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It could be a number of things:
- a subluxation but that is more often lateral
- a bit of joint cartilage tearing off
- a plica being nipped

Perhaps RICE (rest, ice, compression, elevation) will suffice until your surgery, when the surgeon should be able to locate the issue.
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GENERAL KNEE QUESTIONS and comments (good for new threads) / A massive crack...
« Last post by bcerella on July 01, 2020, 08:28:57 PM »
Iím due to have surgery to correct my maltracking patella sometime in the next couple weeks.  I was diagnosed with PFS when I was 16. The pain has gotten worse over the years, but in the last 3 months itís gotten a lot worse, and now itís getting significantly worse every day. I canít even drive anymore. Iíve lost quite a bit of ROM: I was a yoga teacher; now I canít even get to 90 degrees.

My knee cracks every time I straighten my leg, but last night as I sat down in the sofa, as I reached the deepest part of the squat, I felt a massive crack at the top of my patella. I happened to have my hand on my knee and felt the bone move medially - such an awful, *wrong* feeling. Since then the pain (at the top of the patella) when sitting down is blinding. I have to shift all my weight to my left leg and lower myself with my arms.

What is this pain? Iím used to the grinding, but this is new. It doesnít feel like bone - more like soft tissue. Over the last couple weeks, in preparation for my surgery, Iíve had an MRI, TT TG ct scan and several xrays; do I need to request another MRI to look for a new problem, or will the surgeon be able to deal with it once Iím cut open?
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Hello hoopsluv94

First let me say that I understand how frustrated you are. Basketball is your passion and you are grieving the lose of a huge part of your life. Anyone suffering from injury that keeps them from an activity or activities that they love will go through this, in varying degrees. Sending you a virtual hug.

Have a look at this website: injuredathletestoolbox.com
It has provided me with some guidance regarding adjusting my attitude and focusing on the things I can do instead of the things I canít. If you are really stuck you can even contact Heidi directly and perhaps she can offer you deeper insight and support.

I wish I could tell you that you will get back to playing one day. I canít do that, yet I can say that you are not alone in facing a loss like this. I myself never thought that I would be able to function without skiing, running and riding my motorbike yet here I am. While I havenít accepted yet that I will maybe never do those things again, I have been able to accept the NOW and take each day as it comes, with constant hope that I will find my way back to something. This is my hope also for you-at your age you still have good healing potential yet you need to treat yourself kindly. Focus on a healthy diet, good quality sleep, and look for a way to partake in gentle physio if that is possible yet. Read some self help books or look for motivational material online. There is lots out there yet you need to be open to it.

I know you are saying basketball or bust-I donít blame you for feeling that way! Itís completely justified and part of the process you need to go through. You will need to move beyond that though in order to start your healing journey, and I hope that you will be ready for that one day. Please get yourself some emotional support, you need and deserve that right now.
4

Running and playing basketball is my source of happiness and without those things, life just becomes pointless.

The most recent surgeon I spoke to told me a meniscus allograft has too high of a failure to be considered useful for me. That I'm better off just focusing on physical therapy and getting supplementary knee injections.

Mate, that's how I felt about triathlon, but honestly, after a few years, I adapted, found other things and am now at a point where I can race again, but only short races.  And I'm fine with that.

I've also heard meniscus transplants have a low success rate.

Well for me its also been a few years and I've tried other things. Cross trainers, stair masters, rowing machines, swimming, biking, you name it and I hated it all. Thats not how I want to live my life so its pretty much basketball or bust.
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The patello-femoral joint / Re: Second opinion: Fulkerson or LR?
« Last post by Brandon123 on July 01, 2020, 10:33:00 AM »
@Brandon123: Good idea, and thanks for the list. I was able to get an appointment to see Italyís leading PF surgeon this Friday. Weíll see what he says!

Sounds great, let us know what he says!
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Now its close to 3 years later. My knee is constantly aching and burning. I'm not able to run, sit on my heels, or do anything I want. Have been struggling with depression and suicidal thoughts and was at one point on the verge of dropping out of university.

Long-term knee injuries/problems easily affect your mental health. And as many have mentioned on this forum, dealing with serious knee problems is just as much of a mental game as a physical one. With that said, if you feel depressed to the point that it interacts with your daily life and university studies, I think you should consider seeking some support from a mental health professional or student health care. These things are tough to deal with all alone, and sometimes it just feels overwhelming. And no wonder when your life is thrown up side down! So, please don't forget to take care of the mental side as well.   
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The patello-femoral joint / Re: Second opinion: Fulkerson or LR?
« Last post by bcerella on July 01, 2020, 09:42:16 AM »
@Brandon123: Good idea, and thanks for the list. I was able to get an appointment to see Italyís leading PF surgeon this Friday. Weíll see what he says!
8

Running and playing basketball is my source of happiness and without those things, life just becomes pointless.

The most recent surgeon I spoke to told me a meniscus allograft has too high of a failure to be considered useful for me. That I'm better off just focusing on physical therapy and getting supplementary knee injections.

Mate, that's how I felt about triathlon, but honestly, after a few years, I adapted, found other things and am now at a point where I can race again, but only short races.  And I'm fine with that.

I've also heard meniscus transplants have a low success rate.
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The patello-femoral joint / Re: Second opinion: Fulkerson or LR?
« Last post by Brandon123 on June 30, 2020, 02:43:58 PM »
Fulkerson osteotomy is a big surgery, but I would not consider bilateral lateral release as minor either. Also, if a bilateral lateral release goes wrong, it will be very problematic. See this recent thread on LR for more info:

https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=77981.0

As both alternatives could be categorized as a bit "risky" procedures, my advice would be - if you can afford it somehow - to seek out a third opinion by a patellofemoral expert, for example someone on this list:

https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

Tell the third doctor that you have been given these two options and don't know what to do. It will be money very wisely invested. Even if you need to borrow or sell something, it would still be my no. 1 advice in this situation.

Good luck and let us know how everything develop! 
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You may have subluxed medially, which is one of the unpleasant possibilities following lateral release.  I believe that 'lengthening' rather than 'release' is the preferred route nowadays, and only where there are firm indications, and often together with a medial plication.

See https://pubmed.ncbi.nlm.nih.gov/22301361/

You will have to see how things go and discuss with your surgeon. Options include reconstruction of the lateral retinaculum.

This paper may be of interest to you - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441987/
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