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Author Topic: Patellar Entrapment?  (Read 1823 times)

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Offline BadKneeDay

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Patellar Entrapment?
« on: April 01, 2010, 02:58:13 AM »
Had a torn meniscus--left medial in March 2005.  ACL reconstruction using patellar tendon autograph in January 2009.  (Also left knee) ACL was 75% ruptured and went undiagnosed for 2.5 years.  (Injury occurred July 2007).  I have continue to suffer from pain and quad atrophy.  Finally got to another doctor, the first insisted that "nothing is wrong" with my knee, and the new doc told me that I have "marked patellar entrapment and retropatellar tendon adhesions" and that I need "arthroscopic release and excision of adhesions... then immediate PT to work on patella mobility."  I was so excited that the IME could see the problem and knew what to do about it that I didn't bother to ask what the surgery entails, what the re-hab process is like, how long I would be on crutches, etc.  Problem is, it was an independant exam, so I can't go back until I know whether the insurance will approve the surgery.  I have googled for several weeks and cannot find any information on patellar entrapment or retropatellar adhesions.  If anyone has information on these conditions and the treatment thereof, please share!  Thanks!!

Offline smillie

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Re: Patellar Entrapment?
« Reply #1 on: April 01, 2010, 04:34:18 PM »
Check with the arthrofibrosis people.  It sounds like the same sort of procedure. 
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline BadKneeDay

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Re: Patellar Entrapment?
« Reply #2 on: April 01, 2010, 04:43:19 PM »
Do you think that's what it is?  I have looked at arthrofibrosis information and it looks like you have to have loss of extension or flexion to be diagnosed with that... and I have neither.  It's only the knee cap that doesn't track right, so I thought this must be something different.

Offline smillie

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Re: Patellar Entrapment?
« Reply #3 on: April 01, 2010, 04:52:23 PM »
I don't know that it is.  It just sounded kind of like scar tissue, so that is what made me think of looking there at the procedures they have had done.  I had arthrofibrosis and for me it was a loss of flexion, but back when I had mine taken care of, they weren't removing the tissue, they were just breaking through it.  Did your dr. say it was scar tissue?  What else would adhesions be?  I'm definitely not an expert (except with my own knee LOL) but just thinking out loud since no one with more knowledge was jumping in.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline smillie

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Re: Patellar Entrapment?
« Reply #4 on: April 01, 2010, 04:57:49 PM »
I did a quick search using the little box in the top right and it came up with this link:  http://www.kneeguru.co.uk/KNEEnotes/node/2063
Have you read there?
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline BadKneeDay

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Re: Patellar Entrapment?
« Reply #5 on: April 01, 2010, 05:11:44 PM »
Thanks for the link, I read that quickly, and I hope that isn't what I have!  Sounds like a horrible surgery, but it all sounds familiar.  I still (16 months after operation) have horrible atrophy to the involved quad, it's waaay smaller that the other and very flabby when contracted, and he did tell me that the patella was in the wrong position and didn't move right.  I don't know... but now I'm even more nervous!   :-\

Offline smillie

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Re: Patellar Entrapment?
« Reply #6 on: April 01, 2010, 05:24:10 PM »
Oh no!  I didn't mean to make you more nervous!  I don't think yours sounds as involved as all that.  I just thought there might be some tidbits there that would enlighten you.  When you have time, go back and read it again just looking for what might apply to you--definitely not all of it.  And hopefully someone who has experienced this in particular will come along.  You could go to the arthro page or the patella page and ask there, though.  Not everyone comes over to this one--I know I'm usually only around the patella page.  I just have some extra time for browsing at the moment...
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline BadKneeDay

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Re: Patellar Entrapment?
« Reply #7 on: April 02, 2010, 03:07:57 AM »
Out of the symptoms listed in that article:

Early signs and symptoms of patella infera are:

1. Pain with quadriceps contraction
2. Poor, inadequate contraction
3. Soft tissue swelling, edema
4. Joint stiffness, limited motion
5. Decreased patellar mobility, peripatellar contracture
6. Decreased tension in the patellar tendon

... I have all but the number 4.  I did go over to the AF board, and they have suggested IPCS, or the patella infera.  Although I cannot see the doc until I get approval for surgery, I am considering calling to see if they can give me more information over the phone... better than guessing at my diagnosis I guess!  It is so stressful to know that you're going to operated on without understanding all of the particulars!   >:(  I guess it's my fault for not asking the questions when I had the chance!

Offline smillie

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Re: Patellar Entrapment?
« Reply #8 on: April 03, 2010, 02:37:39 AM »
Don't beat yourself up about not asking all the questions at your exam.  I have stressed myself out to no end about asking all of my questions and giving the right information during the few minutes I get with the OS.  It's so hard!  I have failed some times and other times have succeeded. 

I would also suggest that you don't have to give consent for surgery until you have gotten all of the information you need and had all of your questions answered.  Call and see what you can find out. 
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline BadKneeDay

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Re: Patellar Entrapment?
« Reply #9 on: April 05, 2010, 01:27:35 AM »
The biggest problem I encounter is that this whole shin-dig is a worker's comp case.  This opinion was requested by my legal team, and we ended up in court against the insurance company and they were forced to provide the Independant Medical Exam.  So now they have copies of his notes and they are deciding wether to approve the surgery or not.  So, if they approve it, and I say I won't do it, or try to delay it, they can say that I am "not compliant" with treatment and drop my case, which would be horrible for me because I do not have personal insurance because I've been out of work for almost a year and a half dealing with this.  One thing after another!  I am going to try to call again tomorrow.  Hopefully they will give me an e-mail address so I can write it all down and not forget to ask something!  Thanks for the encouragement though!  I really appreciate it!

Jess