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Author Topic: i need help deciding what to do about a flat trochlear groove and other stuff  (Read 1322 times)

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Offline mellophone

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everything started in 2006, i have injured it several times since then. i have had numerous dislocations of the patella, bracing does not work, surgery where they replaced the MPFL with a cadaver graft and did a lateral release, it did not work, physical therapy has not worked. the patellar tendon is in the wrong place and the groove that the kneecap fits in is flat. i have had 2 surgeries my orthopedic surgeon said something about moving the patellar tendon and rebuilding the groove but that is tough to do and go through and he doesn't want to do it because i am only 16, does anyone know of anything that might help. i want the pain to end. it hurts from sitting for a long time (class), hills, uneven surfaces, and just about everything. the dislocations happen when i try to straighten the knee, going down stairs, squatting... the patella just pops out and i can make it do it but not stop. it will also happen when i go walk downhill and it hurts all of the time.i have been in pain since 2006 and need help. i am double jointed/have very stretchy ligaments. any advice would be of a great help. thank you in advance and if anyone else has had the same thing please include surgery information, recovery time, age when you first started having problems, when you had it fixed, and everything. i just want my knee to be back to normal. if anyone has any ideas they would be very helpful. i am very confused at this point though.

this is what my daughter is having a problem with, could you please help us?
8th grade - rt knee scope - chondroplasty of patella
10th grade - MPFL recon (allograft), LR,chondroplasty of patella
summer after 11th grade - TTT, MPFL recon (allograft), LR, cartilage plugs, and chondroplasty of patella
revision of incision and mini MUA (to 90)

Offline mhsflute07

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Hi Mellophone,

It sounds like your knee problems are similar to mine. I was 11 when I started having problems (patella dislocations). I did physical therapy and wore braces, etc for a long time before I had surgery. When I was 16 I had my first surgery which was a Tibial Tubercle Transfer or TTT (basically moving the attachment of the patellar tendon). I had this surgery done on both knees 7 weeks apart (during the summer). My left knee turned out great, but unfortunately I continued to have problems with my right knee. Over the next 2 years I had 2 scopes which revealed a chondral defect on the back of my patella. At that time they did abrasion chondroplasty which is basically roughening the exposed bone in the defect to make it bleed and thus hopefully stimulate scar cartilage to fill the defect. However, I never got relief from that despite lots of PT after each surgery. I gave my knee a year and a half to heal just to see if time would help improve things, but it did not. So, this past March I got another opinion. This doctor scoped my knee while I was on spring break and discovered that the chondral defect on the back of my patella had grown considerably since the last surgery. He also figured out that my patella still was not aligned perfectly and that my trochlea was dome shaped...it was like a hump instead of being flat. So 4 weeks ago today I had another TTT and a Trochleoplasty (surgery to create a groove). So far things are going well. There is still the possibility that I will need another surgery to address the chondral defect.

As far as recovery times go, it took a good 6-8 months to get back to playing sports after my TTTs a few years ago. The scopes only took a few weeks to recover from. This most recent surgery I'm not sure how long it will take to recover from. It has been much more difficult than the first TTTs I had. At 4 weeks post-op I am no longer required to wear my brace and am getting around using just one crutch. However, my quad is extremely atrophied. I'm guess that it will take at least 6 months before I'm back to more normal activities and my leg is stronger.

I hope you, your parents, and your doctor can find a way to fix your knee soon!
June 2, 2005 TTT/LR  R.
July 26, 2005 TTT/LR  L.
June 6, 2006 Microfracture R.
June 5, 2007 Microfracture & Screw Removal R.
March 12, 2009 Scope and ACI Biopsy R.
May 12, 2009 TTT, Trochleoplasty R.
December 15, 2009 ACI (patella) & bilateral hardware removal
December 21, 2010 LOA and LR

Offline Silkncardcrafts

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Hi Mellophone,

Like mhsflute07 I have had a trochleoplasty for trochlear dysplasia, which is where you have a shallow trochlear groove. Essentially the part your knee cap sits in.

I am now just over 12 months post-op and am doing wonderfully well. It never comes out and is really stable. Am soooo happy with my result. I am going back to see my OS on Friday in the hope of him doing my right knee.

This is very major surgery but the recovery is not as bad as people make out. It is hard in the first few months while your bone recovers and heals as you can't do much.

I guess the main issue is how young you are. Would really encourage you to get an opinion from a top knee surgeon that specialises in patella problems. Whereabouts do you live ?

Let me know if you've got anymore questions.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline mellophone

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I live in between Birmingham and Atlanta. I went to see someone at Andrews sports medicine, and he wanted to cut the lateral side of the quads, while i am awake, only under sensory block. This sounds very weird and the patellar tendon is not correctly placed plus the trochlear groove is flat but he said that this did not matter. This was doctor Clancy. I then went and got another opinion from the person who did the MPFL reconstruction and lateral release September of 2008 and i was cleared to march in Feb even thoughthe season was over but we have band camp all year round, he said that if i let Clancy do that and it did not work then there was no way to fix it. I am going to doctor Matt Davis, and I love his attitude, he is great with teens. Dr. Davis said that he would not do that as of yet, he would try several years of PT, other braces, and MAKE ME QUIT MARCHING, (band is my favorite part of school). When do you think that another attempt to fix this should be made? It comes out every day and the entire knee just feels unstable and like it is going to crumple and then i will not be able to march. I have read about fixing both problems, and this seems like it would help. I just want to know that how bad should I let it get before I try to get something else done?
                                                                                                                                Thank You
« Last Edit: June 14, 2009, 05:08:01 AM by mellophone »
8th grade - rt knee scope - chondroplasty of patella
10th grade - MPFL recon (allograft), LR,chondroplasty of patella
summer after 11th grade - TTT, MPFL recon (allograft), LR, cartilage plugs, and chondroplasty of patella
revision of incision and mini MUA (to 90)

Offline Silkncardcrafts

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Hi there,

That is crazy that they are making you do years of physiotherapy. I think you are better to get it fixed sooner rather than later. It can make a big difference if the trochlear groove is flat. Makes me mad !!! Giving up marching isn't the answer either. Doing regular exercise is really important to keep the muscles strong.

I had the trochleoplasty on my left knee last year and will probably have the right knee done in a few months. It has made such a difference to my quality of life.

Are you anywhere near Alanta ? Sorry, I don't know the U.S. geography too well. The clinic that mhsflute07 went to in Atlanta sounds good. Think it was Dr G that did her surgery.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline mellophone

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I am close enough to Atlanta to go there and come home in a day, who is Dr G? and how could i find out more about him?
Thank you for your help and good luck mhsflute07 on your recovery.
8th grade - rt knee scope - chondroplasty of patella
10th grade - MPFL recon (allograft), LR,chondroplasty of patella
summer after 11th grade - TTT, MPFL recon (allograft), LR, cartilage plugs, and chondroplasty of patella
revision of incision and mini MUA (to 90)

Offline mhsflute07

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Hi Mellophone,

The website is http://www.atlantasportsmedicine.com

Good luck!
June 2, 2005 TTT/LR  R.
July 26, 2005 TTT/LR  L.
June 6, 2006 Microfracture R.
June 5, 2007 Microfracture & Screw Removal R.
March 12, 2009 Scope and ACI Biopsy R.
May 12, 2009 TTT, Trochleoplasty R.
December 15, 2009 ACI (patella) & bilateral hardware removal
December 21, 2010 LOA and LR