Her scream reached a pitch I had never heard from her before. It was nine in the evening, and she was playing with her sister, engaged in lively roughhousing before bedtime. When I hurried out of the kitchen, I found her lying on her back, clutching her leg, and there was no mistaking a patellar dislocation. Without hesitation, I switched into urgent care mode, aided by my husband, and successfully reduced her patella. Seeing a dislocated patella is always visually unsettling, whether it’s your first time or not.
That night marked the beginning of a two-and-a-half-year ordeal of recurrent dislocations in both her right and left patellas. My daughter possesses a slender, leggy build, likely inheriting my hypermobility issues that led to patellar instability. Our journey led us to a local orthopedist who confirmed an avulsion fracture with an x-ray, one of many to come. An MRI revealed a tear in her medial patellofemoral ligament (MPFL). Treatment began with knee immobilization, progressing to a J-brace as the swelling subsided. She relied on crutches for weeks, followed by months of physical therapy.
The standard protocol dictates three dislocations before considering surgery. However, each time my daughter neared discharge from PT, another dislocation occurred, rendering her knees increasingly unstable. The physical challenges were daunting, compounded by the mental strain on a twelve- to fourteen-year-old. Sports became impossible, her range of motion was limited, and she became known as the girl with leg braces and crutches.
A turning point came when we connected with a surgeon advocating a different approach. This esteemed orthopedist is pioneering a revised protocol for first-time dislocators. Recent research supports that early surgical intervention (after one displacement) reduces recurrence risk and improves overall outcomes, particularly in pediatric cases. Repeated dislocations inflict cartilage damage beneath the patella, with long-term risks including progressive cartilage damage and arthritis.
At the urgent care, I have seen many similar patients and have done my due diligence in getting an x-ray and sending them to ortho. However, my daughter's struggle with repeated dislocations has made me wish a provider had educated me sooner on newer research suggesting surgery after even just one dislocation was shown to have better long-term outcomes. This information may have spared my daughter much suffering.
So often in medicine, we readily accept and educate patients on the status quo when it should be our job as clinicians to stay current on the ever-changing trends and evolution in treatment for various conditions. We can and should do better for our patients.
I'm pleased to report that my daughter is now three months post her second MPFL surgery reconstruction and recently completed a mile run without hesitation or pain.
