Most fans know that Patrick Mahomes, the Kansas City Chiefs' quarterback, dislocated his patella (kneecap) last night in the Denver Broncos game. Let us clarify this: it was his kneecap which has shifted – not to be knee a great distinction.
This injury is common in contact sports with first-onset traumatic dislocations, accounting for about 3% of all knee injuries, according to a recent study.
While we could not see when the injury occurred at the bottom of the pile, what we saw was an excellent attitude, as a doctor caused Mahomes to relax and stretch his leg and patella to reduce or "shift" the back to its anatomical position. This is the preferred and correct method for acute treatment of the injury.
As can be seen in the picture, the patella moves laterally outwards from its normal position and rests there until it is shrunk by itself or by a service provider.
Although this seems rather innocent, there are actually several consequences that need to be considered here.
First of all: Was there any obvious breakage of the patella itself or the lateral femoral condyle, and if so, to what extent is the damage? We've been told by reports that Mahomes has not suffered A fracture that occurred last night due to x-rays in the stadium is the first thing to be dropped from the list.
In some cases fractures may involve loose bodies associated with patella or femur injury. Second, we must consider the area in which the patella is anatomically referred to as ] Trochleafurche . Was the patella damaged when it was expelled from its normal resting place?
Third and perhaps most important: Was there damage to the so-called medial patellofemoral ligament (MPFL) and medial retinaculum? Job.
One of the main reasons why we as clinicians are so concerned about the medial structures involved in this injury is the fact that compromising dramatically increases the likelihood of a new dislocation.
This injury usually occurs in the most acute and for the first time with a swelling – in others, the chronically slip, less. There is a correlation here that states that a larger volume of swelling tends to indicate the level of damage to the medial structures.
The reason why MRI is so important here is the examination of the surfaces of the patellofemoral joint and the determination of the location / level of any soft tissue damage to all the above-mentioned medial stabilization structures.
The other scary part is that some fractures of these injuries are missed by X-rays alone and then identified by MRI or surgery, up to 30-40%. A CT can be helpful here if a fracture diagnosis is questionable.
After diagnosis and damage assessment, the biggest question arises.
Does the amount of damage require immediate intervention or is non-OP treatment acceptable in the short term?
Again, it all boils down to how the medial support structures work, and there are joint cartilage defects that would be exacerbated by playing. It is always assumed that these patients have this cartilage damage until it is excluded due to the violent nature of the injury.
If a player is non-operational and has no associated damage, I've seen athletes play fast here, though we were usually deluded on first-time dislocations, just to be on the safe side. Chronic stalwarts will notice they dive in and return to the next game or series. This is not the case here.
Rehabilitation consists of strong swelling control and early protected movement. Timely recovery of the larger quad muscles is the key to a speedy recovery. I've seen many cases where a rehab was originally tried and that did not work because of the questionable stability on the knee.
Positional and athletic requirements must be considered as well as – this is Mahome's right leg and is in a factory / post position during his throwing motion and kickback.
The End Result
If reconstructive surgery is required to treat either articular cartilage defects or medial support structures, this would likely end the Mahomes season due to the recovery time.
Even though Mahomes can play this injury now and recover within a few weeks. There is a possibility that surgery may be performed after the season has ended in order to address the problem in the long term, as the factors for chronic failure are not particularly important to a professional footballer.
In short, chances are good that Mahomes will need to treat this problem someday to be more successful in the long run.
Aaron Borgmann is the founder of Borgmann Rehab Solutions . He spent 12 years in the NFL as an assistant sports coach and physiotherapist before moving to Arrowhead Pride.