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Author Topic: squinting patellas  (Read 17328 times)

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Offline cheergirl489

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squinting patellas
« on: December 12, 2005, 02:44:30 AM »
I was wondering if squinting patellas can be a source of chronic knee pain. I have been diagnosed with patellar maltracking and when I did some research on it, I found nothing on what my knees are like. When I stand with my feet facing forward, my knees seem to almost face each other. It is as if my whole leg turns in slightly. Everything I have found on maltracking is lateral tracking, not medial like mine. Is squinting a type of maltracking, or just some sort of deformity? Also, can it cause pain?
« Last Edit: December 13, 2005, 03:13:10 AM by cheergirl489 »
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline Doc79316

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Re: squinting patellas
« Reply #1 on: December 12, 2005, 05:49:20 AM »
Hi,

You are right in thinking that squinting patellae can cause chronic knee pain. I think that if your knees are almost facing each other then the problem could be rotational deformity rather than just maltracking. However, I am not a doctor, so this is just my opinion.
I think maybe you should get a second opinion, preferably from a knee specialist, as there are procedures to correct this.
If your knees are causing you pain to the point of not being able to get on with the things you like to do, then getting it sorted sooner rather than later would be to your advantage.
Have you had any diagnostic testing? MRI/Ultrasound scans or x-rays? These would should precisely where the bones are lying and would enable a doctor to make sure you received the right treatment.
Hope this helps,

regards,

Laura
Left knee surgery
08/06/02 - L/Release
13/08/03 - Fulkerson TTT
05/06/05 - Stabilisation & Medialisation/Tendon Transfer
13/01/06 - Proximal Hamstring Superior Stabilisation
06/03/06 - RSD/CRPS diagnosed
20/07/06 + 03/04/07- Excision of scar tissue
30/07/07 - PKR suggested by OS (no date yet)

Offline cheergirl489

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Re: squinting patellas
« Reply #2 on: December 12, 2005, 11:47:57 AM »
Hi and thank you for replying! I've had x-rays and recently had an MRI. After I had the x-rays my doctor told me it was maltracking. He sent me to PT for 6 weeks (+ 4 more weeks) and said it should begin to help, but so far it has not done much of anything and this is going to be my 8th week. My MRI showed nothing but a small effusion, according to the radiologist. However, my doctor has not seen the films yet. Now I'm not skilled in reading these things, but I have looked up pictures of normal tracking and the patella seems to sit right in the groove. On mine it is tilted onto the medial side and looks like it is actually touching and has a big space on the lateral side. Like I said now I'm no radiologist, but to me that seems to be what could be causing the pain. Oh well I guess I'll find out soon. I return to my current doctor in about 2 weeks. What are some of the treatments available for squinting patellae?
Megan
« Last Edit: December 12, 2005, 12:10:46 PM by cheergirl489 »
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline shade

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Re: squinting patellas
« Reply #3 on: December 12, 2005, 12:44:16 PM »
Megan,

It is very hard to find information about squinting patellae. 

Sometimes physio can help with these problems, but think it is a very lengthy process,  I went to physio for a long period of time and still do physio daily to try to help my condition. 

There are several surgical procedures that might correct the problem. Here is a great article that talks about a brace that will help and also the non-surgical and surgical options to treat this condition.....

http://ajs.sagepub.com/cgi/content/full/30/3/447#SEC4

I've also had problems getting doctors to understand that my knee went this way after a fall almost three years ago..... Most surgeons are used to seeing patellae that sit laterallly not medially and seem unsure how to treat the condition.  They just kept telling me that I was born like that, but looking at old pictures you do not see that my knees were like that......

Here is another procedure, reconstruction of the lateral patellotibial ligament.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8827308&dopt=Abstract

Full standing x-rays from hip to ankle will show the alignment issues.....



Hopefully, you will find a surgeon specializing in patellofemoral pain problems and get some help for your condition.  Good luck.  ~Shade

« Last Edit: December 12, 2005, 01:55:06 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline cheergirl489

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Re: squinting patellas
« Reply #4 on: December 13, 2005, 02:08:59 AM »
Thanks for the information. I was unsure of what the treatment options were. The articles were of much help. It is definitely very hard finding stuff on squinting patellae and I do agree that doctors do not know what to do for it. My doctor seems like he has no clue what to do and my PT seems clueless as well. He was actually using McConnell taping, but taping me medially which made the pain worse. Well thanks again for the great info!
Megan 
« Last Edit: December 13, 2005, 03:13:21 AM by cheergirl489 »
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline Gnasher

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Re: squinting patellas
« Reply #5 on: December 13, 2005, 01:45:57 PM »
I have got squinting patellae too and my right knee has been hurting since January when I twisted it.  I did some physio in the summer which the physio eventually said was never going to sort my knees out and am now waiting for referral to an OS which will hopefully be by the end of January.


