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.