The second opinion Dr. took some xrays and looked at my MRI. He says that there's no point in going back to physical therapy before surgery, but I should still continue as many of the exercises as I can. Balance ones especially will be key.
The good news is that my first doctor knows what he's talking about; The doctor I saw this morning went through and explained each part of the diagnosis on a 3D model of a knee, and went through my MRI and showed me exactly how the TT-TG is calculated and why I'm further from the norm than is safe for my knee, given how short my tubercle is. He also showed me on the model where each thing is, and how it's supposed to be.
The bad news is that the first doctor knows what he's talking about; He strongly recommended the fulkerson's osteotomy in my case, and said that simply repairing the damage to the ligaments isn't going to be good enough, and that there's a reason I dislocated the first time. He also says I'm "loose jointed", meaning my joints naturally go past 180 degrees, or hyperextend.
There was one very interesting difference in the diagnosis, which I don't think really matters in terms of my overall outcome. The new Dr's opinion is that the ligament is actually not as damaged as we think, and that it's likely not going to have to turn into a reconstruction. He says the reason that it's done being a ligament is that it's pulled of a chunk of the bone that it was attached to (see the image below). That's great, in that they may not have to do a graft from my hamstrings, and can repair the existing tissue and attach it to the main chunk of kneecap, so it can go back to being a ligament. He says that in his opinion, the small chunk will need to be removed. The reason this doesn't matter, is that my OS will still need to open up the knee and assess the tissue to see whether I need a full reconstruction for the MPFL or not.
The new doctor also had some key differences from my current OS in terms of how he structured my visit. He described things I should be doing right now to improve my chances, and even though I knew most of what he was saying already, it was nice to be told by a medical professional that I have the correct idea. He also says that I should be able to walk with the straight brace and no crutches after a few weeks, if the brace is a good fit. That's really exciting. Granted, it'll be a limp, but that's really good news.
He suggested that in addition to my physical therapy exercises, it might not be a bad idea to try and really push to drop a few more pounds before the surgery (every 1 pound you weigh is 10 pounds of pressure on the knee joint). I went into 24 hour fitness and spoke with the fine folks there about setting up something similar to what i was doing in physical therapy, but with a heavy focus on building the right muscle groups (quads!! hamstrings! glutes!!) and weight loss. I weighed myself this evening, and it turns out I'm down more than I thought- about 35 pounds in the last year. I thought it would be less, given that my weight loss really hit a plateau the past few months, and I went from losing a ~3-4 pounds every month, to about one per month since my dislocation in May. It's a vicious cycle that I've had problems with since high school-- Less physical activity makes the knee heal and feel better, but you stop losing or put on weight; Start doing the things that make you lose weight, and the knee dislocates.
The strength training should have immediate benefits for me as well; I only have two exercises from physical therapy for quads, and neither is extremely demanding, so I'm really hoping they can help me build up my repertoire for both pre and post-op strength gaining. Obviously they are a business selling me on a product, but I want to be hopeful that they can really help me get into the best possible position for recovering from this thing. Given how much pain I'm in (and that I'm already facing surgery), I don't really have anything to lose.
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