Banner - Hide this banner





Author Topic: Medial Subluxation... NEED HELP!  (Read 4492 times)

0 Members and 1 Guest are viewing this topic.

Liftline62

  • Guest
Medial Subluxation... NEED HELP!
« on: June 16, 2012, 05:53:43 AM »
Hi,

I'm new to this website and I'm not sure if this is where I should be posting this but I figured it would be worth a shot.

For the past 3 years I have suffered from Medial Subluxation, with on and off Bursitis/Saphenous Nerve inflammation. I am fully aware that this is a rare problem, which is perhaps why nobody has a solution for it.

I am desperate. I have all but given up my life for this stupid problem. I love to ski, but in the time of a year I went to from skiing down double black diamonds, going off of jumps and rails, to having extreme pain just from a leisurely turn of stop. I also enjoy playing tennis during the summer months, that too has been given up. I also spent some time dancing, nothing too serious, but I enjoyed it and once more had to give it up. I'm a Sophomore in college, so I'm not necessarily at a point in my life where I'm ready to give up things I enjoy doing. It's not just sporting activities either, simple tasks such as taking a walk, climbing the stairs, or working (which, unfortunately is necessary) causes me a great deal of pain.

Now, for all of the treatments I have had done. Physical Therapy (continuously for 1 1/2 years, on and off for the rest of the time, and at home), Prolotherapy, Cortisone and Lidocaine injections (both made the pain astronomically worse, as in no walking for days), Lidoderm patches, Volteran Gel, Anti-inflammatory, Prescription painkillers, Prescription steroids to lessen inflammation, rest, ice, heat... you name it I've probably done it. I can assure anybody who suggest patellafemoral, that I do not have it. My legs are in great shape and muscle is evenly distributed on both sides, if anything there is more on the inner quad than the outside.

As for surgery, there a quite a few options for people with lateral subluxation, but nothing has been offered to me to fix medial subluxation. Is there anything out there? Most surgeons I see refuse to acknowledge the problem and only offer what they know how to do (Lateral release, osteotomy, etc.). I have finally found a doctor who, if I may, "knows better", than the others and has told me that these procedures have a high risk of making things worse.

I know there are procedures to reconstruct and tighten the lateral ligaments, is this not possible for the medial ones as well? As for an Osteotomy, if the tibia can be re-aligned to stop lateral subluxation, why can it not be moved the opposite way to fix medial subluxation? I know that these should be questions for my doctor, but I'd like some ideas to go in with the next time I see him.

Thank you in advance for any help/advice!

Offline LKnees

  • Forum Faithful
  • ****
  • Posts: 217
  • Liked: 0
Re: Medial Subluxation... NEED HELP!
« Reply #1 on: June 16, 2012, 08:54:25 AM »
You've never had surgery before? Medial subluxation is a common complication after lateral releases. You do mean that your knee dislocates to the inside of your leg right?
 Of course there is surgery to correct it. Most doctors are just not aware of it. You can get lateral patellofemoral ligament reconstruction. Also have you been checked for rotational deformities or if you're bow legged or knock kneed?
I think you made a mistake in your post when you ask about tightening medial ligaments. That's common to correct lateral dislocations. You wouldn't need medial but lateral reconstruction if your knee is subluxing medially.

Offline The KNEEguru

  • Administrator
  • SuperKNEEgeek
  • *****
  • Posts: 2617
  • Liked: 111
  • The KNEEguru
    • The KNEEguru
Re: Medial Subluxation... NEED HELP!
« Reply #2 on: June 16, 2012, 02:17:24 PM »
Orthopedics. 1998 Jul;21(7):810-3.
Medial subluxation of the patella without previous lateral retinacular release.
Richman NM, Scheller AD Jr.
(http://www.ncbi.nlm.nih.gov/pubmed/9672920)

--
KNEEguru

Liftline62

  • Guest
Re: Medial Subluxation... NEED HELP!
« Reply #3 on: June 16, 2012, 04:26:13 PM »
No, I have never had surgery before. Yes, I do mean that my knee moves towards the inside of my body.

I've only had one full leg x-ray, which was recently, and it did show that I was bow legged. Not severely, but noticeable enough.

As for the medial reconstruction, I wasn't sure about that... so I just guessed based on what I had been told. My doctor told me that the reason why the medial side of my knee subluxes is because my medial ligaments are very lax. From this information I just guessed that in order to stop it they needed to be tightened. Wouldn't tightening the lateral ligaments just push the patella more towards the medial side, or would it help lock it in place? As of now, my knee does not move laterally at all, which is the only reason why I asked.

