Just when you thought draft photos couldn't get any worse, this happened.

 

Rangers’ development camp didn’t go as planned for prospect Dylan McIlrath, as he suffered an injury that’s on the OH CRAP end of the hurt spectrum. It’s one of those things that results in horrified facial expressions and a cold sweat in people who’ve experienced it. It doesn’t sound like much, but it’s an unforgettable and truly disgusting experience. What Dylan McIlrath did was dislocate his kneecap.

McIlrath and Kyle Jean hit knee-on-knee in a scrimmage, and while Jean walked away with a two-year contract in the Rangers’ organization, McIlrath limped away with knee surgery and no clear idea of when he’ll be able to play again.

Okay but seriously – a dislocated kneecap? Who cares?

It’s hard to adequately explain how horrifying this injury is to someone who hasn’t experienced it (I’m not suggesting you go bang your knee on a wall in a misguided attempt to really understand). The combination of searing pain, a leg that won’t move, and a knee that looks like no knee should ever look is only overshadowed by the fear that someone might force you to move that joint. With that fear comes a firm belief that were that joint to be moved, the universe would end. It’s that bad.*

*Note: It’s probably not that bad, but it sure felt like the end of the world when I did it.

I’m not convinced. It’s just a kneecap.

Your kneecap (or patella if you want to get fancy about it) is a bone that sits on the front of your knee joint. It’s held in place by an assortment of tendons and ligaments, and it’s supposed to glide smoothly in place as you bend your leg. A direct blow to the knee or a sudden twist can cause the kneecap to get forced out of its groove, leaving it in a truly inappropriate (not to mention painful) location. Most commonly that location is on the lateral side (outside) of the knee joint. Once it’s there, the joint won’t want to bend, and you won’t want anyone bending it.

YES!

NO. NO WAY. NOT COOL.

The first figure above above demonstrates a normal kneecap. All is well in that knee’s world. The second figure is an x-ray of pure hell. The kneecap is way off to the side where it doesn’t belong, and although it’s not visible in the x-ray, the owner of the leg is likely getting ready to punch anyone who tries to touch that leg.

Fine, it hurts. I get it. So what do you do?

If you’re lucky, you didn’t tear any tendons or ligaments. Also if you’re lucky it was a simple lateral or medial dislocation. Those dislocations are fairly easy to reduce (put back into place), and often they’ll slip back into place on their own. If they don’t it’s a matter of holding on to the ankle with one hand, and shoving the kneecap back into place with the other hand while straightening the leg. Sound awful? It is! Often this is done without sedation because it’s so fast (but that’s a bogus excuse clearly thought up by someone who’s never had a kneecap go on a field trip to the outside of their knee).

Did I mention this looks disturbing?

If you’re not lucky, you’ve dislocated your kneecap in a more spectacular manner, like flipping it up onto one side or rotating it. You’re even more unlucky if you’ve fractured your patella or any of the bones in your leg. If you’ve done any of those you’re probably headed to the OR. The good news is they’ll sedate you there before they mess with your knee. The bad news is someone might touch that leg on the way to the OR (Reminder: The universe would end).

So what’s McIlrath’s deal?

Dylan McIlrath walked away after his knee injury, and yet had surgery later that week. Surgery is not the norm in patellar dislocations. Usually conservative treatment with splinting, medications to control pain and inflammation and physical therapy will have a good result. In a hospital situation you’d get an x-ray of the knee before and after reduction. In a hockey rink someone probably just shoves that kneecap back into place, and you limp off to the team doc for x-rays. There’s a distinct possibility that McIlrath’s x-ray showed something that wasn’t going to fix itself, like a bone fragment in the joint. If that were the case, it would be an arthroscopic fix (tiny cameras stuffed into the knee through tiny incisions), with about a four to six week recovery. The fact that the Rangers aren’t floating a timeline for his return is either the Rangers being the Rangers, or a hint that he had more than just a simple arthroscopic joint cleanout – something like a tendon or ligament repair, or a fractured patella.

So which is it?

In case you weren’t paying attention last season, we’re not going to find out anything more than we already know until the Rangers are good and damn ready to tell us. Best case is McIlrath is good in a month and a half. Worst case scenario is he’s not ready to start next season (presumably with the Connecticut Whale). The only thing that’s for sure is that for a brief moment on the ice, he stared horror right in the eye, and lived. Dylan McIlrath: Patellar dislocation hero.*

 

*No, seriously, it really hurts.

Comments (18)

  1. I’ve done it twice…its the worst pain i have ever felt..I went into shock the first time, so imagine your whole body is shaking while your knee is out of place..great memories

  2. Had my kneecap explode in 3 segment after a surgery for an ACL.

    At first, I thought it was my new ligament that didnt heal properly. I though I could pop it back in (didnt know it had broke in 3 pieces)

    Worst pain ever. After 3 try, my wife begged me to stop as she ( and me) were going to collapse.

    I know that all mother complains that giving birth is hell because it hurt so much, broking kneecap must not be far behind on the hurt-o-meter.

  3. Way to totally nail this injury, Jo. Having suffered a subluxation in January, this piece — and the comments — are really validating (i.e., it’s not just that I’m a huge wuss…:). Maybe it’s time for a patellar subluxation support group. @Le fan: I can’t even imagine what you went through.

    The only thing I’d add is the experience of actually having the kneecap dislocate. Your skate goes out from under you like you’ve been shot, you go down like a ton of bricks, and it feels like someone is repeatedly swinging a sledgehammer into the side of your knee, over and over.

    And then later, on the bench, when you get your shin guard off and look at that thing, and you realize that somehow, someway, you’re going to have to get that skate off…

    • THIS. Oh my goodness THIS. I have a poorly designed left knee, and the kneecap has subluxed laterally many a time(10+), though it normally pops back into place on its own. Last time, I was at work, and it got stuck looking like that picture(interesting to see it on someone who isn’t me).

