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Author Topic: Tilted knee caps!  (Read 8866 times)

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Offline Sweetness81

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Tilted knee caps!
« on: November 09, 2006, 09:21:26 PM »
Hello my name is Mary,

I was just diagnosed with tilted knee caps about five months ago. My doctor has talked about surgery but says that she doesn't normally do surgery for tilted knee caps. She says that Physical therapy usually makes it better. Well i have been in physical therapy for four of those months. And I have had no pain relief. Its getting really hard for me to walk. I really need some advice on what to do. I have been in so much pain that my doctor has prescribed Methodone, but I developed a sensitivity to it. and threw up for 18 hrs straight. It worked, but now that I can't have that, well I have been in constant pain ever since and that was about 2 months ago. Please someone tell me what I can do to stop my knees from hurting. Or at least alleviate it. Thanx for your time.

Mary

Offline laforce18

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Re: Tilted knee caps!
« Reply #1 on: November 10, 2006, 03:23:35 AM »
Mary,
I hope that this information is helpful:  I would go to another OS right away.  Don't settle for being uncomfortable for the rest of you life.  if your knees are hurting that bad, then something has to be done.  It sounds like you need an MRI from a new doctor.  Asked to be referred to someone who deals with knees...good luck, and don't waste any more time in pain!!
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal

Offline JakesKarenbug

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Re: Tilted knee caps!
« Reply #2 on: November 10, 2006, 04:59:14 AM »
Mary--

I would DEFINITELY see another OS.  I too have tilted kneecaps...mine tilt to the outsides of my joints.  I also have a lot of pressure caused by my tendons being tight and I have some arthritis.  I am having a Fulkersons Osteotemy for this.  I don't know if this will be what you require, but it may be a possibility.  I'm having my left knee done next Friday the 17th.  I understand about being in pain too!  Mine cause me a lot of pain.  I am a college student, and there are days when I can barely sit through a 50 minute class.  I wish you the best of luck though, and keep us updated as to what you find out!!!

Karen

Offline Linds

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Re: Tilted knee caps!
« Reply #3 on: November 10, 2006, 11:31:20 AM »
Yep, see another DOc... Agreed, Agreed , Agreed. I have laterally tilted kneecaps, I had Lateral Release surgery and it has helped. It hasn't fixed me... but I have other problems too. If your kneecaps tilt laterally then it is likely that they are rubbing and putting pressure on areas that just shouldn't have pressure on them.
Lot's of people have tilted kneecaps and never have symptoms.. . but if you need to be on serious pain killers.. you need serious help. I think 4 MONTHS of PT is a good try ... In the mean time you might think about a patello femoral brace or has your PT tried taping your knees? It can give you relief for awhile, taking the pressure off the areas that are being damaged.  Breg makes a good PF brace, the PTO, and Donjoy alos makes a good one... can't remember it's name.  Hang in there...

GOODLUCK... don't give up

Linney
« Last Edit: November 10, 2006, 11:34:00 AM by Linds »
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline shade

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Re: Tilted knee caps!
« Reply #4 on: November 10, 2006, 12:27:06 PM »
Mary,

Hi there.....  Sounds like you need a good assessment with an OS who has experience with patello-femoral conditions.  You might also need to find another physio center to find someone who has experience with these types of issues.  An experienced physio can help tremendously with different treatment methods like ultrasound, e-stim, acupuncture, massage, address gait issues, etc. etc......   I've unfortunately learned the hard way about patello-femoral problems & now realize you can't have agressive physio with patello-femoral problems, for example instead of using weights use therabands - they don't stress the joint but still give you the needed resistance. 
Try using heat before exercising, then ice/elevate afterwards. 
You've got to do your research and find out as much as possible about your injuries and become your own advocate.
Take care and let us know how you are managing.  ~shade

Here's some info......  

Patellofemoral Pain (Kneecap)
The number one cause of pain in the young, healthy athlete is patellofemoral pain. Patellofemoral pain syndromes are referred to by many different names, some of which include; anterior knee pain, patellofemoral malalignment, chondromalacia patellae, patellar hypermobility, lateral pressure phenomenon, and patellar tilt.

Causes
The primary cause of patellofemoral malalignment is an unbalanced set of forces across the patellofemoral joint causing the patella to not be centered within the trochlear groove, which is a part of the thigh or femur. The abnormal forces that act on the patella to cause this problem can be as simple as a muscular weakness of the quadriceps muscles (thigh muscles) or an imbalance between the various portions of the quadriceps muscles, tight ligaments either on the outside or the inside (lateral and medial, respectively), having flatfeet, being knock-kneed, and having significant ligamentous laxity.

