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Offline momma-cat

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patella baja
« on: January 27, 2014, 09:28:26 PM »
I haven't been on this board in about one year.
18 months ago I had a TTT to my right knee for stage 4 chondromalaca. It was absolutely horrible. I had it done 2 years earlier to my left knee and I rehab'd right out of it. During the surgery, my OS hit a nerve so I had nerve pain for several months. I had adhesions and went be to surgery to break through them. A few days later, his PA-C had to drain my knee from all the blood that occurred because of the manipulation.
Because of all of this, I have been EXTREMELY scared to go back to my OS. But, the pain in my right knee is now unbearable. After shooting a ton of x-rays, his PA-C tells me that I have to have a special metal-reducing MRI (because I still have the screws in my knee) to assess how bad my knee is. I have patella baja, suprapatella bursitis and now arthritis. My OS is not sure if he wants to do anything about the bursitis (which is fine with me). For the arthritis, he wants to shave the patella. He is waiting on the MRI to decide which surgery to do for the patella baja. It will depend on how bad the arthrofibrosis is. I'm freaking out!!!!
I have the MRI this Friday and I will get the results that day (only because I am a nurse practitioner who has access to the records  :P  I see my OS Feb 3rd. I will have surgery within 2 weeks after that. The z-plasty or the autograph seem to be about my only options.
If anyone can tell me what to expect with either of those surgeries so that I can mentally prepare myself for this, it would be greatly appreciated!!
Catherine H.
Pediatric Nurse Practitioner

Offline missmyknee

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Re: patella baja
« Reply #1 on: January 28, 2014, 04:26:08 AM »
Hi Mommacat

How were you diagnosed with patella baja? Did you have lateral view xrays of both knees taken and did your OS take measurements off those xrays to determine your patella was in baja position ?

http://radiopaedia.org/articles/insall-salvati_ratio

MRIs don't always show scar tissue in the knee but can show changes to the patella tendon. In my case, the MRI show my patella tendon had become thickened and shortened.

http://www.radsource.us/clinic/1008

Also physical exam reveals a patella pulled low with little movement in all planes and deficits in ROM depending on degree of baja.

The best thing for you to do is to read up as much as possible about arthrofibrosis. The KNEEguru has one of the most information in one spot about AF. Beginning with Dr Frank Noyes 12 part course on arthrofibrosis. You will learn about patella baja during this 12 part course. Dr Noyes is one of the pioneers of arthrofibrosis treatment. Here is the link to this course

http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-12-part-course-frank-noyes-md

The next link is to a list of Drs in the U.S who have demonstrated specialized treatment of arthrofibrosis. They have seen many cases and successfully treated many cases of AF. Just about all of them have been used by current or former posters. I STRONGLY suggest you seek out one of these Drs to treat you. ( Don't let a doctor do surgery on you that "scares" you esp after your history with this doctor and the fact that you have had a TTT in the past, might complicate it further) These Drs see many cases of AF , they know the specialized surgical techniques, post op treatments and the specialized rehab techniques for AF. The specialized rehab is just as important as the surgery in fact many of these doctors have their own PT depts staffed with PTs trained in these techniques. To be treated by one of these Drs gives you the best chance toward a successful recovery. Many of us AF sufferers have traveled long distances to be treated by one of these doctors. Its an investment in your knee. Here is that link:

http://www.kneeguru.co.uk/KNEEnotes/whos-who-knee-surgery/whos-who-arthrofibrosis-surgery

The next link is to a variety of journal articles , blogs and other information on arthrofibrosis. The more knowledge you have about AF, you will be able to ask informed questions and make better decisions regarding your treatment.

I have battled AF for 13 yrs which began with patella baja and infrapatellar contracture syndrome. My first knee OS said patella baja is the worst condition for a patient to have and for an OS to treat. I have a series of blog posts about my journey in that section.

http://www.kneeguru.co.uk/KNEEnotes/keyword-tags/arthrofibrosis?page=3

Your degree of baja will determine what is done

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 momma-cat

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Re: patella baja
« Reply #2 on: January 29, 2014, 03:02:26 AM »
Pam,

Thanks for the info. He took a ton of xrays on both knees (which is where I first began to get nervous) before he told me about the Baja and the other issues that I have with the knee. My being a Nurse Practitioner, I feel pretty damn stupid because I never noticed that I could no extend my right leg as much as my left. My right patella is definitely lower than my left - obvious enough to the naked eye. As far as seeking out an AF specialist - there may be the problem with insurance (don't get me started on insurance limitations). There is an excellent Dr. in Vail, CO (Steadman Clinic but they do not take Kaiser).

