The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: KatieO on May 01, 2006, 12:46:40 AM

Title: Patella Baja
Post by: KatieO on May 01, 2006, 12:46:40 AM
I am completely new to message boards but here goes. I have had 3 surgeries (partial ACL tear, ACL reconstruction, lateral release) and now, 3 years since last op, the pain is worse than ever. I have been finally diagnosed with patella baja, and told that I "hyper healed" from the surgeries and that caused the patellar tendon to shrink. I have been told that there is nothing that can be done. I am 52 and healthy and can't work with the pain, hence, losing my mind. I am going to start running groups in the fall for people living with chronic pain. That is a positive thing.
Does anyone know about tibial tubercle osteomtomy? Is that what is called "a fulkerson?" Dr. Fulkerson lives not that far from me. My doctor is making contact with him. What about Dr. Minas in Boston? We are also contacting him.
If anyone has any experience, especially positive experience, I would love to hear. Sympathy is also appreciated!
Title: Re: Patella Baja
Post by: Heather M. on May 01, 2006, 02:16:46 AM

Unfortunately, there are quite a few of us dealing with patella baja.  Head down to the Soft Tissue Healing Problems section of the board and check out the hundreds of posts--you'll find lots of company and lots of sympathy.

There are even a handful of folks who have had osteotomies like the one you are researching to deal with the patella baja.  Having a TTT or Fulkerson procedure is not that uncommon on this board, but the patients having it for patella baja can be numbered at about a dozen or so in the last few years that I've been on this board.  I investigated it and still am keeping my options open, but have been told by more than one surgeon that it doesn't really have a chance of reducing my pain because it won't do anything to address the cartilage damage to the back of my kneecap.  Yes, it will help pry the kneecap out of the joint and up off my shinbone, but I will still have craters gouged out of the cartilage from the years of patella for me it isn't really being proposed as a solution.  However, it will be necessary, whatever I do, to correct the mechanics.  So even if I end up having a knee replacement to deal with the ruined cartilage, I'll still need a procedure like the Fulkerson to pull my kneecap up.  But it is not being offered, in my case, as a stand-alone option.

As it stands, I know one of these is likely in my future, but I'm not quite there yet....there are others (Missmyknee and another Heather) who have had this done.  2 others that I can think of offhand have had a patellar tendon graft/replacement to address the length of their patellar tendon, but I don't believe this has proven to be a good solution at all, because their bodies just scarred the new tendon graft and shrank it down (just like their bodies had done with their original patellar tendons, only much faster).

Lots of posts about Fulkersons and other TTT's, mostly done for mal-tracking and PFS (not patella baja) can be found in the Patello-femoral joint section.  Most of the scar tissue and patella baja stuff is in the soft tissue healing problems section I mentioned above.  check them out for more info than you probably ever wanted... ;D

Title: Re: Patella Baja
Post by: missmyknee on May 01, 2006, 04:16:35 AM
Hi Katie

I am the one that had an osteotomy specifically for patella baja and infrapatellar contracture syndrome. I was 47 when I had it done. This particular osteotomy is called a DeLee osteotomy. Not many doctors know how to do this osteotomy. It is a specific cut in the tibial tubercle that moves the patella up and out of the joint space. It is a deeper cut in the tibia than other osteotomies because it is angled.  I required a bone graft placed where the tubercle used to be It greatly improved the mechanics of my knee. It took 6mos to a year to recover. Unfortunately I had sustained severe cartilage damage to the backside of my patella from being in baja for 18 mos. I had another surgery 18 mos later to do a chondroplasty, remove the fat pad and a LOA. I ended up with a knee replacement 3 yrs after the osteotomy because of the cartilage damage but the DeLee osteotomy has done well as far as knee mechanics and I never have regretted having that surgery. I am forever grateful to have had an OS who knew what patella baja and IPCS was and how to correct it. It was the only way to get my patella back up, as scar tissue was so bad the tendon was shortened , thickened and totally adheised down to the tibia and fat pad. Attempts to release the tissues did not budge the patella. I was able to have a knee replacement in Jan 05, even though I had the osteotomy. My OS made a special cut to my tibia to accommodate the osteotomy but he was prepared to revise the osteotomy if needed . I've been dealing with other problems that have come up including scar tissue, but the DeLee osteotomy has held the patella where it should be.

Another Heather ( maybe Heather B) has had an osteotomy for her baja and MelP had a new patella tendon ( I think an allograft) to correct hers. You can read about MelP's success story in the Success Stories thread down towards the bottom of the board, below the Arthritis section. Her thread it titled, my success over patella baja. Her's is a very good success story . I think Sharon had a new patella tendon using part of her quad tendon, for her baja repair.

Title: Re: Patella Baja
Post by: KatieO on May 03, 2006, 12:59:02 AM
Hi everyone,
I am totally wowed by your responses and need to take time to read further. All these surgeries sound so dramatic compared to my 3 surgeries. I thought I was headed for a total knee but learned that the rest of my knee, the part that would be replaced, is perfectly fine (which is a good thing) but the total knee attaches TO the patellar tendon, which is where the problem lies. Oops.
I have stopped working and live on hydrocodone, which doesn't do much, and ice. Lots of icing. It is hard to keep my spirits up when I have pain all the time and don't know how I am going to support myself. Sorry for the whining. At least I have gotten back to some exercise with pilates and yoga and walking but it is hard and painful. I used to dance. Dance was my life. My joy. I am seriously going to whine if I don't stop soon.
I know that I need to read more around the site (thanks for the guidance) but am I going to find people who have really gotten better? I want my life back. I bought a card for myself the other day with a quote from Anais Nin: Life shrinks or expands in proportion to one's courage.... what about in proportion to one's tendon??