      This article actually made me cry laughing because of the comment about anyone touching the knee getting punched. The paramedics I got outright picked me up… I, a 23 year old petite female, punched two of them on sheer reflex.

      I second the motion for a kneecap subluxation support/chat group…

    • This article describes the feeling of a patellar dislocation EXACTLY! I was laughing, even though practically having PTSD symptoms just thinking about it again. I’ve had one subluxation, and a dislocation fairly recently (5 years apart). It is most definitely the worst pain ever and difficult to describe or for anyone else to even imagine. And I can definitely identify with the thought of punching someone should they touch it. In fact, with my recent dislocation, rather than have someone else push the patella back in place, I simply did it myself! I knew it had to be done and was determined not to go through further hell by having someone touch it or go to a hospital and wait for x-rays, etc. I wasn’t even planning to go to a doctor until I realized that there was so much swelling that I should probably have it checked out, therefore went to an orthopedist 5 days later. He drained the fluid, which helped the swelling, but recovery is still EXTREMELY slow! I’m beginning to wonder if I’ll ever get back to normal this time!

  4. Jo have you heard about Sergio Romo? He’s a pitcher on the San Francisco Giants and apparently has a “trick knee” that sounds like it does this fairly regularly, and subluxed his knee around memorial day. It didn’t sound so bad then, now I’m making horrified faces at the computer screen.

  5. I play with a guy on Monday’s and he has a trick knee like that. he crawls to the bench and somehow twists his leg to get things in place again, all the while screaming his head off! Disturbing alright.

  6. I have laterally dislocated both kneecaps repeatedly – it sucks. For the most part, it’s popped back in by itself (thank goodness). The first time it happened to my right knee, it did this – but I ended up spraining my ACL at the same time so it wasn’t exactly pleasant. I also had no idea what was going on and was scared as hell.

    The first time it happened to my LEFT knee, I was with about 1000 others in a moshpit at a concert, and I had no idea what had happened except I had to find a way to walk out of the pit (no easy task) and pop it back into place.

    The most recent one was during a shinny game. Some idiot fired a high slapper as I was breezing around the net. I threw my arms up and tried to dive out of the way, caught a rut and popped the knee, and then fell on my elbow, fracturing it. Not the greatest game ever, but it’s the last time I played.

    Unfortunately I’ve had about 6-8 dislocations (2 of right, rest of the left) and it’s pretty much stopped me from doing any sports (even though I wear knee braces) for fear of it happening again. It’s terrifying to go through and I’m not really looking to do it again anytime soon.

  7. Dislocated mine 6years ago. Hit my knee to the floor quite hard. First it felt / looked like the whole foot had just bent backwards. Put it back myself.

    Hours after it had huge swelling. Couple a days after had blood etc drained out. Used a patella-support for about 6weeks, and after that the knee almost felt OK for 3years.

    But after that, the real hell began. My kneecap has been clicking etc every time I bend the knee, which is to say every time you get up / go down / walk the stairs / ride a bicycle.

    Let’s hope this kid heals up better.

  8. You folks are all so gross, and I love it. I dislocated mine by standing up from a crouch while turning to one side. STUPID STUPID MOVE. I wanted to die. Then I looked at my knee and I think maybe I did die a little bit. Awful.

  9. This is a terrible, terrible comment section. I’m never standing again.

  10. My sister dislocated her knee by, of all things, simply standing and getting out of a chair in her high school library. I made fun of her endlessly by getting hurt in such a ridiculous way. Perhaps I should call her up and apologize.

  11. I stubbed my toe once. It hurt pretty bad.

  12. I’ve dislocated my kneecap about four times (I stopped counting a while ago), but luckily it always returns to its correct place on its own. Actually, even though it hurt like hell the first time, each subsequent time it hurt less and less, but when there’s not as much pain, you can actually feel your kneecap moving around places it shouldn’t be, and boy is that a weird feeling.
    I wear a much more intense knee brace now, and there’ve been many times when I’ve felt the kneecap start to move to the outside, but the knee brace pushes it back into place. It (the knee brace) is a real pain in the ass (especially since the velcro is gone and I have to use hockey shin tape to keep it on), but it’s absolutely worth it to wear it.

    • What type of brace do you use? I’ve been using the Donjoy Tru Pull Advanced Knee Brace for the last 2 years which has been ok. Although once I dislocated my knee wearing the brace but it had gotten soft over a year of hard use. So I’m always looking for a better replacement.

      • Sorry for not seeing your reply earlier. I’ve got the Donjoy Tru Pull Lite (I needed something that wouldn’t restrict range of motion). I used it for equestrian vaulting for 5 years and other than the velcro straps, it withstood the abuse pretty well.

  13. Something something something intern.

    Something something something dark side.

  14. God, this article rang the familiarity bell.

    I’ve dislocated my knees eight times. Three of them have needed invasive (as in, not arthroscopic) surgery. Honestly, the first time was the wierdest, because it had never occurred to me that my body could break in quite that way. I sat there and stared at my kneecap (which at that point was almost beneath my actual knee) and all I can remember thinking through the shock was ‘huh, this is gonna hurt in a while’. In case you’re curious, it did hurt. A lot.

    I’ve dislocated my knees many times since. It seems to be a genetic thing with me. And yes, it hurts like hell every single fucking time. Not one of those injuries that gets easier, no, this one always feels like someone is ripping your leg off by your defective knee. It’s FUCKING PAINFUL.

    So every time I see some asshole go knee-on-knee, I wince. I know how horrible that injury can be. As far as I’m concerned, anyone who slewfoots deserves a 20year game suspension. That shit can screw up someone’s life.

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