Offline j_smi001

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Re: squinting patellas
« Reply #6 on: December 13, 2005, 07:26:13 PM »
Just to add my two pennys worth  --  I also have squinting knees and the rotation is described as 'significant'.  I am waiting for surgery to derotate the leg, however I have been on a long road to this.  PT is well worth trying in the first instance and certainly assisted in the first place as did orthontics (sp) shoe inserts made for you.  These can be very helpful in taking the weight off.  Also I had a lateral release, plica removal and chrondroplasty, which gave me a good three year window of good quality life.  Less intrusive options must be explored first and you may well find relief.  I agree that a knee specialist needs to be sought for this.
2002 plica removal, chrondoplasty both knees and LR right knee. Derotational tibial osteotomy rt leg 07/04/06.  Awaiting for left leg to be rotated and have no more knee pain!

Offline shade

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Re: squinting patellas
« Reply #7 on: December 13, 2005, 08:17:22 PM »
j_smi001,

Certainly I agree with what you are saying and hope that your surgery is a success.  It is a big procedure and long rehab - wishing you a speedy recovery. 

A person needs to see a surgeon that is capable of doing some of these procedures like the LR, reconstruction of lateral patellotibial ligament, osteotomy surgery or the hughston/deese procedure where they take the attached patella tendon and cut a strip and weave to the iliotibial band.  I saw four surgeons before anyone understood what was going on with my knee.  I'm still having problems, but you just have to go slow and steady & like j_smi001 said most surgeons want to try smaller procedures first to see if it will work and relieve your pain.
PT is a great idea also, but just be aware that a pt that does not understand this condition can do more harm.  I've finally realized from my surgeon the wrong exercises for two years created more knee problems.  Unfortunate but true and right to the end my pt tried using weights knowing the surgeon disagreed.   I'll never work through pain again and know you have to take charge and tell them NO, this hurts..... You need to have your patella in the correct position when doing the exercises with taping, knee sleeves or bracing.

Wish that the surgery or the knee injections had helped relieve the pain, but still weight-bearing creates pain.  I've ordered the tru-pull wraparound brace mentioned and hope it will create a more pain-free environment.  Whatever works......
Good luck to everyone....  ~Shade
« Last Edit: December 13, 2005, 09:11:05 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline cheergirl489

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Re: squinting patellas
« Reply #8 on: December 15, 2005, 09:18:58 PM »
Thank you everyone for your replies! I hope all is well. Knee problems are such a pain in the neck (and the knee haha)! My OS is still unsure what the problem is. He still thinks possible maltracking, but he's not 100% sure. My MRI only showed a small effusion, but he wants to do another examination immediately (and see the MRI's) and possibly do an arthrocentesis. I read somewhere that many radiologists do not even include maltracking in the reports, so he wants to check that out. Maybe I will finally get some answers. I guess I'll find out on Thursday. Yay I can't wait! just kidding
Take care,
Megan   
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline shade

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Re: squinting patellas
« Reply #9 on: December 15, 2005, 10:07:03 PM »
Megan,

The docs can use CT scan to help diagnose maltracking.  They put the knee at knee at 30/60/90 degree angles with a relaxed quad and then with a tightened quad to see the tracking.

July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline cheergirl489

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Re: squinting patellas
« Reply #10 on: December 20, 2005, 03:35:45 AM »
Hello everyone! I hope you are all doing fine. Well, two days until my OS appointment. I am a bit anxious as to what he will say this time. Maybe he can get to the bottom of the already. I sure hope so! It is to the point where I had to stop PT because of the pain and swelling. I know it's a little strange to say this, but I can't wait!  ;D My school's semi formal is on Thursday, and I have no clue how I am going to be able to dance like this.  :'( I really hope he can come up with something that will help. I'll update soon.
 ~Meg~
« Last Edit: December 20, 2005, 03:39:54 AM by cheergirl489 »
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline cheergirl489

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Re: squinting patellas
« Reply #11 on: December 21, 2005, 08:31:12 PM »
I've been reading some other bulletins and I've come across one that said something about squinting patellae and subluxing. So now this brings me to another question... if a person has squinting patellae, does that necessarily mean they sublux?
~Meg~
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline shade

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Re: squinting patellas
« Reply #12 on: December 21, 2005, 09:07:28 PM »


squinting patella means that the kneecap goes to the inside of the leg while standing, feet pointed straight ahead.
frog eyes means that the kneecap goes to the outside (lateral side) of leg while standing, feet pointed straight ahead.

Your kneecap can sublux medially or laterally..  Your os can check for this problem, but it is very easily seen while in standing position......
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline cheergirl489

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Re: squinting patellas
« Reply #13 on: December 21, 2005, 10:53:47 PM »
My knees look like that man's in the picture, but that does not necessarily mean they sublux though does it? How, besides being told by an OS, would I know they do this? 
~Megz~
patellar maltracking
mild chondromalacia
plica syndrome
Who knows? Thankfully it's doing just fine!... and I've been cheering!!!

Offline shade

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Re: squinting patellas
« Reply #14 on: December 22, 2005, 01:53:14 AM »
Megz,

Well, I know my knees sublux because it is on my OR report, but also I know that my knee should not slide over to the side of my knee like in the picture above whenever I stand up - this condition is not normal & when it creates pain you need help.
As soon as I got the tru-pull wraparound brace on my knee the pain stopped when I walked and going up and down stairs.
Many people with proper bracing & proper therapy can get their quad muscles and VMO muscles strengthened enough to pull the kneecap back in place again and return to normal activities again.
Good luck.  ~Shade   
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT