The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: kathleenj on February 26, 2004, 09:16:42 PM

Title: Need some opinions
Post by: kathleenj on February 26, 2004, 09:16:42 PM
I apologize in advance for the lenght of this post.  I feel it necessary in order for you to understand my question.

Last July my right knee began hurting.  Pierce like shooting pains under the kneecap and to the inside of the knee.  I went to my GP and she said I was not tracking correctly and had a tilt of the patella.  I began PT which continued for 9 weeks with no improvement.  During this time I began to have locking episodes and the pain was beginning to be more constant.  My PT thought I may have torn my meniscus but didnt recall any specific injury.  She said the reason I was not tracking right was probably because of the limp I had in order to alleviate the pain.  She referred me to an OS.
He agreed that it was probably a torn meniscus and sent me for an MRI.  When the result came back we were all very surprised at the osteochondral defect...meniscus was perfectly fine.  I had an OATS done in Dec and it seems to be healing fine with the exception of the issue with my patella tendon being a bit scarred down right now.  
I am presently in PT and seem to have come to yet another problem.  That darned tracking and tilt problem is back.  The kneecap is grinding and popping all over the place. I feel as though my quad strength is coming along and the VMO is getting there as well.  
My question is....what the heck is with the kneecap?
Is it possible that this was my problem to begin with and the maltracking and tilt caused the need for the OATS?  
This is very frustrating and confusing.  It seems as though I am right back where I was last summer and it is very depressing.  Any thoughts at all would be really appreciated.   Thanks.
Title: HiRe: Need some opinions
Post by: Beauzer on February 26, 2004, 09:32:01 PM

Where exactly did you have your OATS?  If it wasn't on your patella or patellar groove, that problem probably isn't related to your maltracking problem.  The patellar tendon scarring may be contributing to it though... :-/

Title: Re: Need some opinions
Post by: kathleenj on February 26, 2004, 10:48:18 PM
My OATS was done on the femoral chondral which I understand does not have a 'direct' effect from the tracking and tilt.  What I am concerned about is that nobody can tell me how it happened.  My OS says that it could very well have happened with a twisting motion or something along those lines, but he says that most people know when it happens.  Is it possible that because of my severe limp along with being extremely active that the defect could have developed from the original tracking and tilt problem?  Basically, could I have damaged other areas to this extent from ignoring the pain and working thru it for so long? We all know that limping and ignoring pain is not good for the knee but could it have caused the osteochondral defect?  I also have a small defect on the tibia which we are leaving alone for now.  But the OS never mentioned anything about defects on the knee cap or in the grove.  
I dont think it was an issue at the time of the surgery, I believe he thought only the femoral defect was the issue.  The op reports make no mention to even looking at the back of the knee cap.  Should he have checked it out?  
Oh, I am so lost.    Can anybody enlighten me?
Title: Re: Need some opinions
Post by: Beauzer on February 26, 2004, 11:02:22 PM
No one is entirely sure what causes osteochondritis, but it's related to an area of bone dying due to inadequate blood supply.  It is typically related to steroids, smoking, maybe heavy alcohol use, but in a lot of cases, there's no identifiable cause.  They probably looked at your kneecap during the surgery even if they didn't mention it because that's standard practice (for a scope).

Danielle ;)
Title: Re: Need some opinions
Post by: ozzybug on February 26, 2004, 11:25:30 PM
So sorry that you are having these problems.  Has your OS put you in any kind of knee brace to help keep that patella in place while walking/exercising?  I developed some loss of motility of the patella after surgery and my OS now has me using a Bregg patella stabilizer brace.  I'm not sure if it's helping at this point, but it might be worth asking about.

Also, has your PT shown you any of the techniques of patella manipulation to help keep it motile?  Mine has me put both thumbs gently on the patella (one on the lateral side and one on the medial side) and gently slide the patella from side to side.  Not hard and not fast, but slowly and gently.  Then, she has me place both thumbs on the upper portion of my patella and press gently down on the top of it to "tilt" the patella and again- gently.

Before doing either of these though, I'd check with the OS and PT first because I'm not a professional and I don't know the protocal for post op PT of an OATS.

Best of luck sweetie!  Let us know how things work out for you.