Dance With Dislocated Pretella Can I Dance Again

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I am a professional ballet dancer whose left patella has been subluxing and dislocating since childhood. It rarely happens now in everyday movements, but for the past 4 years it has dislocated in rehearsals and gotten stuck. I put it back in by straightening it and it is usually fine, though traumatized, within a few days. I have done lots of pt and am very disciplined in working on strengthening my vmo. But the dr says I could just have a very small vmo and not much more could be done to strengthen it. I have very hyperextended knees and the patella rides high and does not fit into the femur quite right (is most probably tilted too). Besides being noisy (cracking when bending), my knees usually feel fine.
The last time I dislocated it (about 2 weeks ago), I knew something was different. The swelling did not go down for a week and I finally had an MRI. Without showing me the films, my dr says I have a horizontal medial meniscus tear. This does not surprise me as I have pain and weakness and have known many who have had arthroscopy for this. But the dr has suggested I have lateral retinacular release surgery as well to prevent more dislocation. I am already out for the rest of the season and will be laid off for the summer (except for teaching ballet), so it may make sense if it is necessary. However, after reading all the info on this site (such a great site!), I am very leery of this surgery and feel I should just have the meniscus repaired and try to keep dancing. I do not think I will have a much longer professional career (I am 26), and I would like to be able to have a somewhat active life forever. On the other hand, this has been a huge worry in my life for a long time, and if it meant I could dance longer and even rollerblade (!), it may be worth it. It sounds to me most people have not been happy with LR and TTT is often needed at some point. My dr did not even speak about TTT.
I will definitely be getting a second opinion. It seems to me that my dislocation problem is not because the outside tissues of my knee are tight but because the joint itself is too loose and the vmo is underdeveloped. So why fix what is not broken? I would love to hear everyone's expert opinions. Thank you so much for your time and interest.

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Hi Rebeks,

My problem was definitely an overall looseness in the joint and underdeveloped VMO (I couldn't even do a straight leg raise before my surgery), so I had the TTT and LR (with medial plication to tighten the VMO) on my right knee. �My patellas are genetically high and tilted, so it really was the ideal operation for me specifically.

I was extremely athletic before my surgery, and I intend to be at some point in the future, but I admit that 7 months in I'm still having some doubts about the future of my knee and how active I'll really be able to be when it's all said & done (mostly I think that's just b/c the recovery is taking so darn long... my OS & PT both tell me I'll be back to normal w/in another ~5 months). �My operation wasn't urgent... it probably could have waited a few more years b/c I wasn't in any pain, but it seemed like an ideal time in my life to be able to take some time to rehab after a major surgery. �Plus, salvaging whatever articular cartilage I had left seemed like another urgent issue. �Anyways, the recovery is taking WAY longer than I expected and I know there's nothing more I could be doing to further it along faster, so it's been a little frustrating and I can't imagine being a sports professional of any sort and STILL not being able to get back to regular practice routines, etc. �It's been taxing enough on my cushy student life.

So given that you are a professional dancer I think it sounds realistic that you are thinking about just having the meniscus repaired so that you can keep dancing for a few years and then possibly opt for a greater operation at a later time. �If you can safely dance and are not worried about causing too much damage to your knee joint in the mean time (this is definitely something to ask your OS about, though), I would advise waiting in order to prolong your career. �If you're having subluxations and your medial structures aren't overly strong/tight then you're probably right about a LR alone not being a very good option. �

I'm certainly no expert, so don't take my every word on this...but... for most people I'd say go ahead and have the whole procedure done (w/TTT). �However, since your career is at stake (even if just for a few more years) and recovery time is unpredictable, it makes this a much tougher decision. �All in all this seems to be a matter that only you and your doctor (or several OSs that you see) will be able to figure out. �I think you need to find someone with whom you can discuss these options frankly and is well aware of your need/desire to get back to dancing & rollerblading, etc. �You should not only discuss the outcome of one operation, but of several different options and possibly what you can expect YEARS down the road w/and w/o each procedure. �Then hopefully you will be able to make a wise decision regarding your future. �

Best of luck. �Let us know what you decide,
Marie

« Last Edit: April 26, 2004, 04:36:32 AM by Marie »

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24y/o - had subluxing right patella, frequent dislocations, osteoarthritis.
Sept26/03 - TTO, scope, LR, medial plication & microfracture (right).
Slow ROM recovery (126).
My new PT is awesome!!!

I had a LR on my L knee which failed after numerous dislocations, subluxations and years of pain. I was active before the surgery and again after I completed my recovery, but the pain etc didn't get better. Had a TTT almost 2 years ago and that did help alot. No dislocations since but sometimes still pain. Nothing that I can't deal with. When i had my TTT I was convinced that I would never go for a LR but immediately have a TTT on my other knee... now it is possible my OS will need to scope my other knee (know for sure after my MRI May 2nd) and I asked him that he'll do the LR while he's in there....

