Post Surgery, Still Screwed Up

[Allscarredup]

Hey guys,

I posted here a while ago. I had a chondroplasty to take care of some patella injuries I sustained through rugby.The surgery allowed me to go up stairs a bit better, but that's about it. I still can't play sports and I find my job (I train athletes) ridiculously difficult to perform, with a heaps of pain. Here's what I know so far.

1. My ankles don't flex much AT ALL. I have 8x4mm bone spurs in both ankles.
2. My OTHER knee has started to exhibit some of the same problem as the "bad" one. It's not AS bad yet, but this is getting scary.
3. I have grade 3/4 patellar fissure in the bad knee. The pain is extremely sharp and comes on with leg loading where the quadriceps plays a major role (squats, stairs, standing up out of chairs.) The pain can buckle my knee quite easily and that causes problems, like when I Tore my ACL.
4. I have some level of anatomical genu valgum, or knock knees. My ankles are about an inch apart when my knees are together.

I was wondering if anyone has learned anything new about such conditions, and if there are any patellofemoral specialists in the Philadelphia/New Jersey/New York area that are of note. I live in Philly.

Just looking for some updates. I hope everyone here is getting to where they want to be.

Me

[knee always hurts]

Unfortunately, as you've found out, there is no quick and easy surgical cure for anterior knee pain. A chondroplasty can help in some cases, but it won't solve the problem because the underlying tissue is still irritated. Remember that cartilage isn't innervated, so it is something else that is hurting.
 
One thing I'm pretty sure of is that you'll never recover doing that job. There's really only one way for tissues to heal, and that is rest and finding a level of activity that doesn't irritate it. If you're in pain every day at work, then recovery will prove elusive.

Take a look at this thread here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=53006.0

This guy was told by a doctor that he would never recover, but through perseverance eventually did.

If you don't mind reading medical papers, there are 3 written by a doctor who has theorized on the underlying cause of patellofemoral pain. You might glean some ideas from them.

http://docs.google.com/viewer?a=v&q=cache:sIxlKJaiqGYJ:rehabeducation.com/main/wp-content/uploads/Therapeutic%2520implications%2520of%2520tissue%2520homeostasis.pdf+synovium+irritation&hl=en&gl=us&pid=bl&srcid=ADGEESiMFOXRVhxrNp-vyd2N412erMdLYT51ZxagCtws0q--x1BuKdZhvDaCJzzNAvqpjcUGZ6zJEMCf60Yg4McSC8qyqJswR9Yv4SvprHm0UDbt3e-W1MSLtb4nHXQiwt47Nx3sCd5a&sig=AHIEtbTwvpWG6Zql7FWhLn0MInvJsws4Ng

http://docs.google.com/viewer?a=v&q=cache:w42Ub7Mx5UYJ:rehabeducation.com/main/wp-content/uploads/Patellofemoral%2520Pain%2520-%2520Current%2520concepts.pdf+role+of+synovium+in+patellofemoral+pain&hl=en&gl=us&pid=bl&srcid=ADGEESiaF03W7rL6sHTpe32GnYPBQAMLDeDDd65xw95lieCutrCa3-E5p-CdgsisjCmBshwwO3lx_cPk-STSseTcMJ6u-D-lkHWoZ0ZMlhe4jaQra7YrZAZUXxFE90dII0ydmboKuHJx&sig=AHIEtbTtD9pPn0RwGicAjcPFm1nzDR2LhQ

http://docs.google.com/viewer?a=v&q=cache:4msKEpZCA24J:prdupl02.ynet.co.il/ForumFiles_2/19447772.pdf+The+Pathophysiology+of+Patellofemoral+Pain&hl=en&gl=us&pid=bl&srcid=ADGEESgGIVZMNaVoTwM0D9wAvqt3-f2aEHuIF0hnWOdEYXFiLlGFVJnjfQmbs4FsQ7VbWO_OiUmt_jxBwg1wHu5bY24AhdW6X80qJx4w2S-iEiDd8zoQPXkWnPg1c5484uLbMXHdnzTC&sig=AHIEtbRuEhbHlhgdwVnugn-_0eOiBdncTQ

I'd certainly suggest trying a conservative approach first. But if your defects are significant enough, maybe that won't work for you. Assuming that the only irritated tissue in your case is the subchondral bone, there are procedures that have shown some level of success such as mosaicplasty. Search for it and you'll find some folks who have had success with that procedure on these forums.

