Patrick Mahomes right knee patellar dislocation: Explaining the injury & why it’s a best case scenario

Chiefs QB and reigning NFL MVP Patrick Mahomes suffered a dislocated patella (kneecap) on his right knee while attempting a QB sneak vs the Broncos on 10/17.

In this article, I’ll explain the injury itself, why his diagnosis was a best case scenario, and when he’ll be back.

If you vibe more with a video format, I also have you covered:

The injury

Anatomy

The kneecap aka the patella is a triangular bone that bridges the femur (thigh bone) and shin bone (tibia).

Anatomy: Surface level

Superficially, it’s surrounded and supported by multiple tendons including the quadriceps tendon and patella tendon/patella ligament and muscles such as the adductor group and IT band.

Anatomy: Deeper

Deeper, the patella sits in a groove called the trochlear groove and is surrounded and stabilized by a group of ligaments called the patellafemoral ligaments.

Mechanism of injury

The patella naturally has some play and shifts around. The amount of play, however, varies from person to person depending on variables such as ligament laxity and medial to lateral muscular tension.

However, with enough force, the patella (kneecap) is knocked out of the trochlear groove. This is known as a patellar dislocation and most commonly happens to the outside (laterally), as was the case with Mahomes.

This dislocation stretches and damages the stabilizing anatomy around the patella. The severity of the injury depends on how badly those structures are damaged.

Best case scenario

In Mahomes case, we learned that he suffered a patellar dislocation with “no significant damage to the underlying tissue”. It’s likely that Mahomes suffered only mild damage to his medial patellafemoral ligament which accounts for roughly 60% of medial stability of the patella. That’s essentially a best case scenario.

The Chiefs training staff played a key role in limiting that damage as they immediately reduced the dislocation (popped the kneecap back into place). This short time frame between dislocation and reduction was critical because it reduced how long those stabilizers were stretched and under stress and further mitigated the amount of swelling under and around the patella.

Return to play (RTP) timeline

A mild lateral patellar dislocation typically has a variable return timetable of three to six weeks depending on how quickly or slowly things play out in rehab.

Mahomes was likely initially placed into a straight leg brace to allow for healing with an ongoing physio program to maintain knee ROM, address potential muscle tightness on the lateral (outer) part of the leg and knee which can pull the patella laterally, and strengthening of the surrounding musculature.

The Chiefs themselves haven’t given an official timeline but initial reports pegged the projected timeline as three to five weeks. However, that timeline may not be accurate.

Mahomes was back at practice a week after the injury but he was only participating in straight line drills as part of his ongoing activity progression.

He was ruled out of the Packers game with Coach Andy Reid saying “he’s just not ready right now” and that he’s “close” to returning.

From those comments, it sounds like Mahomes could be ready to play vs the Vikings on November 3rd. The key will be how he responds during and after activity progressions this week, with the rehab staff assessing day by day for pain, tenderness, and movement confidence.

If Mahomes is able to tolerate lateral movement and cutting – both of which place a significant stress on the patellar stabilizers – I’d expect him to play.

The major risk moving forward

There’s one major, undeniable risk after a patellar dislocation: Re-dislocation.

Research shows that nearly ⅓ of individuals suffer a subsequent patellar dislocation after the first one, with nearly 50% of those recurrent dislocations leading to chronic instability in the kneecap. For that reason, recurrent dislocations are often treated with surgery.

That risk for recurrence is further magnified in the NFL due to the frequent high force contact.

For that reason, Mahomes’ ongoing strength and conditioning program will be crucial for optimizing the strength of the patellar stabilizers and he’ll very likely wear a specific knee brace that resists lateral movement of the patella.

Additionally, Mahomes will have to carefully calculate the risk/reward of taking contact and the coaching staff will have to limit his exposure as well. As they found out, even a relatively tame call like a QB sneak can lead to an injury.

All in all….

A patellar dislocation can be a serious injury but Mahomes looks to have avoided that based on reports and his quick return to practice. He certainly looks to be tracking for the earlier side of the purported three to five week timeline.

If the team continues to play relatively well with Matt Moore – product of my hometown high school Hart High – there’s a possibility the Chiefs decide to hold out Mahomes out longer, especially if it also allows Mahomes to fully recover from the left high ankle sprain he suffered in week 1 and re-aggravated in weeks 5 and 6 which clearly affected his play.

That being said, if the team’s approach and Mahomes production after his high ankle sprain is any indication – he missed no time with an injury that typically takes four weeks to recover from and in week 2 put up a paltry stat line of 12/17 for 278 yards and four touchdowns vs the Raiders – he’ll be back as soon as possible with guns blazing.

That’s a wrap for this piece, thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and twitter @3cbperformance. Make sure to sub to the blog below and the YouTube channel for the latest updates. 3CB out.

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