The patello-femoral joint :

Diagnosis:  Patello Femoral Pain - - Posted by BBall12 (BBall12), 26 January 2005

Hi,
All

I have been battleing anterior knee pain ever since me acl recon on dec. 23, 2003.  I had another scope on 7-15-04 to clean out any scar tissue and such and look around.  OS found some scarring and removed, not to terrible, had full rom before 2nd surgery.
So after a month and a half after scope i started to add some good weight to the leg presses and such and sure enough the pain came back.  Os just kept saying giving it time and its been over a year since the initial acl recon and 6 months since last procedure on 7-14-04.
So i went out to seek other doctors opinions and have been diagnosis with petellofemoral pain by another doc. he has sent me to PT and first visit was today.  PT found some maltracking of the knee cap and tends to go to the outside.  HE says my vmo does not fire first before the other quad muscles and is a big part of the problem.  Unfortunitly no doctor include the one who sent me to PT can say for sure what is causing the patellofemoral pain.  PT guy is guessing maltracking.  Although my good knee which does not hurt and has some maltracking as well but not as bad.  So who know what is really behind the pain...maybe more than one thing....who knows.   I am a basketball player so this situation is quite difficult for me.   My symptoms include  Hurts to walk down stairs, squat and of course play basketball.  Anyone here have any experience with Patello femoral pain following acl recon

My VMO is small compared to my other quad muscles.  However collectivly my quad strengh is good and can leg press alot.  Of course the pain is there with the leg press.  So in my PT i am going to focus on strenghing the VMO.  Im not so confident that this will solve my problem, but i am willing to give anything a try at this point without more surgery.  Does anyone know if playing basketball with the petello femoral pain is a bad idea.  I have done some research and found that no doc can say one specific thing that causes PFS but overuse can be an issue.  Although, i don't get much better with rest or much worse with playing bball.  Except the fact that my pain limits me on my jumping ability and have to rely more on my shooting skills and such then the quick explosive play i used to have before my injury and acl recon.  

I guess my biggest concern is if playing through pain does no damage i might as well play. But on the other hand if playing cold do damage i don't want to do so and wait.  But i have been waiting for  6 months for pain to go away and no luck so far.

Anyone that has PFS following acl recon like me i would LOVE to hear from you and your experiences.  Also know how long it took to get rid of the PFS pain.

Has anyone had patellafemoral pain on this site do to maltracking and find the PT corrected the problem and the pain went away without surgery??  Would love to hear also from any of these successs stories, but i am afraid there are not many out there.  So if you have one also please let me know.

I am pretty down and out about my situation.  I love basketball and can not do the thing i love with the pain.  I can play, but not the way i want to.  Im pretty grounded and play with pain which is no fun.  I know there is much worse cases out there and some people just want to walk and for that i feel selfish that i can walk fine, just can't play bball like i want to and just have to live with pain.  So this is my story and i hope i can get some answers, comments, or words of hope that someday i can play basketball without pain, walk down stairs without pain......pretty much get back to my life without knee problems and pain.

Hope to hear from you all.
----Jason  

Posted by 3of3 (3of3), 26 January 2005

You might find this explanatory:
"Patello-Femoral joint pain is a common problem not only with repetitive sports, but after surgery or other seemingly unrelated knee injuries. This is because the VMO weakens far more easily than its more active cousin. It has been shown experimentally that the activity of the VMO decreases if only 30 ml of swelling is present in the knee. However the Rectus Femoris is not inhibited until the knee is swollen with about 100 ml of fluid. Again, the potential for a muscle imbalance is clear."
It's on this page:
http://www.ecn.net.au/%7Ejp/page31.html

Looks like your ACL surgery caused it. Your VMO was probably strong enough to do its job before that surgery but afterwards, it has lost strength while the other quads haven't and/or, they all lost strength but you've strengthened your other quads at a rate faster than your VMO has been able to gain strength.

So, it seems to me, if my assumptions are true, that you should just keep doing your quad strengthening and wait for the VMO to become stronger. More importantly, though, you need to get that VMO to fire earlier than the other quads. I'm no PT, but as far as I know, this can be aided by electrical stimulation (to fire the muscle when you want it fired) and biofeedback (which involves putting an electrode on your VMO so you can see how much you're contracting it when you contract your quadriceps. This would let you know just how strongly it's contracting). The biofeedback might be the most important part because you can be firing your other quads but not firing your VMO early or strongly. This could well be the case with your leg presses- you're strengthening those other quads while your VMO isn't being strengthened very much and you're actually making the muscle imbalance worse! Therefore you may have to "train" the VMO to fire strongly and earlier than the others via a conscious effort. You may also want to start icing after workouts and, after icing, wear some kind of knee compression sleeve to stop swelling as, as that articles says, swelling can atrophy the VMO while leaving the other quad muscle's strength unaffected. Any swelling, in and of itself, could negate any strength gains otherwise achieved by your workout.

Sorry for that big fat run-on sentence, complete with redundancies.

To throw my opinion in- I would stop playing basketball for now as that's a pretty high-impact activity and every time you land from a jump and your patella is mistracking, your articular cartilage is getting battered by the impact. Wait until you have your kneecap tracking correctly. Then go play ball but don't go back full blast. Build up your duration and intensity slowly- 10% per week- or you'll get an overtraining injury and those suck.

Hope this helps and that other posters will "proofread" my assumptions and advice and balance it with their own.
Posted by Linds (Linds), 26 January 2005

Hey, read lot's... it'll help you to understand Patello Femoral Syndrome. PFS is called a syndrome as there is no one cause it's more a collection of symptoms that describe a problem. VMO strength is vital to the stability and tracking of the knee joint.   Hopefully you can get some of that back. I'm working very hard in my physiotherapy to regain some VMO strength... and so far, it's not going so hot..but i've had Chronic Patello Femoral Pain since I was 8 years old.    

hopefully the info that 30f3 found you will help.

Goodluck, and keep up the good work
Linds
Posted by BBall12 (BBall12), 26 January 2005

Great acticle 3of3!!!  THanks so much for your post.  I will do everything the PT says and be sure to do my home exercise like religion.  I will post on my progress here and hopefully with increased VMO strengh i can get rid of my pain for good.
Thanks everyone.
---Jason

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