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Author Topic: Patellofemoral dysplasia, hypermobility, instability and recurrent subluxations  (Read 890 times)

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Offline mnckiwi

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Hi there, new to this but keen for some opinions.

I have been very active and sporty my whole life, playing top level water polo, swimming competitively, playing hockey, touch rugby, walking and tramping. I have mild hypermobility and due to a constantly active lifestyle and strict adherence to gym strengthening programme have limited problems from this aside from creptis and occasional mild joint and back pain.

I have suffered from recurrent patellar subluxation from aged 13. My first was aged 13 playing water polo, and the problem was at its worst aged 13 to 15, and slowly eased off until last subluxation aged 17.  Although surgical options were discussed at this time, the decrease of instances and my age meant it never went ahead. For the record I'm very glad it didn't as aside from some mild patellofemoral pain due to damaged articular cartilage and patellofemoral dysplasia (long lateral and short steep medial facets), I have been symptom free for the past five years, until about 3 months ago.

So there I was, aged 22, walking on some wet floor, I slipped, tried to save myself from falling, but my knee twisted, my patellar subluxed and next minute Iím on the floor in rather a lot of pain.

Initial diagnosis was grade 1 MCL confirmed by ultrasound, and likely patellar subluxation. Having experienced it before, Iknew it was.

I live in New Zealand, and have been following the clinical pathways of our public system for the past 3 months. I've worked with a physio and sports doctor for this time on strengthening etc, and having had limited improvement, finally saw to the premier orthopaedic specialist for this problem. The issue is, his opinion following examining me and my MRI has come up very different from that of the sports doctor, also highly respected in this field.

Aside from the standard bone bruising of the anterolateral femoral condyle and focal cartilage loss patellar apex with subohondral reactive change due to subluxation, my MRI showed Oedema within Hoffa's fat pad and lateral patellofemoral impingement, as well as an attenuated medial patellar retinaculum. All major ligaments and menisci look ďbeautifulĒ.

The sports doctor explained that the attenuated retinaculum was damaged, thin and stretched, and not doing its job to hold my kneecap in place and this was causing the lateral impingement and would lead to further subluxations. Although strengthening is worth a try, given my history he felt it would only get me so far and hence referred me to the surgeon.

The surgeon however said he didnít think Iíd even subluxed my patellar and had actually landed on it, and that there was nothing structurally wrong with my knee. I definitely subluxed my patellar and landed on my ass but anyway. He sent me away with anti-inflammatories that are supposed to enable me to do strengthening exercises I have so far been unable to do due to pain. I go back in 2 months (Early August 2012).

Quite different assessments obviously, Iím really interested in hearing about other peopleís experiences if they have been similar.

Offline Silkncardcrafts

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Get another opinion !

CT scans and plain x-rays are best for patella problems.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty