My Patellar Dislocation and Torn MPFL Initial Injury
How I injured my knee and came to need MPFL Reconstruction
Since I’m chronicling how I ended up with a torn medial patellofemoral ligament (MPFL) in May, and my journey through MPFL reconstruction surgery this October, I think it’s fitting that my first entry explains how I injured my knee in the first place.
The Initial Injury: May 17th, 2017
The day was just as ordinary as any other; it was happier actually — I’d spent the entire day with my friend Adrianna and her family, celebrating her graduation from George Mason University that afternoon, and I had a standing invite to tour DC museums with them the next day. Upon returning home that evening, I began doing a bit of light cleaning; my friend Alyssa was going to be visiting in a week, and since I’d gotten some leftover meatballs (yum!) from Adrianna’s graduation party, it occured to me to defrost and clean a mini-fridge I have. I dislodged a large chunk of ice and carried it to the bathroom for disposal, but I bumped a wall, and it fell to the floor, breaking into pieces all over the tile. I thought little of it; there were so many pieces I figured they would just melt and evaporate, and to be safe I’d leave the light on to remind me to be careful if going in there the rest of the night — this was my fatal mistake.
Less than an hour later, around midnight, melting ice being the last thing on my mind, I wandered to the bathroom for regular use. Taking just one step onto the dimly lit bathroom tile whipped my full body weight on my left leg sideways into the cabinet, twisting my body 180° as I fell down hard. I landed on my back facing the door I’d just stepped through, and screamed in the most agony I’ve ever experienced in my entire life. I’d felt and heard my knee “pop” on the way to the ground; at first I though I’d broken my leg, but after a few minutes of screaming probably the loudest I’ve ever screamed in my life, I realized the pain I felt was probably a knee dislocation. In my childhood, around age 7 or 8, I fell down a staircase and dislocated my left shoulder… that was uncomfortable, but it didn’t hurt.
The pain wasn’t subsiding, but I’d come to grips with the initial shockwave, and I knew I had to deal with whatever I’d done to myself — I have to get my leg straight immediately. Due to how I fell, and the pain’s intensity, I was still flat on my back and unable to sit up. To my surprise, I was able to straighten my leg without increasing the pain, and suddenly I felt a *pop* and at lot of the pressure dissipate — thank God, this told me it was a dislocation before I’d even been able to sit up. The pain was still incredible, and I laid on my back just catching my breath for probably another 5 minutes, at which time my Dad finally got there to help me. He’s suffered knee injuries before, and had grabbed his old knee imobilizer, and I’m lucky he did, because using it, standing with his assistance, and then moving with his old crutches is the only way I was mobile at that point; I was no longer able to bear any weight on my left leg, nor bend it in any way. Putting even slight weight on that leg caused it to buckle.
I knew it was a dislocation, but with the pain intensity I’d experienced, and the severity of the fall onto that exposed joint, combined with my inability to use the leg, I annoyingly had him take me to the Emergency Room to get checked out. They took x-rays and confirmed it was only a dislocation with no fractures. What surprised me was they indicated it was a patellar dislocation (dislocation of the kneecap), and not a knee joint dislocation like I’d thought. They explained that the patella can slide sideways outward during quick twisting motions with sudden stops, and that knee joint dislocations are much more rare and very serious injuries — knee joint dislocations can actually rupture blood vessels and sever nerves, causing painful numbness in the shin, and cut off blood supply to the lower leg; if this injury isn’t caught quickly, one can actually lose the leg due to insufficient blood supply. My x-rays and symptoms of course didn’t match this, so I was referred to an orthopedist for patellar dislocation follow-up, and sent home with some Percocet (which I quickly found were like taking sugar pills — what gives?; it worked wonders for my wisdom teeth! Aspirin is what did the trick.).
