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Author Topic: Patella infera (baja)?  (Read 5232 times)

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Offline Lana1

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Patella infera (baja)?
« on: January 13, 2013, 10:10:46 PM »
I had a scope 5 weeks ago, had some chondroplasty, some synovitis and plica removed. Had a fever after the op for about 4 weeks, was on antibiotics. Have had a lot of swelling mostly on top and above the patella so couldn't engage the quads to do exercises. Noticed my patella on the operated knee is much lower than on the other knee, especially when I bend them, the patella nearly disappears down on the bend. Can't move patella up with my hand as there is still some swelling pushing on it from above.  Flex and extension of the knee are good though. Should I be worried about that it could be patella baja. My surgeon discharged me already. Should I get another opinion?
Thank you.

Offline Lana1

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Re: Patella infera (baja)?
« Reply #1 on: January 14, 2013, 10:20:56 AM »
Please anybody could help me? I am so worried..

Offline EdD

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Re: Patella infera (baja)?
« Reply #2 on: January 15, 2013, 10:40:22 PM »
Sorry you are going through this. It does not sound like Patella infer to me, but  I think there are other posters like Pam who know more about it than I do. I understand that Patella Infera is caused by adaptive shortening of the patella tendon. It can happen if there is a substantial loss of extension over a period of time. The tendon shortens which pulls the knee cap down. It is usually diagnosed by doing X-rays with both legs in a particular bent position and then measuring difference. Since you have good extension, it does not sound like patella baja. Sounds like swelling. It does not take a lot of swelling to shut down your quad. Are you elevating the knee above your heart and icing? Follow-up with your Dr. and PT even though you were discharged.  If they are not responsive, see a specialist if you can. I hope this helps.
1/23/2006 tore the ACL, MCL, meniscus, femoral nerve while  skiing
1/30/2006 ACL reconstruction hamstring graft, meniscus repair at Vail
4/2007 femoral nerve damage diagnosed
8/1/2007 LOA/MUA at Vail "severe arthrofibrosis"

Offline Lana1

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Re: Patella infera (baja)?
« Reply #3 on: January 16, 2013, 02:24:40 PM »
Sorry you are going through this. It does not sound like Patella infer to me, but  I think there are other posters like Pam who know more about it than I do. I understand that Patella Infera is caused by adaptive shortening of the patella tendon. It can happen if there is a substantial loss of extension over a period of time. The tendon shortens which pulls the knee cap down. It is usually diagnosed by doing X-rays with both legs in a particular bent position and then measuring difference. Since you have good extension, it does not sound like patella baja. Sounds like swelling. It does not take a lot of swelling to shut down your quad. Are you elevating the knee above your heart and icing? Follow-up with your Dr. and PT even though you were discharged.  If they are not responsive, see a specialist if you can. I hope this helps.
EdD, thanks for the reply. I had knee X-rays done yesterday, and looks like the patellas are at the similar height. The OS didn't measure them, he just looked at two pictures and said he doesn't think it's patella baja. Should I have asked to measure them too?

Offline tking

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Re: Patella infera (baja)?
« Reply #4 on: January 16, 2013, 05:47:19 PM »
I would have asked the OS to measure them. There was not a huge difference between my kneecaps and there was still damage done.

Trinity

Offline EdD

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Re: Patella infera (baja)?
« Reply #5 on: January 16, 2013, 07:21:21 PM »
That's great news! I think you are fine. Your history does not indicate patella baja. The doctor said there was no difference so it does not seem like there is anything to measure. I don't think thee is an effective treatment for Patella Baja in any event so I am not sure having a measurement would help at this point. I think you should concentrate on getting your swelling down and making sure you do not have an infection.
1/23/2006 tore the ACL, MCL, meniscus, femoral nerve while  skiing
1/30/2006 ACL reconstruction hamstring graft, meniscus repair at Vail
4/2007 femoral nerve damage diagnosed
8/1/2007 LOA/MUA at Vail "severe arthrofibrosis"

Offline tking

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Re: Patella infera (baja)?
« Reply #6 on: January 17, 2013, 02:25:41 AM »
If you are worried about it, ask to have the measurements. It never hurts to double check. If by chance, there is the start of patella baja, it is better to treat it sooner rather than later.

