The patello-femoral joint :

"squinting patellae" anyone? - - Posted by rhea (rhea), 18 October 2002

Hi everyone.  I hope you are all having an okay knee time, although from the posts it looks like everyone is in a rough patch.  I've been at home on crutches for the past 2 days.  Must be something in the air, geez!  Lets hope next week is a better one for all of us.

One thing I remember my OS's student say was that I had "squinting patelli".  From my research thats where the  thigh bones are turned in to each other making the knee caps "squint" at each other.  Anyways, the student said that was one of my "predesposing factors" making me more prone to having pfs and not recovering without surgical intervention.   Does anyone else have "squinting patellis"?  What have you been told about it?

Thanks a bunch guys.  And I hope everyone is having an okay day.  

(((hugs)))

rhea  
Posted by AC (AC), 18 October 2002

Hey Rhea,

Just wondering how you use crutches if both your knees are sore?

I have the same problem (where both knees have issue) so if I use crutches, bearing more weight on one leg to take weight off the other one, it ends up hurting the less sore one more.  Kinda like a vicous circle.

What do you do?
Posted by Linds (Linds), 18 October 2002

Hey Rhea, I have squinting patelli..it's just what you said. I don't think there is much else to know about it. It's just a way that the joints happen to line up. If I contract my quads, they come back into an appropriate position...but if I am just standing, my knee caps squint at eachother.  Maybe that helps...probably not...
But I hope that you are feeling better soon
Take care knee buddy and you know I am here for you
Linds
Posted by rhea (rhea), 18 October 2002

Hey AC.  Usually for me one knee is mega worse than the other, so the crutches help alot.  Only downside is the crutches are really hard on my RA eaten up shoulders, elbows, and wrists.  But than on the days Im on crutches I only use them to get to the washroom or back to bed.  

Linds!  I had no idea!    LoL  I guess the squinting patelli is nothing more than a silly predisposing factor helping us along to the OR.  GrRr.  I guess its something more to include in our little project .  I hope you are feeling better too Linds.  Im glad the scan is over and done with.  Back to more waiting...  I hope your OS has some answers for you girl.  

(((hugs)))

rhea
Posted by Grace (Grace), 21 October 2002

Can one of you guys better explain this whole "squinting" thing to me...how do your kneecaps squint??  I don't get it!
                                                                       -Grace-
Posted by Linds (Linds), 21 October 2002

A squinting patella is when the femur is rotated slightly inwards at a standing and relaxed position. This causes the knee caps to sort of face eachother when your legs are together.  That is what they call a squinting patella grace, why they call them squinting I don't know. But...
that's it
Take care
Linds
Posted by Jak (Jak), 21 October 2002

As I understand it, it can also be internally rotated tibia's.  I have squinting kneecaps, which is not the same as knocked kneed, so my OS corrected me!  You are more likely to have squinting kneecaps if you are female, walk with pronated feet and flat footed.  I'm about 45 degrees out.  I have had the plica removed and a lateral release on one knee to ease the pain of maltracking.  The one leg is great but the other is not great.  I'm trying physio to correct the problem of pain at the moment but I'm aware that either a TTT or derotational osteotomy were discussed prior to surgery as a way of correcting the rotation of the tibia and thereby solving the maltracking.  Apparently if you strengthen your 'gluts' (bum muscles) it can help turn the kneecaps out.  I could crack a wallnut with my bum but no such luck with the knees pointing forward, alas.
If anyone has had a tibial derotational osteotomy I would be interested in hearing from them.
Posted by Linds (Linds), 22 October 2002

Thanks Jak I was not aware that it could also be rotation of the lower leg that could have that affect as well. Strengthening the gluts would have an affect on the femur thinking of physiology..but I can see why it might not help if it is the lower leg that is rotated. I hope that you get some help for that other knee soon. I had a LR on my right knee in April 02, it;s trakcing better I think..but it still hurts like..well you know. And the left one, is even worse, but doesn't hurt as much.   Take care and good luck.
Linds
Posted by Grace (Grace), 22 October 2002

So does that have anything to do with rotation or tilt of the kneecap?
                                                              - grace -
Posted by Jak (Jak), 24 October 2002

Grace,
I don't really know, but my kneecap was shifted and tilted hence the lateral release.  I can only presume it isn't shifted and tilted now that has been done.  It certainly doesn't clunk click every trip (showing my age with that quote)  so that is an improvement and driving the car is a much more pleasant experience.  It still squints and aches like hell most of the time.  I know one thing, I'm sure the rotation doesn't help any with pain in the knee regardless of where it decides to lay.

Posted by hmaxwell (Heather M.), 26 October 2002

I was looking for info online and found a picture of squinting patellae.  The photo is about 1/2 way through the article.  Enjoy!

http://veggie.org/run/chondromalacia/

H
Posted by standardgrrl (standardgrrl), 15 February 2003

This is a fantastic article - thank you for posting it!

I too have squinting knee caps. Mine are from femoral anteversion. I've been to 2 OSs who've recommend femoral derotational osteotomies and 2 others who have warned against this procedure.  

I've been in and out of PT for 2 years now (currently in again) and am working with a Physical Medicine MD and a new PT to try to overcome the knee pain by working on core conditioning/functional training rather than just static quad strengthening exercises.  I'm especially focusing on increasing my pelvic stability. I'm hoping that by really strengthening my glutes and abs I will be able to develop a posture in which the internal rotation of my femurs will be lessened and my knees will squint much less.

Keep up the good work, everyone. Best wishes to you all.
Christine J.
Posted by windbarb (windbarb), 16 February 2003

I had no idea that I had squinty patelli until I looked at the pics on the Kneeguru site, actually.  One of my kneecaps (the bad leg) squints in farther than the other; I also see a bit of bow-leggedness.  But I don't walk flat-footed.  

Of course, my current OS never had me stand up so that he could look at the blasted things to see if they were out of alignment.  Guess that's why I'm going for a second opinion.  

Cheers,
Barb
Posted by Christine (Christine), 17 February 2003

What is it with medical professionals who overlook the obvious?
I went to four doctors and three physcial therapists (all specialists in sports medicine) in the city where I live and none of them ever mentioned that I have squinting knee caps or femoral anteversion.
The last of these four, a highly regarded expert on knee injuries in femal athletes, examined my knees only while I was lying on the exam table - not while I was walking or standing - and then recommended exploratory surgery!
I had to travel to another city, 1,000 miles away, to see yet another knee expert before I got my diagnosis. He pointed out the anteversion immediately.
Now that I know my legs are abnormal, and can see just by looking at them what the problem is, I can't understand how people highly educated in anatomy and biomechanics could have missed this! I had no idea that my legs were "poorly built," having lived with them as such all my life. But the doctors... what's their excuse?

I apologize for ranting, but I'm so very confused and frustrated. I've lost two years of my life and have spent thousands of dollars for marginally appropriate and medical care.

I'm now taking it upon myself to learn as much as possible about the body, rehab and movement science so I can take control of my treatment and recovery. I just can't expect the MDs and PTs to figure this out for me. I can't sit back and expect their prescribed exercises to "fix" me either. I need to work with them to develop a customized program that will get me stong enough to dance again and will protect me from further injury from my own faulty anatomy.

I put myself back in PT again, but this time I'm armed with much more knowledge and the ability to question, propose and collaborate with the professionals I've chosen to help me.

Be strong and be informed. I wish the best for you knee patients out there!
Christine

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