By 3AM I was back home, my leg secure in a new and well fitted knee mobilizer, new lightweight crutches under my arms. With great disappointment, I texted Alyssa on the drive back explaining what I’d done, joking that while yes, she’d guessed correctly about the trail I was going to take her hiking (Old Rag Mountain), but that we’d have to do it another time given the severity of my injury; she’d have to settle for Netflix marathoning during her stay. I also shot a note to Adrianna explaining what I’d done, and that I wouldn’t be able to join her and her family for museum-hopping the next day (to my surprise, she and her mom dropped by the next day to see how I was doing!).
Orthopedic Analysis
It wasn’t for a week before I could be seen by a highly recommended orthopedist at OrthoVirginia, which is Northern Virginia’s largest sports medicine orthopedics office, and official sports medicine provider for the George Mason Patriots. I specifically wanted to see a sports medicine doctor because of their emphasis on return to full sporting activity, not just a “good enough to get around” approach for recovery.
My first visit to the office was fairly straightforward; my orthopedist examined my leg, including the knee and my passive range of motion, and shows me some details about my x-rays. After performing an apprehension test (I failed), he showed me that my x-ray revealed I have Trochlear Dysplasia (a shallower than normal patellofemoral groove) and Patella Alta (an abnormally highly placed patella). He told me that the two conditions predisposed me to a patellar dislocation injury, and quite frankly he was surprised I hadn’t already had this type of injury. 90% of patellar dislocations result in tearing of the medial patellofemoral ligament, which is the ligament which holds the patella in place laterally while the knee is in full 0° extension to ~30°; after this point, the patellofemoral groove grips and holds the patella in place from ~30° to ~120°. He ordered a set of MRIs to check for full extents of damage, but he preliminarily told me I probably don’t need surgery. Fitting me with a J-Brace (a compression brace with a band to grip the patella and hold it in place), I am sent on my way and told to perform leg-lift exercises to begin regaining function of my muscle groups — they weren’t working, causing my leg to buckle, and are caused by the nerves as a defense mechanism against further damage.
The MRIs were easy; they took under a half hour for the whole group of images. I downloaded a reader to save and view my own images before I was able to follow-up with the orthopedist — I was very nervous to try and decipher if I need surgery or not. Looking at my MRIs, with no formal medical training, the torn MPFL was very evident, as it lit up like a Christmas tree. With that same lack of knowledge, however, I saw bands around my meniscus which I thought was a meniscal tear; this proved to just be excess fluid caused by inflammation of the MPFL injury. Let this be a lesson to you; it’s ok to be curious, but be smart about it, and don’t get yourself worked up — know and accept the limits of your knowlege.
My orthopedist showed me the key features on my MRI, which included the torn MPFL, and further proof of some degree of Trochlear Dysplasia and Patella Alta. He told me that meniscus was fine, as was my cartilage, and I have no loose bodies in my knee. Actually he said I got lucky — the MPFL was the only thing I had damaged, in a type of injury that commonly is paired with damage to other ligaments and structures.
So that is when I finally got the answer to what I’d been dying to find out all week; do I need surgery? My orthopedist explained to me that since the MPFL has been torn (and they don’t heal), I am all but guaranteed to continue to have patellar dislocations. The MPFL acts as a leash for the kneecap for the first 30° of flexion until the trochlear groove takes over, and since that leash is now severed, it’s not a matter of if, but when I have another dislocation. He explained it to me like this; it could be in 10 days, it could be in 10 years, but at some point I will have another dislocation, which will be just as painful as the first one, and has the potential to damage other structures when it happens. This means I could go on living without the surgery; I don’t *need* it, but getting it fixed now will prevent further dislocations and other problems down the road.
So there I had it; I could live without surgery, but as a preventative measure it made the most sense. Coming from a background in preventative maintenance, and knowing my family tends to end up with arthritis, I opted to get my knee fixed; my doctor made a good point; I’m going to end up with an MPFL reconstruction at some point in my life — it’s best to do it while I’m still young, able to heal and rehabilitate easily, before the looseness causes arthritis, and so I don’t have to worry about more seriously injuring myself. My orthopedist assured me that I will be able to play any sport I want within 6 months; baseball, basketball, track & field, or in my case, hiking and biking. I said let’s get it over with.