I will do more research on AF and try to get this figured out before I see my OS on Monday. I will know the results of my MRI before I see him (because I am a medical provider, I have access to reports  ;D )

I'm just so bummed that my left knee (which was the same surgery) has done great but my right has had so many problems.

I will let you know what my OS says and I will see what my options are with insurance. I will also review the links you posted.

Thanks,
Cat
Catherine H.
Pediatric Nurse Practitioner

Offline momma-cat

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Re: patella baja
« Reply #3 on: February 01, 2014, 02:25:10 AM »
So, I had my MRI today and I got the results. I don't see my OS until Monday and the results are discouraging.

I have moderate patellar tendon scarring extending through the Hoffa fat representing area of impingement, moderate bandlike scarring along the anteromedial capsule representing another area of impingement, a new full thickness chondral fissure, a new subchondral osteophyte and mild scarring or degeneration of my ACL. The only good news was that the bone edema has improved. 

This is not encouraging news. For one, I have not had any problems with the ACL or have any known injury to it and to see that there is either scarring or degeneration to it is discouraging. Second, there is a lot of scarring going on. The bone spur is not surprising nor are the fissures.

I am very saddened by this and will wait to see my OS to see what he has to say about it all and his suggestions. Then, I will need to rethink all of this and make a decision on what to do. My knee is becoming debilitating due to pain. I can only make small runs to the grocery store which is not feasible as I have two teenagers that eat a lot. I just don't know which way to go  :-[
Catherine H.
Pediatric Nurse Practitioner

Offline Asbmommy

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Re: patella baja
« Reply #4 on: February 02, 2014, 12:29:51 AM »
What is exactly patella baja? My 8 year olds MRI showed that
With discoid lateral meniscus among other stuff but surging the appt with the ortho Dr he didn't mention that and I forgot to ask.

Offline momma-cat

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Re: patella baja
« Reply #5 on: February 02, 2014, 03:54:15 PM »
In Spanish, baja means low or below. In the simplest terms, patella baja means that the patella is sitting lower than anatomically normal. Because it is sitting lower than it should, it comes with its own set of problems. Its also called patella infera. When the patella is sitting too low, it can cause restricted range of motion, crepitus, and pain.

For me, I am missing about 5-8 degrees of full extension. My right patella is sitting about 1.5 cm lower than my left. Did your daughter have a knee injury? I know that discoid lateral meniscus is rare condition that is acquired, not as a result of an injury. But I was just curious if she had an injury that led you to find this condition.
Catherine H.
Pediatric Nurse Practitioner

Offline Asbmommy

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Re: patella baja
« Reply #6 on: February 02, 2014, 04:48:13 PM »
Thank very much for explaining it was noted on his MRI but the dr didn't mention it at our appointment. Two out of my three children have discoid meniscus and my daughter played a lot of sports and was having significant pain. My son however has the discoid and patella baja and he would go through knee pain where he would not walk at all for 5-7 days because he said if he walked his knee would pop out of place.
I found my daughters too late and she had a complete tear and she has no meniscus now and severe arthritis from it. They are doing surgery on my son on March 18th because his discoid is the weisen berg type (?spelling) and it is thick and getting caught in the joint along within aments not attached correctly and a very small ACL,
How did they find out yours? Was it from the pain! Did yours make it feel unstable?
Thank you again for your valuable input,

Offline Asbmommy

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Re: patella baja
« Reply #7 on: February 02, 2014, 04:49:53 PM »
Sorry my phone I meant ligaments not attached.

Offline momma-cat

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Re: patella baja
« Reply #8 on: February 02, 2014, 07:25:58 PM »
I went to me OS last week for increasing pain over the last two months. That is when they found the low patella. I had sugery on that knee 18 months ago and had a couple complications. I had a lot of bleeding in the joint after the surgery and then again after manipulation a few months later which is where I am sure all the scarring came from. I had the same exact surgery to me left knee and had no complications and no scarring.. I ruined my knees as a young adult.  I hope that your children have speedy recoveries. I'm really quite nervous about what my OS has to say tomorrow but what ever it is, I am ready to start the healing process.
Catherine H.
Pediatric Nurse Practitioner

Offline Asbmommy

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Re: patella baja
« Reply #9 on: February 02, 2014, 08:33:21 PM »
Wishing you a speedy recovery.















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