Squinting Patellas and Prolonged Knee Pain

[stickshifty]

I am running out of patience with my knee pain.

Two and a half years ago, I injured my left knee horseback riding when the stallion I was riding jumped too far left and caught the jump standard in between my knee and the saddle. It immediately started swelling and hurting. I didn't get an appointment with an orthopedic sports-medicine doctor until two weeks later. X-rays showed nothing and so they scheduled an MRI. Two weeks later, they said the MRI showed that nothing was torn and that it was probably just a hyper-extension of the lateral collaterl and that'll get better in a few weeks yadda yadda. Oh, and by the way, you have squinting patellas-- inwardly twisted femurs. He sends me down to the PT people to get a list of exercises to build up my quads. The PTs gave me a sheet, told me to add ankle weights gradually and to have a nice life (they were overcrowed that day and didn't have time to show me anything). But unfortunately, the pain had gotten worse because band camp had been the week before (nothing spells summer fun better than 48 hours on a 140 degree parking lot).

As the end of the summer drags on, I have to quit riding because the pain was just overwhelming after I dismounted. Adding to all of this is band, which makes the pain even worse and hurt for longer periods of time. It got to the point where both my knees hurt. After marching season ended, the pain became more manageable and it wasn't really worth complaining to my parents about so I just took it with a grain of salt (more of a capsule of Aleve) and tried to go on with life.

The pain didn't come back full-blown until marching in the Fiesta Texas parade (nothing is worse than marching on a slanted street with drunk people throwing beer on you while wearing band uniforms in the Texas heat x.x). After couple weeks after that parade I went back to the doctor and he told me that I should just deal with it because he has no clue why my knees hurt.  He tells me that I should do real physical therapy during the summer because (after my mom showed him the list the PTs had given me two years before) out of the 8 exercises on the sheet only 2 would be beneficial.

So I do the pt all summer and I go back to him the week before band camp. He gives me a note to give to my band director stating that I have "quadric sublaxtion patellar tendonitis" so my bd would let me sit out if the pain got really bad. But he encouraged me to just "ignore the pain" because the supposed problem with my knees "won't make you crippled." On the way to billing, I read my chart and it said I had a "partial tear to the meniscus" (me: wtf why haven't I been told of this???)

Marching season was hell to say the least. A crack in the parking lot during practice and then a week later a muddy downfield during a competition escalated my pain to a completely new (higher) level. For the last 4 weeks of the season, I marched only 4 times- at the competition- and the pain started in the first couple sets and in the eight minute show it went from worse to "holy crap I want to scream and cry and pass out and die." I pretty sure people here can relate. The only perk of this was being carried off the field by hott percussionists after every show.

So after all the season ended, I went to a new knee doctor and he told me the first one followed "all the right steps" and so he said that the only thing he could really do at that point was to give me cortisone in both knees and see what happens. After that traumatizing experience (I am a complete needle-phobe) and the first two days of burning, the cortisone really helped. REALLY. Unfortunately, it only lasted for about 1 and a half weeks. But it was the most pain-free week and some in a looong time. But, as timing would have it, I had to march in the Hollywood Christmas Parade 2 weeks after the injections x.x. The new doctor recommended me to an orthotics person and a rheumatologist. So I get my custom inserts (which don't fit into my Converses x.x) and I go to the rheumatologist. I get tested and come back negative for rheumatoid arthritis and lupus (I have no clue what else he tested in addition to those). He re-ran the tests at a return visit and those were negative too.

So three doctors have no clue why my knees hurt. They all come highly recommended and are supposedly "some of the best," but I still have knee pain. My first doctor briefly mentioned a surgery to "unsquint" my squinting patellas but he highly un-recommended it because he "wouldn't do it to his daughter." The second doctor said arthroscopic surgery was next step, but the rheumatologist is against any "unnecessary evasive surgery." The rheumatologist prescribed 750mg of Nabumetone 2x a day and those helped manage the pain until a few weeks ago. Now the pain still keeps me up at night. I starts on the inside with a stab and then a buring sensation... then the whole joint feels like its on fire. And with an average of about 4 hours of sleep a night, I need all the sleep I can get. Please help me! I just want to be a normal high school girl and worry about boys not joint pain!

