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Author Topic: patalla allta  (Read 951 times)

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Offline Mr Mom

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patalla allta
« on: March 26, 2010, 05:02:54 AM »
I just got custody of my daughter, she was told in AZ that she had patalla allta I'm in the ER right now as I'm typing this and when I tell the nurses what she has they all say they have never heard of it!! Is this Rare and what can be done? Any help would be much appreciated

Offline TwoBadKneesUSA

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Re: patalla allta
« Reply #1 on: March 26, 2010, 12:45:48 PM »
Hi there, sorry you are in ER with your daughter at the moment.  I don't know how rare patella alta is, but many do have it.  I've had it all my life.  Basically the kneecap rides up to high on the end of the thigh bone.  So the kneecap does not always engage properly in the groove on the femur.  Depending on a few other factors, this can cause the kneecap to either dislocate (which would be pretty obvious) or sublux (which is to say it jumps the track a bit and comes back in line).  This can cause wear and tear on the back of the kneecap, which in turn causes pain.  I also had a lot of pressure behind the knee cap too (I also have shallow grooves on the femur).  What you should do is have them call for an ortho if she is there for a knee problem.  The ER docs are good, but for anything like that I demand they call an ortho.  Hope she is better.

'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline crankerchick

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Re: patalla allta
« Reply #2 on: March 26, 2010, 12:46:51 PM »
Patella alta is a knee cap that sits abnormally high on the femur. I wouldn't call it rare at all. In fact, it seems to be a rather common occurrence in people with patellar stability issues. In and of itself it doesn't have to be the reason for patellar pain and/or instability, but it is certainly considered as a contributing factor.

I'm not sure why you are in the ER, but I'm going to assume it has something to do with her knee, since you are asking about patella alta. Did her patella dislocate?

How old is your daughter? What kind of treatment has she had in the past?

I hope everything is ok for you and your daughter!
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Mr Mom

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Re: patalla allta
« Reply #3 on: March 26, 2010, 02:33:15 PM »
Thank you all for your help we were in the ER till 430 am , my daughter is 16 I don't know a lot of her history about this, her mother abducted her several years ago so untill I found her 3 months ago and won custody I have been out of the loop, the ER doc said x rays did show the patella riding high, I'm guesing she needs a CT scan, I am trying to find an ortho now, can any of you tell me the best way to deal with her pain when she has it? What it did last night was pop it out of place, But the ER doc really had very little clue on what to do,

Offline crankerchick

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Re: patalla allta
« Reply #4 on: March 26, 2010, 02:49:02 PM »
Glad to see you back to DrMom and glad everything is ok.

I assume the ER doc reset the patella? Or was your daughter able to get it back into place on her own? Either way, I assume they just did x-ray in the ER, possibly gave her a stabilizing brace and some crutches and a script for pain killers and instructions to see an ortho? That seems to be the standard ER procedure.

Some things you can do for pain are basically R.I.C.E. - rest, ice, compression, and elevation. Any light exercises and stretching she can do such as quad sets, ankle pumps, and straight leg raises are beneficial, but usually only if they don't cause pain. Drugs can of course help.

As for an OS to help, the key here is to find one that specializes in knees and has specific interest and experience in patella issues. There are a variety of reasons for why you daughter's patella is unstable. Patella alta is just one reason. There may be more to the story. It's important to get to the root reason (or reasons) for the instability and that starts with a good patella doc and some imaging.

1. Lateral x-ray with the knee bent to 30 degrees to reveal patella height. you know its high, but just how high?
2. X-rays of the knee bent to various degrees of flexion, called sunrise or merchant views
You will find less doctors do these imaging, but they are good, in fact essential:
3. standing full length x-ray to show if there is a malalignment such as knock-knees or bowed-legs
4. CT scan for rotational deformity of the femur or tibia (femoral anteversion and tibial torsion); assessment of the trochlear groove; more assessment of patellar tracking (knee bent to various degrees of flexion); also gives other helpful info for making surgical decisions

X-rays and a CT scan are the best tools for patella issues. An MRI will reveal such things like cartilage damage, bone bruising, inflammation, and ligament damage, but the x-ray and CT scan are the bread and butter.

This can be a big process to under take. There are a lot of doctors out there with different opinions on how best to treat this. Please tread cautiously with any surgical treatments, as different doctors have different approaches and all aren't created or applied equally.

Physical therapy will undoubtedly the next step once regardless of what OS you see. Keeping the quadriceps muscles strong and balanced is really important regardless of any underlying structural issues.
« Last Edit: March 26, 2010, 02:58:31 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline TwoBadKneesUSA

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Re: patalla allta
« Reply #5 on: March 26, 2010, 04:50:50 PM »
Basically ditto....

Also don't be afraid to get a second or third opinion on what is going on.  If the ER gave you pain meds for her give them as prescribed.  If not, usually a standard is 600MG ibuprofin 3 times a day.  Tylenol may work well too.  Check with her GP on that if the ER did not give you any medication info.  You can take both ibu and tylenol together (take one then in 15-20 mins take the other), just remember the ibu is every 8 hours and the tylenol is every 6.  I would also elevate the ice the knee as much as she will tolerate (elevate it above the heart to reduce swelling).

Hope she is doing well for now.
'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.















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