The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: kizzietaylor on June 22, 2007, 04:23:55 PM

Title: do I have a malaligned patella
Post by: kizzietaylor on June 22, 2007, 04:23:55 PM
Hi.. newbie here.. with a not so new knee problem.. I was diagnosed with OSchlatters when I was young and have always put knee pain down to that.. the tiny bump at the top of the tibia where it meets the patella tendon has always been tender.. anyway, I had a car accident a few years ago on the same knee and needed blood drawing out from under my knee cap.. unfortunately I was in a non-english speaking country and didnt really find out more than that.. and put the rest of the knee pain down to the prior Oschlatters too.. The pain went back to how it was.. a dull ache on kneeling or pressing.. (like a bruise)... I gained a heap of weight (wont go into that!).. and obviously had more problems with the knee, including increased grinding and crunching  in both knees but worse on the problem right knee.

For the last year I have had a stabbing pain under my knee cap (it feels to me like it is just above the schlatters area but inside ... ) and on a few ocassions I have been unable to straighten my leg as it feels something is sticking under myknee cap preventing me straightening it... like a thin stick or something... it can happen suddenly and for no reason at all.. last a few days and go as quickly as it came.. So two weeks ago it happened again and I decided once and for all to get it seen to.. it was xrayed and a little piece of cartlidge coud be seen poking up from those two bumps on the top of the tibia.. so I thought it was that.. the doc said NO.. and sent me for an mri.. he examined me as well.and said my knee cap was misaligned.. that BOTH knee caps were misaligned and in pretty bad shape (but didnt go into what pretty bad shape meant!)!!.. (didnt see this on the xray until AFTER he examined me)..anyway... I was given an agonising cortisone shot for the mild pain..and told to wait for the mri results... so basically today I find out that it is a genetic misplacing of the knee cap and it needs to be phsyio for 6 months or surgery..

I have looked up the symptoms of misaligned knee cap and I feel I don't have them!!... I dont feel it move.. or slip.. or feel it is tracking incorrectly (maybe because it has always been like it??)... there is no knee cap ache.. the pain I get is shooting pain INSIDE the knee.. and on the right side of my right knee.. and tightening of the muscle at the back of the knee.. when it is really bad i cannot straighten my knee at all..and suffer from the muscle at the bottom of the femur swelling slightly... it is NOT constant.. when the pain isnt there I can walk around quite happily.. as if there was nothing wrong...

does anyone else have this problem??... does it sound like anything other than a misaligned knee cap??.. I want a second opinion and will send my scan to my own doctor back in the uk. ( i am overseas and using my employers doctor..who is telling me to have physio and not surgery-  because of my being unable to work afterwards and I cannot be put out of work.. but can have six months physio and damned painful shots!!)...I would much prefer surgery than to have physio manipulate it back over six months... am I mistaken??

anyway, sorry it is long.. but I have never discussed this with anyone before.and YES I am losing weight.. I have lost 10 lbs in three weeks already!.. I knew they would blame a lot of it on that too.. I just want to begin exercising again.. I have always walked about 4miles a day .. so it isnt like I have been inactive since I have been overweight.. and new to exercise.. I just cannot walk when I have the shooting pains and inability to straighten the knee..

Thank you..
Title: Re: do I have a malaligned patella
Post by: brianne on June 22, 2007, 05:54:24 PM
It is possible that your patella could be slightly misaligned.  If it took an MRI to diagnose it then any misalignment is probably small.  The misalignment could be caused by a muscle imbalance.  Some muscles could be pulling too tight while others are not strong enough.  PT will be a good place to start.

I have misaligned patellas and they are obvious to the naked eye.  My right patella has successful been realigned and my left still needs work.  My left patella looks like it is on the side of my leg more than in the center.

I would recommend staying away from any sort of surgery.  My patellas are so bad that I can barely walk almost every single day.  Having surgery was a last resort for me.  Surgery is a rough rough recovery and should not be considered unless everything else has been tried.  Patella realignment is not a one-time fix.  It is serious surgery that should be avoided at all costs.  Try Physio and that should give you relief.  Surgery is a big risk.  Compared to the pain of surgery, cortizone shots are much less painful.

Even if you do have surgery you would be facing many many months of physio anyway to rehab after surgery.  If you have any doubts, find a patella specialist...that will help.

Title: Re: do I have a malaligned patella
Post by: kizzietaylor on June 22, 2007, 07:35:33 PM
Thank you for taking the time to reply Brianna, I am most grateful.

I have always lived with 'dodgy' knees..but have only this week actually looked up the conditions etc.. I just thought it was mild arthritis or something.. I didnt realise in my ignorance knees were so complicated!.. I mentioned the surgery as I remember friends of mine having arthroscopic procedures done to 'clean up' their knees.. and were fine almost a week afterwards.. So in the back of my mind I was thinking on those lines rather than on the actual misalignment surgery... which I know is completely different. Anyway, I havent yet spoken with the doctor, my employer did.. (patient/dr/confidentiality right out the window)...I will see him on Tuesday and find out exactly what is going on. He mentioned both knees are in a pretty bad state.. so I am wondering if there is cartlidge wear and tear because of the excess grinding and crunching.. I thought the stabbing and inability to straighten my knee was due to floating cartlidge or something.. I found it strange that all these problems could be due to something so small it needed the mri to find it.. (like you said you can visibly see your misaligned knee caps.. I can feel mine are slightly to the outwards side of my knees but not excessively)...

anyway, I appreciate your advice about the surgery and will now go for the physio without thinking I am being seen off on a quick repair!.. do you know what kind of exercises they do in physio as i have never been before for anything.... they said it would cause a lot of pain as they are doing it and will ice it prior and give me pain relief as they do it...

Ihope your knees are doing ok !!.. thanks once again

Title: Re: do I have a malaligned patella
Post by: redtoblack on June 22, 2007, 07:41:04 PM
PT would be a good place to start either way.  Muscle imbalance can cause a lot of pain and worst case is you end up having to have surgery.  Plus, after working with a physical therapist, they may be able to suggest a few OS's to you for 2nd opinions before you jump into surgery.  I have a mal-tracking patella and PT has helped.  It hasn't fixed it, but it is better than it was.  

Best of luck!


Oh, you posted while I was typing this.  As far as PT goes, it's not exactly comfortable, but I don't experience any extreme pain or anything like that.  If something starts to really hurt, let them know.  I do a lot of different strengthening exercises that, yes, you could probably do at home, but they monitor to make sure you are doing them the correct way.  I also have a scar tissue problem, so we do some massage and really work on ROM.  They will be able to set up a program specifically for you.
Title: Re: do I have a malaligned patella
Post by: kizzietaylor on June 22, 2007, 08:07:51 PM
Thanks Jordan,

Crazy that I have had bad knees all my life and just put up with it not realising that something could be done. Silly really..
I appreciate the advice and hope that the PT will work .. it really feels like something is catching under the knee cap.. not the knee cap sliding.. what does malaligned actually mean??. that it is permanently in the wrong place or keeps moving to the wrong place when  using it?.. The whole knee is incredibly painful to straighten.. stiff at the back and catching and crunching under the cap.. not looking forward to manipulation!.. bit of a wimp !
Title: Re: do I have a malaligned patella
Post by: brianne on June 22, 2007, 08:23:20 PM
The biggest thing you will want to work on is VMO strengthening.  It is the inner part of your thigh and the most likely to be weak and causing misalignment.  PT is a good place to start.  If nothing else, having strong muscles before any surgery will help make the recovery after surgery go smoother.