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Author Topic: Is Realignment the answer?  (Read 1229 times)

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Offline wendyd

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Is Realignment the answer?
« on: March 25, 2005, 01:13:45 AM »
4 years ago I developed ITBand syndrome after suffering a severe ankle sprain at a professional sports tryout.  The biomechanics of my running changed to compensate for the ankle injury leading to overpronation of the ankle.  3 weeks later ITB syndrome developed and 3 weeks after that, my knee began to swell after 20 minutes of activity to the point that my quad completely shut down.  An MRI revealed severe damage to the lateral side of my patella.  A lateral release was performed and the rough cartilage smoothed.  The LR simply allowed my kneecap to track more abnormally and cause more problems.  I currently wear orthodics to correct the pronation in my ankle.  I also have a history of SI joint disfunction in my pelvis.  Clearly the  poor tracking that has developed in my knee is a function of pelvic instability and ankle pronation in combination with 25 years of sports including college and professional athletics.  At this point, it is clear my playing days are over.  However, I have a career in coaching so I need to be able to be on my feet and active.

Two years of physical therapy have produced little results.  At this point there is so much damage that pain limits my ability to do any therapy or strengthening exercises. At the very least, I need to have the rough cartilage smoothed to eliviate some of the pain.  My new doc is one of the best and specializes in knees...specificially sports injuries.  He wants to do the Elmslie-Trillat procedure in combination with another Lateral Release to correct the tracking problem.  I do not have any malaignment visible in an x-ray.  The problem is strictly limited to an active range of motion between 15-45 is within this range that the creptitus is greatest and only in the lateral facet.  My ITBand is still extremely tight and I know it is the cause of the problem coupled with a quad imbalance with more force on the lateral side.  Moving the patella medially there is marked tilt as though the ITBand is anchoring the lateral side of the patella.

The Elmslie-Trillat is a major procedure that will change my biomechanics permanently.  After this, I am out of options.  My hesitation about this procedure is patellar tendon is in line with my ankle and hip...the problem is not that.  My thought is a distal realignment may not be necessary in my case...proximal realignment using the Lateral Release and medial reefing to tighten the medial structures to pull the patella into proper alignment could be an easier and more appropriate solution. 

Any feedback would be surgery is scheduled in 3 weeks.