So, based off of what you said, if I had a lateral release, and like so many other people i formed even worse medical subluxation, it can be fixed? Should I ask my doctor about this, or is this something you think he should already know?

Thanks for the help!

Offline aaa

  • Forum Faithful
  • ****
  • Posts: 392
  • Liked: 1
Re: Medial Subluxation... NEED HELP!
« Reply #4 on: June 16, 2012, 04:46:51 PM »
It might not be a ligament issue, or maybe it is in combination with other issues.  Medial subluxation is very rare without lateral release.

There may be a rotational issue, or possibly some trochlear dysplasia that is causing the problem.

I would check out the list here - http://www.kneeguru.co.uk/KNEEnotes/node/418
and here - http://www.kneeguru.co.uk/KNEEnotes/node/1725

You may want to consider seeing Dr. Robert Teitge, he has done extensive research and surgeries for PF problems.   

Offline allyd

  • SuperKNEEgeek
  • *****
  • Posts: 678
  • Liked: 34
Re: Medial Subluxation... NEED HELP!
« Reply #5 on: June 16, 2012, 04:48:49 PM »
speaking in very general terms... as there can be a lot going on in a knee causing it to do some of these things, and there's not a one size fits all fix.

If you are medial subluxing, that would mean theoretically your lateral ligaments are lax - hence why via a lateral release (loosening of the lateral restraints) a few will develop medial instability. For the majority of us that dislocate laterally, we have developed loose medial ligaments that need to be reconstructed.

In your case - by tightening the lateral ligaments, it should provide a check rein to stop it from moving medially so much. Where as for me, I had my medial ligaments reconstructed to provide a check rein to stop it from dislocating laterally. The knee guru posted a good study link for you as you are definitely a rare case of medial instability w/out previous surgery. Doesn't mean it can't be fixed, just that it's not seen often, and therefore likely unknown for the avg doctor on how to deal with. 

Moral is there are fixes for whatever is going on - you just need to get in front of a doctor who has experience in seeing such cases. Yes, I would ask your doctor about an LPFL reconstruction, if for nothing else to see if he understands more options, etc. It's not a common surgery, and he just may not have the expertise to help you pursue all options. It's hard for us to say exactly what you'd need for a surgical correction, but asking your doctor about various options will help you understand your knee better.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Liftline62

  • Guest
Re: Medial Subluxation... NEED HELP!
« Reply #6 on: June 16, 2012, 05:15:18 PM »
YB - As for any other issues, the only thing that has ever been mentioned to me so far is that I'm hypermobile. The doctor who preformed my Prolotherapy treatment mentioned Ehlors-Danlos syndrome. He told me that I would need genetic testing to confirm it. He only mentioned it once, so I figured it wasn't something to be worried about. From the little research I did, if I do have it, it is definitely not in a severe stage.

I will also look into those links and the Dr. you recommended. Michigan (wear it say's he's located) is about an 11 hour drive from my current location, so it's definitely something I will seriously think about.

Thank you for the suggestions and information!

ALLYD - I believe what you're saying, I honestly do, I guess I just can't wrap my mind around it. It makes sense that loosening the lateral restraints will result in people developing medial instability. However, I think where I become confused is that since my medial ligaments are lax why am I not subluxing laterally. Which is more of a rhetorical question, I'm not holding you responsible for answering it... just reflecting on the situation. As you and the others on here have suggested, my lateral ligaments should be tightened. I don't exactly disagree with that, I just wonder if that will work due to the fact that my medial ligaments are so lax. Will it act as an anchoring device to help stop my patella from moving so much?

Thank you so much for your input and ideas. I really do appreciate then, I just hope I'm not confusing/frustrating anyone!

Offline The KNEEguru

  • Administrator
  • SuperKNEEgeek
  • *****
  • Posts: 2617
  • Liked: 111
  • The KNEEguru
    • The KNEEguru
Re: Medial Subluxation... NEED HELP!
« Reply #7 on: June 16, 2012, 06:07:23 PM »
For reference, please also note that we have a Hypermobility board - http://www.kneeguru.co.uk/KNEEtalk/index.php?board=22.0
--
KNEEguru

Offline allyd

  • SuperKNEEgeek
  • *****
  • Posts: 678
  • Liked: 34
Re: Medial Subluxation... NEED HELP!
« Reply #8 on: June 17, 2012, 03:09:43 AM »
You are taking a great approach to this. Asking the questions up front.... before any surgical approaches are embarked upon. Ask all the rhetorical questions  you want - we obviously don't have the exact answers to help you solve the problen, but this board is great for thinking through your issues and helping you devise a list of questions you ultimately want to ask your doctor. There is a lot of collective knowledge on various problems, and we've all been at the beginning stages before trying to wrap our heads around our problems.

