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Author Topic: patellar maltracking says physio nothing wrong says ortho...  (Read 1928 times)

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Offline Alicat

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patellar maltracking says physio nothing wrong says ortho...
« on: March 23, 2013, 11:02:02 PM »
hi again!!

Hope someone might have some advice or words of wisdom :)

Basically Dec 2011 twisted on the spot in a rush to go other way knee cap dislocated but wasn't painful and after some tugging went back in place, didn't go to A&E because when my mum fell and dislocated her knee she was in agony so thought I'd be fine, re-dislocated twice next day so busy decided just to wait and see GP on the Monday because it wen't back on own.

Slowly but surely got more and more painful so started in house physio at the GP surgery she recommended I see podiatrist because she noted my legs were "wonky" podiatrist said nothing they could do so referred me to a knee specialist dr at another GP practice, saw their physio and the Dr noted mal-tracking patellar so he referred me to the hospital saying I'd likely need surgery.

Its now May June time I have an initial appointment with ortho surgeon he sends me for MRI querying torn meniscus, got quite grumpy with me as I was in so much pain he could hardly perform the exams he wanted without me hitting the roof, wrote on my notes that my knee dislocates to the right when it seems to go left.

Fast forward 3 weeks, still in lot of pain and Dr said he'd have MRI results back after 2 weeks at latest. I received scan copies in post less than a week after MRI so felt confident they'd have them and I'd query when I could get an appointment. According to secretary no results back yet, 2 months later again same story, this carried on til I rang and asked to talk to any ortho Drs secretary for an opinion on what to do, next thing I know appointment lands on my door mat for the following week, excellent I think! (only 7 or so months later)

Day of appointment sat waiting 75mins past my appointment time to be seen, the man in front of me in the queue couldn't be seen as my dr's sec had lost his notes!

Saw Dr he performed exam, wasn't in as much pain as last time and MRI didn't show meniscus tear so he declares to me the only reason my knee dislocates is because I'm fat! yes those exact words!! If I lose weight it will stop, he'll refer me to physio and told me I must see GP about my weight. I walked out of his office in floods of tears!! yes I'm a little overweight and I know losing weight can only help reduce the stress on the joint but it was like a slap in the teeth and to be honest I didn't think it was quite right...

Maybe a week later I'm in physio department at hospital discussing all the key points about everything thats been going on, symptoms who i seen etc I tell her what Dr said and her face was a picture she couldn't believe it, she said your normal sized and there is no way you're big enough to cause you knee to randomly dislocate!

After all the tests she explained to me my knee problem as she saw it, all my tendons felt intact but both my knee caps were not sitting in the correct place at rest, the left kneecap tended to ping into the groove and track up and down properly when bent but the right one slips outwards and grinds on the bone, she tracked each knee cap with her finger to show me where they both ended up, left ended up in normal place right pulled out to the side and twisted its angle. Made so much sense to me because the pain I experience when going down stairs is a sharp stabbing pain at a particular angle of bending and thats where she pointed my knee cap was.

Any way left the physio feeling really really positive with exercises to do and I'd see her again in two weeks which is this monday coming...

About 5 days ago I woke up in agony like a knife was stuck in my knee, both were tucked up in front of me like in the fetal position, couldn't straighten my leg out, I take very strong meds for another health issue and they also act as a sedative so I wasn't quite with it and yanked on my leg and suddenly felt and heard a twang like an elastic band and it was straight and moveable again, pain subsided a bit with pain relief and I fell asleep (codeine + my meds cld knock out a small horse) woke up in pain, now I have this constant stabbing pain and even one step up or down makes me whince and shout, walking flat is ok-ish but i get twinges where I have to pull up cos I can't hack it. Ive cried a lot over it this last week, got prescribed some extra pain meds from GP over phone helped a little still killing me so I saw emergency dr this morning at GP practise who upped pain relief even more and said sounds like you could do with a second opinion and offered to refer me to whoever I'd like I just need to provide him with a name and address which was great!

