from a kneecap dislocation? I've got a marathon coming up that I don't want to miss.

The jury may still be out on this one. A recent study of young, active (male) military recruits compared arthroscopic repair with nonoperative care. They found that arthroscopic repair got the soldiers back in action faster than conservative care (bracing and exercises), but the rate of recurrent (second or third) patellar (kneecap) dislocations wasn't any different between the two groups. And that can be a significant factor in training for sports, marathons, or military action. So, they are back to the drawing board in terms of finding the best way to treat these types of injuries. Using measures of pain, activity levels, function, and patient satisfaction help them sort out what works best and for whom. There are multiple factors that weigh in on the treatment decision. These include severity of injury, accompanying soft tissue damage, presence of any loose bodies inside the joint (e.g., bone fragments, pieces of cartilage or meniscus), and how recent was the injury. Most kneecap dislocations are lateral patellar dislocation. Lateral means the kneecap moves away from the midline (toward the outside of the knee). When that happens, the structures along the medial (inside) of the knee are often torn or damaged. In particular, the medial patellofemoral ligament (MPFL) is usually injured. Studies have shown that half the restraining force holding the kneecap in place comes from the MPFL. Successful treatment must address the condition of the MPFL. If it's torn and is not repaired, then the chances of recurrent patellar dislocation increase dramatically. Successful outcomes may depend on the type of surgery performed. Arthroscopic repair reduces the risk of injuring blood vessels and nerves in the knee. And any loose fragments of bone, cartilage, or meniscus can be removed easily. But complete rupture of the MPFL at its femoral attachment may not be seen and cannot be restored fully by arthroscopic surgery alone. There may be other soft tissue injures that remain unidentified with arthroscopic repair. The surgeon relies on MRIs to help identify the location and extent of soft tissue damage. Once you have been examined and necessary imaging studies have been done, the surgeon will be able to give you a better idea of what to expect for treatment and rehab. Be sure and let him or her know about your upcoming marathon, goals, and the time line involved. All of this information can be taken into consideration when forming the best plan of care for your situation.


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