[Jules71]

Hi there Stickshifty,,,,,,

My heart goes out to you, numerous amounts of trained specialists are unable to help you.....poppy cock, if you have noticed on your chart a possible torn meniscus, I think your problem could lie right there. Is the pain inside or outside the knee, does it lock or pop, can you extend and bend, is there pain in the jointline???.....if you have any of these, are torn cartlidge can catch and cause pain, or fragments may have broken away from it and cause inflamtion, have they tries to drain you knee?? I just do not really like the sound of your pain, you sound like you are young and if this persists you could be facing some substancial long term problems?

Let me know

Regards
Jules

[shortyclairebear]

hi there like you i was "fobbed" off by several specialists before my current one admitted there was a problem with my knee,i also had x rays,mri and physio to try and cure my knee probs after i had a road accident where i landed on my kneecap.
i was also told that arthroscopic surgery was the next step but it may not work or make any difference.
i decided to have this done as i wanted this sorting once and for all!!
once this was done the surgeon discovered that there was "alot more going on in there" then he first thought and i have recently had my second op done which so far so good seems to be going ok.
the arthroscopic surgery i had was small incisions were the surgeon goes in to the knee or "keyhole" surgery,mine was more as of a "diagnostic arthroscopy" as having this done diagnosed the real problems going on in there and i have just had another op to correct these problems.

in a way my surgeon for the first op more or less described the arthroscopic surgery as evasive too,but for me im glad i had it as this found internal problems that were there that none of the other things showed up.

whatever you decide to do good luck and keep us posted on how you get on!! i got x 3 opinions for my knee probs as in the uk our health service do try and save money by telling you there is no hope and you have to put up with it!!

[stickshifty]

Is the pain inside or outside the knee, does it lock or pop, can you extend and bend, is there pain in the jointline???.....if you have any of these, are torn cartlidge can catch and cause pain, or fragments may have broken away from it and cause inflamtion, have they tries to drain you knee??

During marching season, the pain is generally around the lateral collateral and under the kneecap. However since the season has ended, the pain has usually started on the inside and then spreads to the whole joint x.x (this usually happens while I'm driving). And both the knees will pop (my hips pop more though...) and that is usually followed by a stab of pain on the l/c side. During marching season, they would buckle occasionally while I was trying to haul it backwards (that would usually end up in me stumbling and getting carried off the parking lot because the whole joint would just burn). As for extending and bending, after doing anything on my feet would lead to my knees swelling and stiffness. They have not tried to drain my knees because the second doctor felt it and said "it didn't feel like there was any fluid in the joint." But that could explain the three days my left knee was swollen despite numerous icings and anti-inflammatories...

I just received a letter from the second doctor's peoples and it said that they would no longer accept my insurance company. Who cares that majority of the people in Tennessee (US) use that brand? So if I want another appointment with that doctor, instead of paying a $20 co-pay, it would cost $200. Those dirty little bastards... 

[stickshifty]

if this persists you could be facing some substancial long term problems?

Oh btw, the first doctor explicitly told me at my last visit that my knee pain would "not cause me to become crippled." But I don't exactly trust what he says because he told me 2 1/2 years ago the pain would go away.

And I know some of you might ask why I keep marching... french horn is my way to pay for college. If I marching (which means band), I will have thrown away pretty much my life.

[Jules71]

Hi there Again,

This all sounds oh to familiar,,,,,what the heck is going on with the medical profession. Has it just come down to the dollar, and the "cant fix" claim, the shame about it is that there is another mug around the corner who will need their services, so whether we return to them or not will not put them out of business, so the have a compassiontless attitude, and at the end of the day whether we are paying for their services or this is being done by a third party should be irrelevant and that we are owed as the customer/consumer/client/patient a level of care. If your injury/pain is left to long, months/years you could become crippled, our knees are really the hub of our mobility, they carry so much of our weight, and are needed to get us from a to b, and without this ability you are then crippled to a degree. If it takes a second or third or even fourth opinion to find a SPECIALIST whom will find rhyme or reason for what is going on with you, then it may be worth the search. Like with all professions you sometimes need to go through a few "think they know it all's" to one who actually is not only endowed with lots of letters after their name, but is also passionate about what they do, and endevour on a daily basis to acheive the best they can for their patient without failing them and fobbing them off. It now becomes a search and sometimes a lengthy one at that, but worth it for closure.
It is a bit of a catch 22 for you, you can roll over and play dead and cease to enjoy life as you know it, and maybe in the medical profession's eyes aggrevate your problem, or you can continue to strive to provide for your future and wellbeing.
Please keep us posted as to your progress, and at the end of the day if the insurance company will not play ball, and you are having to pay full price for services, you may as well seek out the best and that will mean your money will be well spent. And lastley if your gut is telling you not to trust your current specialist then DONT, there are plenty more fish in the sea.
GOOD Luck
Jules

[Linds]

Hi my opinion is likely going to go against alot of what the other's have said but i'm going to say it.

