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Author Topic: What's causing the pain? 'Significant femoral neck anteversion'?  (Read 1489 times)

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Offline jenny1000

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Hi, I'm 21 and have had knee pain since I was about 13, getting progressively worse.  I'm in constant pain, can only stand up/walk for 10 minutes and can't sit down or drive for more than an hour.  The pain is all patellofemoral (just below the kneecap, where the patella tendon is).  I've had lots of physiotherapy, an arthroscopy and lateral release to both knees in November 2009, steroid injections, acupuncture and tried knee taping - nothing has helped.  I'm on diclofenac and also tramadol when it's really bad but that doesn't do much.  Before the LR my kneecaps were laterally drifted and tilted - now they are in about the right place (different surgeons say different things) but I have j-shaped patella tracking (again, my surgeon initially said it was fine but when I showed him that you can see my kneecap move out of line he said that it's out).

When they did the LR my cartilage was fine, but a recent MRI showed that I have chondromalacia (got the impression it's pretty bad) with an osteophyte (they only scanned my left knee).  X-rays, including skyline ones, were normal - I have a fabella on one knee.  A CT scan 3 months after the LR showed my kneecaps to be in the wrong position.  The OS I'm currently seeing at Addenbrookes Hospital wants to do another arthroscopy and suggested removing both kneecaps, which I really do not want and have told him this.  He has said I'm 35 years too young for a partial knee replacement and nothing else can be done.  My hips under rotate by 10% (inwards) and again, I have been told that this could and could not be contributing to my pain.  I have just receieved copies of all of my notes from 2 hospitals and recent notes say that I have 'bilateral absent VMO', a 'slight lack of distal VM bulk' and 'significant femoral neck anteversion'.  Does this mean that my femurs are rotated?  This was never mentioned to me, just written in my notes.  And I have no idea what the absent VMO means.  I also have midly flat feet, orthotic inserts that put the arch back in my foot didn't help my knees.

I'm so desperate just to lead a normal life again, I can no longer walk the dogs, go shopping, drive far, swim, snowboard etc.  Please let me know if you know what any of this means or what could be causing the pain.

Thank you!
« Last Edit: August 06, 2011, 06:37:42 PM by jenny1000 »

Offline kneepaincure

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Re: What's causing the pain? 'Significant femoral neck anteversion'?
« Reply #1 on: August 07, 2011, 08:55:16 AM »
First of all, removing both your kneecaps is a stone age solution to your problems. Don't go down that route. If the surgeon says that nothing else can be done then he's probably not very experienced in knee issues, because that could severely reduce your quality of life. Femoral rotation could be affecting your knees but you should get to another OS who will know a better way to go about fixing your knees. The LR may have caused medial instability in your knees. Absent VMO means that your inner quad muscle is very weak or non existent. Maybe other people on this board can guess what may be causing your knee pain..
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline jenny1000

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Re: What's causing the pain? 'Significant femoral neck anteversion'?
« Reply #2 on: August 07, 2011, 09:23:35 AM »
Thank you for your reply.  Yes, I had read about it and people's experiences of it on here before I went to see him, thinking he might suggest it.  When he said about it I said no way, he's not doing it.  When I said my reasons - the long term disability, ending up in a wheelchair etc he just brushed that aside, saying I might be pain free a few months afterwards.  I found out that he's not even a knee specialist, although he is who another hospital who did the LR referred me to.  I've asked to be referred to a knee specialist and am still waiting on that.  I'm also seeing a private surgeon, Mark Forster, in Cardiff tomorrow so hopefully he will find something.  Oh ok, I know my knees were fairly bad before but I could still do everything I enjoyed, just couldn't do a job standing up all the time or sitting down all the time.  When I said this, the surgeon tried to tell me all the pain is due to the chondromalacia but this wasn't there before the LR and I still had constant pain.  Ok, thank you.  A physio before the LR said I had overactive quad muscles?  Thank you.

Offline kneepaincure

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Re: What's causing the pain? 'Significant femoral neck anteversion'?
« Reply #3 on: August 08, 2011, 03:53:14 AM »
Yes don't give up on getting the right medical opinion. They are your knees after all and no doctor should tell you to sacrifice them at such a young age. Maybe you can try posting in the patello-femoral section where you can get other answers..
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline jenny1000

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Re: What's causing the pain? 'Significant femoral neck anteversion'?
« Reply #4 on: August 09, 2011, 05:01:54 PM »
Thanks.  Yeah I saw a private surgeon yesterday and within minutes he found that my patellar tendons aren't straight - they go towards the outside of my shins as they go down, if that makes sense.  That, along with my leg bones being twisted is causing my kneecap to track too far outwards.  He said I need a TTT on both knees (done separately) and that should bypass the twisted bones problem as they're not that bad, maybe a LR at the same time aswell.  He also couldn't see any chondromalacia on the MRI and that's the only diagnosis anyone else has given me.  Funny how he found the tendon thing in minutes yet over 6 NHS surgeons didn't find anything (and hurt me a lot more pushing my kneecap around etc).  There's no way I'm letting my NHS surgeon near my knees!  I even asked if a TTT could help and he said it wasn't suitable!