Good luck!

[orthoped]

Hey guys,

I posted here a while ago. I had a chondroplasty to take care of some patella injuries I sustained through rugby.The surgery allowed me to go up stairs a bit better, but that's about it. I still can't play sports and I find my job (I train athletes) ridiculously difficult to perform, with a heaps of pain. Here's what I know so far.

1. My ankles don't flex much AT ALL. I have 8x4mm bone spurs in both ankles.
2. My OTHER knee has started to exhibit some of the same problem as the "bad" one. It's not AS bad yet, but this is getting scary.
3. I have grade 3/4 patellar fissure in the bad knee. The pain is extremely sharp and comes on with leg loading where the quadriceps plays a major role (squats, stairs, standing up out of chairs.) The pain can buckle my knee quite easily and that causes problems, like when I Tore my ACL.
4. I have some level of anatomical genu valgum, or knock knees. My ankles are about an inch apart when my knees are together.

I was wondering if anyone has learned anything new about such conditions, and if there are any patellofemoral specialists in the Philadelphia/New Jersey/New York area that are of note. I live in Philly.

Just looking for some updates. I hope everyone here is getting to where they want to be.

Me

Firstly you dont have genu valgum because 1inch is well withing normal limits (8-10 centimeters).
Secondly, spurs dont have anything to do with ankle flexion and extension but are generally associated with heel pain and pain along the plantar aspect.
Thirdly, from your description I think you are suffering from chondromalacia patellae. You may need a replacement sooner or later or maybe even arthroscopic shaving of the cartilage can help too.
Just remove all these misconceptions from your mind and get along with some good orthopedist who will properly diagnose your condition and give you an appropriate treatment.

Dr Gauresh.

[KW]

Allscarredup - I will send you a Private Message with the name of a OS in Philly that has a special interest in the patella femoral compartment. 

Best of luck,
Karen

[jumpi5d]

Ok so I know this might not be the place for this, but... normal for 'textbook' does NOT mean normal for everyone. I had surgery to correct a very minor valgus in my femurs and it has made all the difference in the world. I'm not saying to jump into surgery.... please don't, but don't let someone say it's not 'bad enough' if you think it's something that is. It's something to think about. I was told that 99% of doctors would have told me nothing was wrong, much less considered surgery.  I can't even begin to tell you how much it has helped me. 

[Allscarredup]

Orthoped,

My doctor suggested the spurs had something to do with my lack of dorsiflexion. I work in the athletic field and all the professionals around me who manage athletic injuries agree. They aren't heel spurs, they're large anterior ankle spurs and the x-rays show they impact with dorsiflexion. They cause sharp pain and move my ankle into pronation under pressure. I don't know why you'd suggest that bone growths in joint space wouldn't affect motion...

The amount of valgus I have in my knees is not extreme, and certainly doesn't warrant surgery. But I have knock knees, anatomical and dynamic valgus, which is on video contributing to my ACL tear last year. This has also been repeatedly observed and confirmed by health and athletic professionals. My Q angle is pretty large, I have laterally tracking patellas, some valgus, and, surprise, anterior knee pain.

I don't know why you think these concepts are misinformed, but thank you for offering your help.

@Everyone else, thanks a lot for the guidance! I'm talking soon with a knee specialist who works with the professional teams here. I'll let you know what he says.

[jumpi5d]

BTW My post wasn't directed at you.