Offline missmyknee

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Re: Patella infera (baja)?
« Reply #7 on: January 17, 2013, 05:02:34 AM »
Hi Lana

I agree with the others about getting the measurements. Early recognition and treatment are key to successfully treating patella baja and AF. My first OS did not have a clue about arthrofibrosis  I had patella baja and IPCS that was left undiagnosed for 11 months and had surgery for it 18 mos after it developed. It required a rare procedure to treat it. Unfortunately the baja position caused extensive damage to the backside of the patella , which led to a TKR 4 yrs after the initial injury. If you aren't already, you should be doing patella mobes several times a day to get the patella moving. If you are not in PT, I would suggest asking for PT so they can work on your patella by doing ultra sound first, then doing patella mobes and deep tissue massage. You also need to get the quad working, as a weak quad can cause the patella to drop. Strengthening it would help pull the patella up in correct position. If you don't already have one, I would suggest using e-stim to aid in quad contraction as you do quad sets. Post op infections are often times the cause for arthrofibrosis. It is important to know if your OS has knowledge about arthrofibrosis signs and symptoms and that of patella baja because many of them don't! As I said before, my OS kept saying nothing wrong with my knee when I really had arthrofibrosis that developed into patella baja and IPCS that damaged my knee for life, because of my OS's ignorance. Don't let this happen to you. Read my blog

Here is an explanation of patella baja from Dr Noyes AF tutorial.

http://www.kneeguru.co.uk/KNEEnotes/node/2063

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Lana1

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Re: Patella infera (baja)?
« Reply #8 on: January 17, 2013, 02:45:59 PM »
Hi guys. Thanks for your replies. :)
I can move the patella sideways and down easily with my hand but only can move it up tiny bit by engaging my quad, I still have some swelling above the patella which doesn't let me to fully contract the quad.
I booked an appointment with another OS in two weeks time. I also will see my current OS next week and ask him about the measurements of my patellas.
If it is patella baja does it have to be treated surgically?
Pam, tking and EdD, could you tell me, please,  what symptoms of AF and patella baja did you have?
I couldn't engage my quads for a few weeks after the op because of the huge swelling above my patella and I have seen my OS about it a few times, but he didn't seem worried about it. Now after taking anti-inflammatories the swelling came down a bit and I can engage my quads.

Offline allyd

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Re: Patella infera (baja)?
« Reply #9 on: January 17, 2013, 03:22:51 PM »
Lana Ė I donít want to sound harshÖ but Iíll say it best I can - you may simply be doing too much reading about (rare) complications, and psyching yourself out. Weíve all done it. Now, Iím not there with you, and I havenít seen your knee, nor would I know what to look for if I did - but I wouldnít overly worry. Your doctor took your concerns seriously and addressed them w xrays. 

My experience in regards to any type of measurements is this: just because they donít do them right in front of you, doesnít mean they didnít happen. You may be able to call the clinic and just ask for them.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Lana1

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Re: Patella infera (baja)?
« Reply #10 on: January 17, 2013, 04:13:48 PM »
Hi Allyd.
You don't sound harsh at all. :) I understand what you mean.
If my patella on the op knee wasn't much lower visually than the patella on the other knee, I wouldn't have worried. Because I didn't do any exercises except heel slides for 5 weeks and swelling above the patella was pushing it down all the time and stopping it engaging the quad, and now I can't mobilise patella well, now I am worried.

Offline Lana1

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Re: Patella infera (baja)?
« Reply #11 on: January 17, 2013, 07:47:35 PM »
Is the knee supposed to get very sore and swollen after patella mobilisations and deep massage?

Offline tking

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Re: Patella infera (baja)?
« Reply #12 on: January 22, 2013, 08:16:26 PM »
Hi Lana

My main symptoms have been extension loss (anywhere from +2 to +25), quad inactivation due to the extension loss, muscle weakness, and muscle atrophy. My doctors were very focused on the extension loss and muscle atrophy. When the insurance (worker's comp) finally allowed me to see Dr Millett (I fought for 6 years to be seen and treated by him), Dr Millett found that my right kneecap had moved into patella baja position (though not as severe as most). Though my position wasn't as pronounced, it has caused a grade 4 chondral defect in my knee which causes me a lot of instability. My patella baja went unnoticed by my regular orthos.















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