Medial Subluxation... NEED HELP!

[lisa424]

You need to find a surgeon that acknowledges medial instability. I know you don't want to travel but it may be necessary. The surgeons that don't acknowledge it probably weren't taught about it in med school so they're going around with their outdated surgeries and poor knowledge base. If a doctor tells you that medial instability doesn't exist walk right out. A lot of them are such egomaniacs that they won't admit that it's something they're unfamiliar with or don't know how to fix. Instead they'll try and convince you that you're wrong. You do not want a fulkerson procedure as that would create even more medial instability since the tibial tubercle is moved medially. Perhaps another TTT.

[Liftline62]

I'm willing to travel, but there's a cap on what I can do. I know it's hard to diagnose someone over the phone, but I would need confirmation from whoever I see that they accept that there are people with medial problems and there are solutions to them. For example, had I flown to my doctors appointment today I would have wasted all of that money and time for a 15 minute appointment that got me nowhere. I don't want to sound stubborn about the travel thing, but expense is a big thing... especially for a problem that many doctors have trouble accepting. For example, a family member had back surgery to correct scoliosis. My family traveled  by plane to Florida to have the correct doctor fix it. Scoliosis is a common problem that can be fixed relatively easily, whereas medial subluxation is not as common. I hope my logic makes sense, or that I have at least illustrated my view on the subject a little better.

Oh ok, thanks for clearing that up. I wasn't sure of the specifics for that procedure. Are there other procedures that move the tibia laterally?

[allyd]

I think when speaking with your OS that does in fact acknowledge the medial instability, just be straight with him. Explain that you have been doing a lot of research on the topic, and that you've read about various fixes, and are curious about how he thinks they may or may not be indicated for your knee.  I also don't think it's ever out of line to ask an OS how many cases of medially instability he's dealt with or how often he performs a specific procedure... This could be a good transition into asking for a consult/referral with someone who has more experience/specialization in PF problems.

Yes, I'm sure there is a TTT that would move the tibia tubercle laterally - It would theoretically be the same procedure as a Fulkerson, just a different direction. Like Lisa says though a Fulkerson specifically moves it medially.

You don't sound stubborn about the travel... Just smart.

[Liftline62]

Lisa424 - I got your message but it won't let me respond, I believe I have to post 21 times in order to send "personal messages"...? But I just wanted to thank you for specific names! I've actually looked into Dr. Grelsamer, it's within my range of a "day trip" to see a doctor so I will absolutely look into him again. Would you mind telling me more about him and how he works? Does he have reasonable availability when it comes time to schedule an appointment? I just ask because I'd rather not have to wait 2 months for a visit, but I've done it before, so if you've had a good personal experience with him I'd be more thank willing to wait. If you'd rather not discuss it publicly (sorry if you would rather me not have responded this way) you can send me another message... I should be at 21 posts soon.

[Liftline62]

[/b]Allyd[/b] - Sounds like a good idea. I just don't want to feel like I'm forcing him into something he doesn't want to do. Even though he is a professional and should know better than to be swayed by a patient to do what they want them to do, I just want to make sure I don't pressure him into it... although, that's obviously something I would discuss with him.

I definately agree that if the tibia can be moved medially it can be moved laterally as well, so I guess it's just an experience thing. Although, to be honest, having a surgeon preform a surgery for the first time on me doesn't really intimidate me. In my logic I would feel that whoever is doing it would be sure to take extra care and pay special attention and documentation of what they're doing. So if for some reason something would go wrong, it's easy to re-trace the steps. However, that's just my opinion on the matter. I realize it may sound farfetched, but hey, I'd want somebody to give me a chance if I was willing to try something new. I'll look into it.

I found a medical journal entry that talked about a 17 year old girl who had the exact same problem I have, and they fixed the ligaments with arthroscopic surgery, so I'm sure that'll  be something to talk to my doctor about too... actually, that article may have been referred to me from this website, so if it was I apologize for the repetition and my terrible memory.

[Silkncardcrafts]

It's important to realise that a lot of doctors and physios don't think medial instability of the patella exists. It is a very rare problem and there are very few that know how to fix it.

I was at a Sports Medicine conference a few years ago and the speaker, who is a well known physio didn't believe it existed. I actually posed the question to her how she'd fix it. When I said I knew someone with it she totally denied it.

Also, I know of two renowned Sports Medicine Practitioners who have written a book together that say medial instability doesn't exist.

So, the first start is finding someone that believes it exists. This will probably be your largest battle.

Getting some CT scans will definitely help too.

[Liftline62]

Silkncardcrafts - I don't disagree that having extra scans will help, but those are very costly out of pocket expenses, so I would need a doctor to request them. As of now, they only seem concerned about my MRI... which doesn't show much.

I've been researching and taking the suggestions of those who have recommended doctors. It is a struggle, but I'm hoping to be closing in on someone who is willing to solve this problem for me.

[Alicat]

which way is medial?

[allyd]

Alicat - Medial dislocation would be towards the inside (groin) of your leg. Lateral (most common) would be moving towards the outside.

[Alicat]

This is what happened when I dislocated my knee! I'm sure of it, it felt like the kneecap went up and inwards but one dr told me this was impossible and the other has written in my notes lateral, the first dr said that it would of been my thigh I felt go in and that my kneecap would have had to have gone outwards. Will sit and read the whole thread now

[Liftline62]

Alicat - So sorry to hear about your dislocation! My knee has never dislocated, so I can't empathize with you on that, but it is medially unstable and subluxes medially. Hopefully you'll be able to gain some knowledge from this thread! It also stinks having to go through doctor after doctor to find someone who will listen to your story. I've always found it amazing how one doctor can say one thing and the other completely dismisses it. I'd like to have two of them in a room and listen to how they justify each of their findings... Are you still having pain with your knee?