Although it is possible, traumatic causes of patellofemoral pain are not common. In a traumatic situation, pre-existing malalignment often exists and it is harder, but not impossible, to treat the pain and discomfort conservatively. When traumatic injuries do occur and a cartilage lesion is caused, treatment by any means is more involved and full recovery harder to achieve. In fact, it is not uncommon in these situations, for surgical intervention to be suggested and/or required to return athletes to their full potential.

Symptoms
Aching around the patella
No specific area of point tenderness
Pain worsens with stairs – up or down
Pain worsens with long periods of sitting – Theatre Goers’ Sign
Clicks or pops (though some clicking and grinding under the patella is normal)

Treatment
The type and duration of treatment is dependent on the severity the condition. A period of non-operative treatment is normally the initial step taken to correct the problem.

Non-operative
The treatment of patellofemoral malalignment centers on the factors which predispose it to occur. The most common of these is lateral (outside) tightness especially of the ilio-tibial band (ITB). Stretching of the lateral retinaculum and ITB, though difficult, is very beneficial. Significant knock-kneed (genu valgum) position of the knees can also lead to and cause patellofemoral malalignment. This is quite common in females, as they have broader hips for giving birth. In these situations, reversing this knock-kneed condition is possible but is a large undertaking, and is usually not necessary. Flatfoot deformity (pes planus) also can contribute to patellofemoral malalignment symptoms. In situations where flat footedness exists, a medial arch support and sometimes some medial posting in an orthotic will dynamically help the patellofemoral joint. Placing an arch support is a common first step taken during the conservative treatment of patellofemoral malalignment.

Overall, non-operative treatment of patellofemoral problems is successful 85% of the time. Patience and diligence increase the success rate with several courses of therapy and activity modification often necessary.

Alternative Treatment Options
Glucosamine
Hyaluronic Acid
Non-steroidal Anti-inflammatory Medications (NSAIDs)

Operative
Though not common, operative management of patellofemoral problems is sometimes necessary. Long standing malalignment problems that are resistant to non-operative care as well as traumatically induced patellofemoral problems which cause surface damage can be treated surgically.

Operative treatment begins with an arthroscopic procedure to remove loose fragments from within the knee and to smooth out rough and/or irregular edges when they exist. Re-alignment procedures are then performed to correct abnormal forces as is appropriate. A lateral release is commonly performed and will treat tilted knee caps well when this is the sole problem within the patellofemoral joint. Re-aligning the forces within the joint, however, when subluxations, dislocations, and/or significant ligamentous laxity exist requires more extensive procedures. These procedures include tightening of medial or lateral ligaments, advancement of muscular attachments on the proximal pole of the patella, and sometimes osteotomies of the patellar tendon attachment to the tibia via an open procedure (i.e., tibial tubercle osteotomies).
« Last Edit: November 10, 2006, 12:30:34 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
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Offline Sweetness81

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Re: Tilted knee caps!
« Reply #5 on: November 13, 2006, 12:42:48 AM »
Thank you so much for these ideas.

     It might also be helpful to let you guys know that I have tried tape. anti-inflamatories. Even Toridol in the hospital. My knees didn't respond to it. My physical therapist is actually a really good guy. He is very concerned about what to do. He has worked with me the whole way. He is very reluctant to do any strenuos activity because of my level of pain. He says that normally working our bodies can work through muscle fatigue, just not joint pain. He is definantly right on that one. Tape has helped, but only for a short time. It hurts really bad under my knee caps. I was prescribed infrapatellar bands. But they don't help for pain. They do help me walk better though.  I can use heat just not ice. It has no effect on my knees. The heat only works while it on my knees. I don't have any ideas what is going on but even my PT is baffled. I am at my whitts end. I knew that if I posted on here that someone would have some ideas for me. Thank you so much. I will keep taking suggestions and trying them. I appreciate everything. My knee caps tilt to the outside of my leg at about a 45 degree angle. The OS showed me the x-rays it looks freaky. Any way thanks for everything. Look forward to further replies. Thanks for your time and information.

Mary

Offline Chips

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Re: Tilted knee caps!
« Reply #6 on: November 27, 2006, 09:16:50 PM »
I also have tilted knee caps.  I have grade 4, meaning no cartlidge is left behind my kneecaps.  I took Glucosamine & Chondroiton for about 3 months with no noticable improvment.  But then when I added Hyaluronic Acid each day, I noticed a difference within a week.  It has made a huge difference.  I tried an experiment and quit taking it for a couple weeks and the pain came back and was unbearable.  So I faithfully take the above 3 supplements, and my pain is diminished about 70%. I still cannot squat or go upstairs completely without pain, and may eventually try injections.  But for now this regime has helped me tremendously.  It has kept my swelling and inflammation down completely.