pfs....or kneecap sunken into joints?

[Davidf66]

I am kind of freaking out right now so if anybody could offer so insight I would appreciate it. I had an acl reconstruction with a patella tendon graft almost 4 months that seems like it has turned my knee into a mess.  I am still in constant pain everyday.  I have been having pain under the kneecap that my PT and OS suggested was PFS and told me to strengthen my quad and it should go away.

However, my quad is fairly strong. If my understanding of PFS is correct it is basically a maltracking problem due to a lack of qaud control. When I contract my quad with my knee straight my quad seems to pull my patella properly with plenty of control. If have any bend in my knee between 0-90 degrees I feel my kneecap pull into my joints and is pushed to inside of my knee because it doesnt have any where else to go. If I contract my quads hard enough it feels like I am going to rip my kneecap off.

I have a fairly high q-angle which I understand increases the contact of the patella with the joints. However, I never had any pain prior to surgery. I think my patella tendon shortened after the graft was taken which has further increased the contact with the joints. Obviously, I should have used a different type of graft for my ACL, but the patella tendon was what my OS suggested and I trusted him.

I am going to seek a second opinion from another doctor because my OS has been pretty useless and does not seem to really care. Am I correct in thinking my kneecap pain is not a result of true PFS?  If my kneecap is sunken in is there anyway to fix it? Again, I would appreciate it if anybody could offer me some insight on the matter because I am driving myself crazy trying to figure out what is goinging on with my knee.

[Jaci]

Davidf66-

It's very possible that you developed a condition called "infrapatellar contracture syndrome." Some big words for a condition characterized by shrinking of the joint capsule and tendons and ligaments. Shrinking of the patella tendon is called patlla infera or patella baja. All of these problems stem from a condition called arthrofibrosis-- an exaggerated healing response to trauma that causes you body to perform too much scar tissue.

The most important thing you can do right now is read and learn everything you can about these uncommon conditions. You've found the right website to help you become eductated. Go to the Hub (look of link in upper right hand side of this page or use this link

http://www.kneeguru.co.uk/KNEEnotes/node/632


Then look around for a section called arthrofibrosis. You find Dr. Noyes' amazing tutorial on arthrofibrosis, along with many theads and article reviews coving excess scar tissue and it's complications such as infrapatellar contracture syndrome. If you got the the ACL recon section, you'll find anotjer excellant tutorial written by Dr. Noyes on complications following acl recon. Read through the info several types as you'll really want to digest it.

Also, take a look down in the soft tissue healing problems-- arthrofibrosis bulletin board; you'll find stories from many people who have gone before you dealing with this condition.

Best wishes,

Jaci