I to am an avid equestrian, eventing is my sport of choice, I am also a trainer and Coach.

I also have internally rotated femurs as well as externally rotated tib/fib so my kneecaps and femurs do not get along well at all. My kneecaps constantly are subluxed, and I have chondromalacia which is a softening of the cartilage on the back of the patellae.  My pain problems started when i was just 9 years old and I was an avid runner.  I have had the same orthopedic surgeon for those entire 17 ish years.  He had no idea what to do for me for the longest time. Like you they tried physiotherapy they tried all sorts of things that did very little to help me.   I did have surgery a Lateral Release on both knees as my kneecaps had a severe tilt. It is debateable how much this surgery helped, if at all.   What finally helped me was finding a really good physiotherapist. He doesn't even specialize in knees. He specialises in Postural therapy and chronic pain.   But he was wonderful.  He pushed me to push myself but understood when I was just in too much pain and we spent those sessions with ultra sound and accupuncture.   Eventually I graduated from seeing him all the time and did my exercises at home. I began walking... increasingly longer distances until I was walking 4 km's twice a day to the stable to feed, water, clean out and turn out my horse.  Then I got back to riding and was riding atleast an hour a day 6 days a week.  My knees aren't/weren't perfect but i was able to do what I wanted basically with liveable amounts of pain. 

9 Months ago however I was injured in a riding accident jumping a 3x3 square cross country fence. But this injury isn't related to that chronic problem.

There is surgery that can fix what is wrong with your knees... i'm just not sure it would put you in any better a position.  I have read and researched alot .. and things like femoral osteotomy's where they cut your femur and rotate it are pretty extreme and I haven't found alot of people who got back the active life they wanted.  I don't think your surgeons are blowing you off... they are being cautios just like mine was.  And now that i'm 26 years old, I understand.  He didn't want to do anything that could put me in a worse position after surgery than before.   

What is wrong with your knees likely wont' cripple you. The pain is frustrating, I know.. been there plenty but it won't cause deformity in the joint. The knee joint is still functional it just hurts.   Keep in mind that just because a surgeon says he'll operate on your knees, doesn't mean he's a "good surgeon".  A Scope might be in order to look around and see what is going on in there, but I wouldnt' jump into anything drastic.

You might consider trying a different physiotherapist, and /or some type of brace. I wore breg PTO braces with plenty of success. I also made ice my very best friend.   As soon as my knees start to feel sore I slap on an ice pack and take a break for 20 minutes.  I ice before and after I ride my horse as well... 

There is a possibility you may still grow out of this.  Just be careful because some of hte surgeries can leave you in alot worse shape then you started in.  You might also try a joint supplement like Glucosamine, Chondroiton and MSM that encourage your body to repair the damaged cartilage and produce more synovial fluid within the joints.

You have to do what is right for you. I just thought I would share with you my experience as i'd hate to see you permanently "crippled" from a surgery that didnt' fix the problems you started with.

Goodluck
Linney

[Jules71]

i do tend to agree with you Linds, you are both very young and I know that surgeons will at all cost avoid surgery on younger people, but there are cases where like mine if your knee is bent to long or you limp to long the os's and pt's can get concerned about this becoming permanent, and it does happen, some people are never fully able to straighten their leg again. But the bottom line is to remember everyone is different, what works for one maybe completley different for another, and not all practioners are like yours, and also bearing in mind that people heal or get worse at varying rates.
It is not right to live with unexplained pain, be it young or old. There are people sure that can help, and others who will fob you off, that is the difference between and true professional and a try hard, and not all of us are blessed with a good os from the start some need to find the one that treats you like a human not a number, the better the realationship you have with your medical team the better the communication and generally the better the outcome.
I think the position of sugery would need to be one that would not put the person in a worse postion than what they are already in, but alas sometimes things go wrong, it may fix or make the situation worse, and I think that someone can do all the research that they like, but key is Everyone is Different, no 2 people are the same, I recovered from major bowel surgery and a c-section a couple of months later very rapidly, more so than just a simple arthroscope and debridement, which is only keyhole,,,,,,go figure

Jules

[Linds]

Totally Agree with Jules, everyone is different and you have to do what you think it right for you.  I just see so many people rushing head long into surgery thinking it is the end all be all and that isn't the case at all...

Goodluck