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Author Topic: Guess my next step!  (Read 661 times)

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Offline Allscarredup

  • MINIgeek (20-50 posts)
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Guess my next step!
« on: February 19, 2013, 05:35:19 PM »
I am posting here because I have no idea to which specialty my next course of action will take me. I would not be offended by any moving of my thread  ;)

I am 26, 5'11", 220lbs, former elite-amateur/semi-pro rugby player. Throughout most of my life I had bad spurs in my ankles and limited flixibility there, which seems to have given my knees a pounding. Add some knock knee to that, and I'm 26 posting on the kneeguru (have been since 24?)!

Went through an ACL tear and chondroplasty to address chondromalacia and a phantom, crippling acute pain that stopped my athletics completely. Recently I finally got a 3-Tes MRI with cartilage mapping. My knee presents like this:

>>> Q-Angle of about 30 degrees (yikes!) My tibia recurves in after the tuberosity, so the leg itself is not but so knock-kneed but the patellar tendon is WAY off. Thirty is bad.

>>> Some lateral patellar tilt

>>> Relatively pristine cartilage throughout the knee except for one area in the medial trochlear sulcus where I have a FULL THICKNESS tear, all the way down. This happens to be right under the patella, where the tilt has pointed that part of the kneecap slightly medially (top goes lateral, bottom goes medial.)

>>> Knee seems to be bent valgus ABOVE the knee, as the patella and TT point out when the thigh is straight, and the absolute most inward point I can get from my foot when the knee is flexed 90 (sitting) is straight ahead, but the foot can turn laterally very easily. The lower leg faces out about 20-30 degrees at that position. The head of the femur seems to be larger on the medial side, again facing the lower leg and P/F joint laterally.

So it seems the structure of my leg has caused too much forced to be dug in to a very small area in the knee, causing the cartilage to break open, despite minimal wear. The pain is only at a certain angle of flexion (where that defect happens to be) and I have no pain other than in that area.

I assume they'll do some procedure like DeNovo or Microfracture to address the tear, but if the patella just plows there habitually something else will have to be done to re-route it.

My question is... knowing these things... is it reasonable to assume I'm headed for DFO? Would a lateral release/medial tightening retrack the patella away from that defect without changing the Q-angle? Do TTTs work in knees with valgus without also correcting the valgus?

Sorry for the long post, I'd rather give you too much info than not enough. I know few of you are doctors, but in my experience you lot are pretty good anyway. Lemme know what you think. Appreciate it.

N