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Author Topic: Medial patellar retinaculum tear what to do?  (Read 22571 times)

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Offline RLE

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Medial patellar retinaculum tear what to do?
« on: October 09, 2011, 06:11:09 PM »
Please forgive me if this is in the wrong spot. I just spent an hour typing only to lose my post. I'm very nervous and have been lurking only to realize I can post my own question since I can't find this anywhere.
On August 21 I was run into by a large dog at the dog park. My right knee was never injured before but somewhat painful due to my kneecap going sideways. I wear a brace when I exercise and no problems. The MRI said:
1.Sequelae of lateral patellar dislocation including impaction injury of the medial border of the patella with associated chondral denudation/chondral defect as well as adjacent tearing of the medial patellar retinaculum with extensive surrounding soft tissue edema. Assoc. lateral femoral condyle impaction fracture injury is identified.
2. Joint effusion with contained debris as well as circumferential soft tissue edema with evidence of a posttraumatic collection anteriorly.
3. MCL sprain
4. Grade 2 signal within the posterior horn of the medial meniscus without tear.  To be honest I don't understand most of this.

The doctor wanted to do surgery. The paper he gave me said: "knee arthroscopy and lateral release" also "repair inside knee." I thought that I had read on here that lateral release is not called for with this injury? Am I wrong?

He said I could try PT first. I went to two other doctors who said they would not do surgery. They would try PT first. But both of them and my PT said there was only a 50-60% chance of PT alone working and that surgery might be necessary.

The pain was excruciating. I was in a full-length brace for 3 weeks then began PT for 3 weeks at the end of PT I was able to bend my knee 73 degrees(?) when the PT measured it and up to 8 3/4 inches at home when I measured it. But that was only a few times using pain meds and forcing it it was tight and painful especially across and under the kneecap. It does not bend on it's own.

On Monday it froze completely and there was a tightness like a band above the kneecap. The kneecap was acting weird-feeling pushed in then up then freezing. A couple of times it would relax then begin the sequence again. Like a spasm which is happening again today. I began to have sharp pains on the bottom right when I would step down (I was never putting my weight fully on it) and a popping (kneecap instability?) The PT and her supervisor couldn't move the kneecap it was frozen. A steroid shot (for diagnostic purposes I was told, lessened the pain but no more ROM still frozen except this weird spasming) On Monday the surgeon is doing a manipulation. He says he can't do surgery on a frozen knee.

I'm scared that I made the wrong decision regarding surgery and unsure what is going on with my knee. I do produce a lot of scar tissue I know that. I'm scared that after the manipulation (which will be so painful!) that I still won't be able to use the knee because the kneecap will be unstable. Anyway, any information/thoughts/ideas you have would be gratefully appreciated!!
« Last Edit: October 09, 2011, 06:13:50 PM by LER »
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture,
2011 MUA
PT on-going
2012 MPFL reconstruction,TTT
        Lateral lengthenin
        Arthroscopy/clean out
Thx Dr. T

Offline kneepaincure

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Re: Medial patellar retinaculum tear what to do?
« Reply #1 on: October 10, 2011, 02:10:59 AM »
Sorry to hear about your troubles and hope that you will be on your way to good knee health soon.. I'm not sure what the first two points of your MRI state, but the second 2 are not too serious and generally don't require surgery. A grade 2 tear doesn't require surgical intervention, but the tear in the retinaculum may require it. I don't see how a lateral release will help but you should ask your doctor that.

Don't go into surgery with any doubts in your mind because many times it's irreversible or only partially reversible.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.