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Child Orthopedics
Spine - Cervical
Spine - Lumbar
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I'm in the military and on an intramural soccer team. I dislocated my kneecap in the last game. The physical therapist suggested trying a knee brace and doing a rehab program for six weeks. But this will keep me off duty and out of the game. If I had surgery to fix the problem, would I get back on my feet sooner?

Minimum time of recovery for an injury of this type is six weeks. Surgery would delay recovery by another six weeks since you would still have to complete the rehab program. Treatment is usually guided by your activity level, age, type and severity of injury, and the presence of any bleeding or loose fragments of bone or cartilage in the patellofemoral joint. The patellofemoral joint is between the patella (kneecap) and the femur (thigh bone). There is at least one study of military recruits published that compared surgical treatment versus bracing and exercise for patellar dislocations in active recruits. All patients had a traumatic injury either from a military exercise or a sports activity. All of the patients were in the military. Most were men between the ages of 19 and 22. The real question behind the study was: should a primary (first-time) patellar dislocation be treated right away with surgery? Or can it be managed nonoperatively with a knee orthosis (brace). What are the long-term results of both approaches? Everyone was randomly placed in one of two groups: either surgery or bracing. Except for gender, the patient make-up of the two groups was very similar. Surgeons performing the operations could use any surgical technique they thought was best. No one was told to follow a specific surgical protocol. The brace group received a knee brace designed to hold the kneecap in place. This is called a patellar stabilizer. Patients in both groups followed the same rehab program after their treatment. So, that part of their management was the same. The only difference was one of timing: the surgical group began the exercise program 24 to 48 hours after surgery. The orthotic group began their exercise program right away. Exercises were prescribed and supervised by a physical therapist. The main outcome measure was whether the patella dislocated (partially or fully) and whether another operation was needed during the follow-up period. Patients were followed for an average of seven years. What they found was that there were far fewer redislocations in the follow-up period for the surgical group. Nearly one-third of the nonoperative (bracing and exercise) group had a second patellar dislocation. If partial dislocations called patellar subluxation are included, then almost half of the nonoperative group had patellar instability. The authors concluded that early surgical stabilization and repair of the surrounding damaged soft tissue structures can reduce the risk of redislocation in young, active military recruits. Criteria for surgery used by these surgeons were: a traumatic patellar dislocation with ligament injury along the inside edge of the patella. This ligament is the medial patellofemoral ligament. You have a valid concern. But even more important is the question of whether or not you are at an increased risk of redislocation. In many places, a six-week course of conservative (nonoperative) care is the standard of care. If you can make a follow-up visit with the therapist, perhaps you can ask for an earlier reevaluation with these concerns in mind.


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