And a little food for thought... If your medial ligaments are indeed lax... It's possible both medial and lateral ligaments could need to be reconstructed? I believe YB had both done at once?!...
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Liftline62

  • Guest
Re: Medial Subluxation... NEED HELP!
« Reply #9 on: June 17, 2012, 04:00:03 AM »
Thank you for accepting all of my questions! I always find that when I get to my doctor there never seems to be enough time to think of/ask questions because he has already moved onto the next topic of treatment. This way, hopefully I can suggest something to talk about.

I have do not have a problem with surgery, whether it is arthroscopic or open. I just want to be sure that whatever procedure done is the right one, so I don't need countless more to correct something that should not have happened in the first place. I am convinced however, that as soon as somebody takes a look inside my knee, they will see the problem clear as day. Of course that's a lot of optimism to have... but I'm not convinced my images are showing the whole problem. An example of this, during an ultra sound for Prolotherapy, it showed I had a pretty noticeable tear in my MCL. I know that an MCL usually repairs itself over time, and my doctor fixed it with injections but still, wouldn't that show up on an image such as an MRI?

For procedures such as the LPFL and MPFL reconstruction, is there a certain criteria for it that I may not fit into? Which is why nothing has been said about it. I've done some research since it has been mentioned on here and it seems to be what I need... yet of the 6 doctors (3 surgeons) I've seen, this has never come up and the problem has always been the same... Medial subluxation and instability

As always, I thank you for the input, I really can't thank you enough for the ideas, information, and possible questions to ask!

- On a side note, about a year an a half ago, when my bursa was really giving me a problem I was given the option of looking into having it removed or try Prolotherapy. I opted for Prolo just so when I went to a surgeon I could say I tried everything. Do you think it may be worth looking into having it removed? Would the decrease in pain from that area in turn make the medial pain more bearable?

Offline aaa

  • Forum Faithful
  • ****
  • Posts: 392
  • Liked: 1
Re: Medial Subluxation... NEED HELP!
« Reply #10 on: June 17, 2012, 04:01:52 AM »
Yep I had both done at once :)

Although, I had a dislocation from trauma (shin to kneecap) and no prior instability at all, I was playing sports at a pretty high level.  After that, an LR was done so I ended up with multi-directional instability.   I had allografts of both MPFL and LPFL.

How did your first medial subluxation / dislocation happen?  Was this a gradual onset of symptoms or was there a traumatic episode that started causing problems?


Liftline62

  • Guest
Re: Medial Subluxation... NEED HELP!
« Reply #11 on: June 17, 2012, 04:29:40 AM »
My problems were definitely gradual, and only certain things set it off towards the beginning.

In September 2009, when my dance season began after summer break I began noticing a lot of pain after my dance classes. That began my process of going from doctor to doctor trying to find a fix for it. From September on my pain gradually became worse, but only when dancing. The instability became a big problem towards the end of the year, in June. However, what I always though was weird is that up until this past winter skiing did not bother my knee at all, while dancing did. It makes no sense to me. I was skiing down double black diamonds, flying off of jumps, going over rails, and turning hard but I never had any pain at all. Not even muscle soreness the next day, but dance was still a problem. The next fall (2010)I took the year off from dance with hopes of my knee feeling better. Still, it got worse in everyday life, but still didn't hurt when I danced. My senior year (2011) I took up dancing again, pain and instability still a big problem, but it was going to hurt regardless so I figured that I'd at least be happy. Went skiing, still no pain. My first year of college, I didn't dance at all... but when I went to go skiing, within an hour I was in extreme pain... even when I slowed down and did intermediate slopes. It was the only time I went out this year.

So to answer the question it was gradual, but it's just weird how dancing always irritated it but skiing didn't up until this year.

My knee has never dislocated. As soon as I started physical therapy there was never a moment where I was not taped or braced to keep my kneecap in place as much as possible (besides sleeping). The instability was still there, but it wasn't dislocating, just subluxing.

This may sound absurd and unethical... but if after a lateral release many people, like yourself, experience general/medial instability, which can be fixed. Would it be unadvised to ask my doctor to go ahead with the release, knowing that he can fix the instability after it's done? I think that's what I don't get. If I already have the medial instability, why can't he just fix it now instead of waiting for a surgery to make it worse? Should I consider another opinion?

How have you been since your LPFL and MPFL reconstruction? As an active person would you recommend it to someone like myself?