Physio monday, lots to talk about! Is physio likely to fix this? Im in so much pain its really getting me down. Any advice? positive stories where physio cured you even if it took 3 years?? is surgery an option? I know its not a cure all but my knee has only got worse and worse over last 15 months. Any suggestion of ortho in East of England that might be worth seeing?? the guy who dealt with my shoulder dislocation and operation was wonderful and I still cant get over the hassle this ones been.

Sorry for the long message!! Hope someone can help a little, thank you!!!

Offline Vickster

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #1 on: March 23, 2013, 11:18:19 PM »
Second opinion sounds like a fine idea.  This surgeon has a special interest in patella issues and is based in Norwich.  I'd discuss this with your GP

http://www.kneeguru.co.uk/KNEEsurgeon/donnell01/contact.php

http://www.nnuh.nhs.uk/Person.asp?id=211

I don't know alot about kneecap dislocations but you can stretch the ligaments which can be reconstructed (called an MPFL, plenty of posts on here about it if you use the search function).  Physio can also help and is the usual starting point

Good luck :)

Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline allyd

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #2 on: March 24, 2013, 12:16:55 AM »
Agree it probably is best to find a second opinion at this point. Your current OS likely just has no experience in patella instability and has no idea how to help you; so he is pushing the responsibility/problem off on you.

From personal experience... Physio may alleviate the problem to a point and always worth a try if for no other reason than to try to avoid surgery; but once dislocations become ongoing and chronic - if unbearable; surgery becomes your best option. There is a lot they can do. One of the most common lately is the MPFL surgery Vickster pointed out, which I had done myself after 3 years of PT not helping. It basically reconstructs the ligament on the medial side of your knee that has been torn and stretched out from all the dislocations. The new ligament provides a check rein to your kneecap and helps restore tracking. Depending on your anatomy, there are a couple of other surgeries that are possibilities as well, such as a TTT.

I don't know much about the UK health system; so I'm not going to attempt to help you navigate who and how. But do try to find someone with experience in patella instability. I'd trust Vickster is pointing you in the right direction. And for what it's worth your PT is spot on with your weight is not causing your knee to dislocate. I'm not the smallest person in the world, but after losing a lot of weight; I had two orthos (one of which specializes in patella instability) tell me that no amount of additional weight loss was going to stabilize my kneecap.

Good luck.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Alicat

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #3 on: March 24, 2013, 12:46:18 AM »
thank you very much for your help! That Dr sounds ideal he specialises in patellar instability, which I assume covers both the mal-tracking and the re-current dislocation/subluxation and only 1 hour away. I wonder if he'd mind if I sent him an email since he leaves his address on multiple web pages? might do that tomorrow, then after I see physio monday ring the GP and ask for that referral.

Offline Vickster

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #4 on: March 24, 2013, 10:25:17 AM »
I am not sure that I would email him out of the blue when he has not examined you or know anything of your history. I would wait for the GP referral myself.

 If you are seeking to speed up the process, I would suggest having the initial consultation privately. It will cost you around 150-250 and you'll get a longer appointment than if NHS. It'll also be quicker and you can make sure the time is convenient. If surgery is then required etc, you can then transfer to his NHS list. Looks like he is the top dog there, so he may have a longish waiting list.  He has a private clinic at the Spire in Norwich.  Be warned that scans, x rays can get costly if paid for privately!

Have a chat with your physio and then see the gp. Even privately, a GP referral will be required.

That said, as you say his email address is clearly in the public domain, so it's up to you :)
« Last Edit: March 24, 2013, 12:31:27 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Alicat

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #5 on: March 24, 2013, 02:39:03 PM »
i just meant a really quick overview of situation and ask if he'd be happy to take it on a a 2nd opinion case or whether he could recommend someone else if not. Nothing heavy :) Looking fwd to physio :)

Offline Alicat

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Re: patellar maltracking says physio nothing wrong says ortho...
« Reply #6 on: March 26, 2013, 08:27:26 AM »
had physio yesterday she had me try the bike I just cried in pain so we stopped. am in agony! spoke to GP on phone yesterday he said he's surprised i'm not in a brace considering my knee has dislocated maybe 6 times so far this week. if it goes again today I'm definitely going to a&e I'm in agony despite pain relief :(