A LR is only effective to correct patellar TILT, not tracking. That explains the high failure rates, because it's often done for the wrong reasons. My R patella is badly tilted also so that's why I would try it again IF they have to scope my knee.

Good luck!

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Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Hi Rebeks -

My only advice would be to make sure your OS specializes in sports medicine if you intend to keep dancing for a few more years. I'm willing to bet you might also find, somewhere, a surgeon who specializes in dancers, too. It's up to you, but while I'm thrilled with the results of my recent TTT and looking forward to having the other one done, my quad is still not quite strong enough to allow me to run beyond a slow jog and I am about 8 months post TTT (I also had a ligament reconstruction as well). I do walk several miles per day, though, and am even doing some squats now though slowly and carefully (I still need my left knee done and it dislocates frequently).

Good luck.

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1982 - R patella tendon transversal
1983 - L patella tendon transversal
2003 - R TTT and patella medial ligament reconstruction
2004 - L TTT and PMLR

Hi, it's Rebeks. I haven't visited for a while because I was doing so great. I saw a new doctor who looked at my films and said I do not have a torn meniscus! This was confirmed by a radiologist friend. So I stuck with this doc and have been doing pt since. I returned to ballet the last 2 weeks of the season, and was headed on a nice road to recovery. Except my kneecap dislocated again on July 1st, while in a ballet class. I was doing so well! pt 3 x a week, private pilates sessions working on alignment and proper muscle usage and teaching ballet. Thing is, the ballet company is laid off for the summer, so I was taking classes when I could to keep working on getting in tip top shape for the beginning of the season at the end of august. That's when it happened. I know I was pushing myself but was not aware of the pain because my dr had put me on Bextra only a week or so before. This makes me angry, but I cannot change the past.
Well, now my doc of course recommends TTT and this scares me to death. In all likelihood I will not dance professionally again, (which she wouldn't really say but I know what taking a year off does for a dancer). When I asked, she said quitting dance may not guarantee that the dislocations will stop but then again it may, considering it's happened the past few years only when I dance. However, I do want to remain a somewhat active person throughout my life, and this dislocation may stop me from that. The doc did not go over which method of ttt would be best and I really did not learn much, probably because I was so emotional. I would like a second opinion, I think. Besides this stress of future life decisions, the worker's comp ins is now disputing this because this time it happened when I was laid off!!!! If I quit dancing I will have no health ins, besides no income!
I have read people's accounts of recovery from TTT, and sorry, but it makes me sick. If anyone out there could please explain to me what exactly is done during the surgery, I'd really appreciate it. Like how do they lift the patella up and it still looks like the same knee? Or does the operated knee look and feel completely different? Thanks.

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« Last Edit: July 14, 2004, 12:56:25 AM by Helena »

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« Last Edit: July 14, 2004, 05:27:32 AM by cat »

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"Miserable malalignment"
Lateral release, medial reefing, VMO advancement, and TTT-� 3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Thanks for the info. I did find it helpful. Helena-I have a hard time seeing the problems from the knee pics. This could also be because I have never actually seen my knee dislocated, I always pop it back in as soon as I fall. The after surgery pics showed no scar-do you have any, either of you? thanks. -rebeks

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Something that a lot of fellow-kneegeeks might have experienced...

A patella dislocation

OUCH!

PS NOT my knee

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Helena,

That picture is worse than the one of the tarantula I posted! OUCH!! I've seen that on my own knee, but only once. And luckily I was able to reduce it myself (accidentally) by straightening the knee....ouch. Makes me queasy to think about it, and that dislocation was over 20 years ago!!

Heather

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Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

thanks for all the pics guys. That surgery looks like a long and drawn out process... I am at the mercy of the insurance company right now, so no new news on my decisions. I so appreciate all the info, help and advice though!!

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Ahhhh...that picture just looks so familiar to me. Well, except for the fact that my legs are quite a bit more tan and not hairy

Fortunately I haven't had a lateral dislocation in a while, but now just picture that lovely kneecap on the medial side of the knee and you can picture what I look at pretty much at least once a day.

-Heather G.

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Rt. knee-plica resection, LR, 4 TTTs, MPFL repair & 2 MPFL reconstructions
Lt. knee-2 TTTs, & 2 MPFL reconstructions...
Scheduled for bilateral hardware removal, lt. knee TT revision, MPFL recon and LR recon with new wonderful surgeon.
Plus 9 other orthopedic surgeries

shookflosoney.blogspot.com

Source: https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=7695.0

Shook Flosoney

Dance With Dislocated Pretella Can I Dance Again

Topic: back to ballet (Read 3340 times)

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