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Author Topic: good results on patellofemoral joint pain due to patella alta after surgery  (Read 427 times)

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Offline samuel_s

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Hello, I am new to the forum so I hope this is the right place for this post.
I would like to share a little bit of my positive story with you :)
I was born with high knees (patella alta) and have never been aware of it until two years ago.  After a hike during which I completely over pushed my limits I started to have very acute and violent pain in my patellofemoral joint (basically it's super painful to get down the stairs).
The knee never fully recovered and kept deteriorating over the following year. I had seen several doctors but without gaining any great insides.
It's only when I moved from France to Copenhagen for my job that a Danish knee specialist could diagnose the patella alta. (edit: The patella alta was diagnosed using the Patellotrochlea index by Biedert and Albrecht. More info here: http://www.larsblond.com/mri-knee/ ). The patella being too high in my knee it wears out faster then normal (I'm 27 now). So he suggested that he could do an arthroscopy to clean out the patella and lower the patella by cutting out the part of the tibia where the ligaments are fixed and refixing it lower with some screws. This would pull down the knee by a few millimeters hence stopping the wear out.
I took a second opinion in France where the knee specialist told me not to do it, that it would be almost impossible to get any benefit from it, and had a high likelihood of making things worse. He however didn't suggest any real alternative than to just leave with it and deal with the pain. I couldn't picture a life without hikes and sport so after numerous questions and clarifications with the specialist from Copenhagen, who spoke about an 80% chance of improvement, I went for the surgery.
It has now been 8 months now. I'm going to physiotherapy twice a week to rebuild the muscles I had lost in my painful leg, and things are going great. It's not a light surgery and it is a lot of work to regain the flexibility in the knee and the muscles in the leg. I still have some pain on the patellofemoral joint but it gets less and less as the muscles regrow and I'm definitely much better off then before the surgery. Two months ago I could start climbing again.
So I am extremely happy that this option was offered to me. It really changed my life. I never thought I would enjoy going down the stairs so much :)

Hope that helps some of you.
« Last Edit: June 18, 2018, 10:09:20 AM by samuel_s, Reason: mentioning the diagnose method of patella alta »

Offline frustrated101

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That sounds like a risky procedure.  Glad you're doing better.  How many months did it take to walk down steps again?

Offline Brandon123

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Thanks for sharing, Samuel, very interesting!

I suffer from patella alta myself, which might be the reason for why my cartilage wears down and I'm in pain. 

Can I ask if you had any major cartilage damage on you patella? If so, traumatic or just wear and tear? You said the surgeon "cleaned out" the patella as well?

Also, the specialist in Copenhagen, was it Dr. Lars Blond?
« Last Edit: June 17, 2018, 10:17:22 AM by Brandon123 »
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline samuel_s

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Thanks for the good wishes  frustrated101. It took me around 7 months to walk down steps properly again. it's still not back to a 100% now to be honest. I would say 90% back to normal, still lacking a bit if muscles to get down smoothly. I had one month without moving my leg and another month moving with crutches just after surgery to give you an idea. The procedure was indeed somewhat risky, but the logic behind it made sense form a mechanical point of view, that is why I decided to take the surgery.

You're welcome Brandon123. Yes I had serious cartilage damage but just from wear and tear. My limited understanding from the procedure is that he removed the inflamed cartilage from the patella with arthroscopy. I also had a little piece of cartilage that had detached and was floating in my knee that was removed with this procedure. That's what I meant by "cleaned out" :)
And yes you are right it is Lars Blond who did the surgery. I can only recommend getting his opinion if you leave close by.

Offline Brandon123

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You're welcome Brandon123. Yes I had serious cartilage damage but just from wear and tear. My limited understanding from the procedure is that he removed the inflamed cartilage from the patella with arthroscopy. I also had a little piece of cartilage that had detached and was floating in my knee that was removed with this procedure. That's what I meant by "cleaned out" :)
And yes you are right it is Lars Blond who did the surgery. I can only recommend getting his opinion if you leave close by.

Many thanks, Samuel. I also have quite serious cartilage damage from wear and tear, and patella alta, hence my interest in your story. 

I have actually read about similar surgeries, but dismissed the idea because some docs say that distalization of the knee cap (lowering it in the groove) can increase the pressure/load over the knee cap, and that is not good when you have patella cartilage damage. But I really don't know?

Did you discuss any of these things with Dr. Blond, the effects of this surgery when it comes to increase/decrease pressure/load on the knee cap?

Thanks for you comments, they are really valuable as your case sounds quite similar to mine.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline samuel_s

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Hi Brandon123,
really sorry for the late reply I've had quite a busy week. I actually had a shoulder surgery with Lars Blond on Wednesday. An old injury I decided to fix while I had a good surgeon at hand :). He mentioned your post when I met him. He would be very happy to talk to you directly if you contact him (by email or so). He told me that since a bigger area of the patella will be in contact with the femur, the pressure would be decreased. Maybe there would be more force applied to the patella, but it would be distributed over a bigger area, so less pressure. I hope that helps. :)
I don't have a great technical inside in the knee matters and you seem to know much more than me.
I'm really happy to answer any questions, but I would really recommend that you would contact Lars directly as he can provide you with the more accurate answers.

Offline Brandon123

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Thanks again, Samuel!

You actually seems to have a really good grasp of the technicalities, I understand much better now :) These things are not completely easy to understand for us laymen I guess, as shifting the patella up or down seems to change forces/distribution in several ways.

Yes, I will probably contact Dr. Blond at some point for more information. From what I've seen, he is doing great work and is really knowledgeable about patellofemoral issues.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline samuel_s

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You are very welcome.

And yes I completely agree, it is a much more complex matter then what I expected. I have to say I was really surprised that there are still so many disagreement in between experts even nowadays.

I can only confirm that from my personal experience.

I wish you best of luck.

Offline Dave33

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You are very welcome.

And yes I completely agree, it is a much more complex matter then what I expected. I have to say I was really surprised that there are still so many disagreement in between experts even nowadays.

I can only confirm that from my personal experience.

I wish you best of luck.

Glad to hear a successful outcome, samuel. I also have patella alta, and have an osteotomy on both tibias to lower the kneecap and try and unload the damage. I think the problem for most, is that they wait too long to get diagnosed and have the surgery - and in the meantime, they damage the patellar cartilage to an unrecoverable state through ill concieved joint loading in physiotherapy, etc. That's what happened to me, at least, and I'd imagine in many cases. The good thing, is that at 27, you stand a decent chance of some cartilage improvement.