Offline aaa

  • Forum Faithful
  • ****
  • Posts: 392
  • Liked: 1
Re: Medial Subluxation... NEED HELP!
« Reply #12 on: June 17, 2012, 05:01:12 AM »
The choice for surgery is a difficult one.  Some people would say don't try surgery except as an absolute last resort, or even more extreme if its only a life or death situation - because any surgery has a risk, no matter how small it may be, of triggering some other problem.  I had a friend who had a  failed lateral release.  The lateral release took his pain to an epic level, even trips to the ER for morphine because it became basically uncontrollable.  Ok, that is an extreme case, I don't mean to shock you, but it does happen.

On the otherhand, if quality of life is affected enough, then maybe a surgery is the answer.  I've certainly been willing to take the risk myself.  I'm still recovering, but my kneecap feels stable.  I don't have any medial or lateral instability that I can notice now.  Sometimes my left (surgical) leg feels a little better than my right.  It has been so many years of undiagnosed problem for me, that both my legs are re-learning how to work again.   I honestly couldn't even remember how to do things like walk around a corner or turn around, I had to think about how to do that because my brain had simply forgotten it.  In fact, I have been watching other people move so I can remember how to move again.  Its coming along.

 There is still some healing of tissues around the knee, so I can't really say for sure if its a success until probably towards the end of the year.  I'm not pushing things too hard at this point at all.  The prognosis for me is excellent, I should be able to return to day-to-day activities and recrreational/sports, but time will tell for sure.  Its so weird because I used to be a goalkeeper in soccer, middle linebacker in football, and a high jumper!  The kneecap dislocation totally messed me up, I had sham surgeries and wrong diagnosis for 10+ years, but I think I finally had the surgery that will take care of it.

In my opinion, it all starts with having a correct diagnosis as to why your kneecap is subluxing.  Without that, every other step would become an enormous risk.  There has to be a cause for your subluxations.  About the skiing, I am guessing that wasn't so painful because your knees are bent a lot more, and with the knees bent the kneecap tends to sit in a deeper area of the trochlea, so it is less likely to shift around.  With dancing, your legs are working in a different range and would likely be sitting higher in a more shallow are of  the trochlear groove so any rotational or ligament issues will present themselves more.

Again, it comes down to a correct diagnosis.  I think trying any surgery, especially a lateral release, without a real diagnosis is too much of a risk to take.  Going through a failed LR and then having it repaired is no cake walk.


Liftline62

  • Guest
Re: Medial Subluxation... NEED HELP!
« Reply #13 on: June 17, 2012, 05:31:03 AM »
I agree that surgery is a difficult decision to make, but given the right circumstance, like yourself, I am willing to take the risk.

Will I agree to have a lateral release if it's offered again? No, probably not, because as I've learned from this site, the problem of instability can be corrected... I just need the missing pieces to the puzzle. As you mentioned about the groves where the kneecap sits, is there a procedure that can be done which makes the grove bigger? Or, do you think that perhaps if I ask for an exploratory surgical option? Sometimes one small problem is what creates the large amount of pain... but again, there would have to be some reason to go exploring, and as of now my doctor does not believe there is one.

Wow, good luck to you on the long road you have been on with your recovery. I certainly wish you the best of luck as you progress towards an active lifestyle again. I'm sure you're glad to have an excellent prognosis after so many years of struggle and I would guess frustration! Thank you for sharing your story with me. It certainly makes me feel more confident about the choices I've made thus far concerning my choice not to have surgery, due to the discrepancies of the procedure verses my problems.

Thanks so much!!

Offline Silkncardcrafts

  • SuperKNEEgeek
  • *****
  • Posts: 3916
  • Liked: 6
Re: Medial Subluxation... NEED HELP!
« Reply #14 on: June 19, 2012, 02:17:36 AM »
I think I can help you.

After having lateral releases on both knees I developed medial instability.

There ARE operations to fix medial instability. PT won't fix this problem.

Dr Elizabeth Arendt in Minneapolis has treated those with this problem. I would get in touch with her. I had heard the waiting times for both appointments and operations for Dr T are incredibly long. So, I would look elsewhere. He is also near retirement.

A TTT can be an option as well as a trochleoplasty and lateral reconstruction. It all depends if you are a candidate for these type of operations. You really need to have a CT scan to have your problem properly assessed.

It is an incredibly frustrating condition for both patient and practitioner.

I have had trochleoplasties on both knees and am so much better. Still having a few issues with my left knee but I had a couple of car accidents, which worsened things. My knee surgeon is in Melbourne, Australia and extremely experienced. Dr De Jour in Lyon, France may be able to help you too. let me know if you want details of my knee surgeon in Australia.

Hope this helps.
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















support