I need to know if I need a second opinion on the treatment of my MCL injury.

[lmtt]

I need some medical advice.  I have seen an orthopedic surgeon and I don’t know that I feel confident that he is giving me the best medical care.  I slipped and fell 6 weeks ago in the evening.  I hurt my knee pretty badly.  I stayed in bed the following day, and then went in to urgent care the following day (Wednesday).  X-rays showed no breaks, but a severely dislocated patella.  Initial diagnosis: sublaxation of the patella.  When I got in to see the orthopedic specialist two days later, he did not order another x-ray.  There wasn’t much he could tell from all of the swelling by palpitation.  He diagnosed an MCL injury and a need for MRI to see the extent.  He assumed that an MCL reconstruction would be necessary.  I asked what the conservative approach would be.  He said that we could keep it immobile (braced) for 6 weeks to see if it would heal on its own.  I kept my knee straight for 6 weeks, which is no small feat.  Fast-forward 6 weeks, I went in for a follow-up and he moved the knee in two different directions, checked the mobility and ordered PT. His PT order states diagnosis as:  patellar dislocation, left, initial encounter and sprain of medial collateral ligament of left knee, subsequent encounter.  I was in and out in 5 minutes.  He said I could bend it on my own carefully, wear the light brace if it helped or not.  He didn’t give me any warning signs, didn't ask me about swelling or continued obvious heat in the knee, nor did he tell me if the dislocated patella had moved back into place, nothing.  Do I go forth with the PT or get a second opinion ASAP?  The “good” orthopedic specialists in my area book out a good ways.  

Thanks for any advice you can give.

[lmttgimp]

Thank you for the reply.  I'm more than positive that the kneecap was completely dislocated, but did move back into place on its own.  Within the first two days, I had an xray done that showed continued displacement, but I beleive that it is healing normally.  I kept the knee braced and completely straight for a full 6 weeks.  I have been doing physical therapy for 5 weeks now.  My knee still only has about 95 degree range of motion.  There is an audible crunching noise when my knee extends from a bent position.  My orthopedic specialist has prescribed continued physical therapy.  I have not had an MRI to assess damages.  If PT shows significant progress, do you think a second opinion and/or MRI is necessary?  

[lmttgimp]

Thank you for the reply.  I'm more than positive that the kneecap was completely dislocated, but did move back into place on its own.  Within the first two days, I had an xray done that showed continued displacement, but I beleive that it is healing normally.  I kept the knee braced and completely straight for a full 6 weeks.  I have been doing physical therapy for 5 weeks now.  My knee still only has about 95 degree range of motion.  There is an audible crunching noise when my knee extends from a bent position.  My orthopedic specialist has prescribed continued physical therapy.  I have not had an MRI to assess damages.  If PT shows significant progress, do you think a second opinion and/or MRI is necessary?  

[KaleemMohdBPT]

hi...Sorry to hear about your ongoing knee problem...

If the kneecap has been completely dislocated out of its groove, the first step is to return the kneecap to its proper place. This process is called reduction. Sometimes, reduction happens spontaneously. Other times, your doctor will have to apply gentle force to push the kneecap back in place.

A dislocation often damages the underside of the kneecap and the end of the thighbone, which can lead to additional pain and arthritis. Arthroscopic surgery can correct this condition.

If the kneecap is only partially dislocated, your doctor may recommend nonsurgical treatments, such as exercises and braces. Exercises will help strengthen the muscles in your thigh so that the kneecap stays aligned.

Research has proven that surgeons who typically perform more than 25 surgeries a year have lower complications rates.

[caregiver222]

First off, the treatment protocol seems reasonable. That being said an X-ray doesn't show much. An x-ray does not meet the "standard of care" criterion, circa 2016. You absolutely positively need an MRI. Based on what that says, get a second (or a third) opinion.