Banner - Hide this banner





Author Topic: "Complete Chronic Tear of MPFL"  (Read 1659 times)

0 Members and 1 Guest are viewing this topic.

Offline bike_buddy

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
"Complete Chronic Tear of MPFL"
« on: January 27, 2015, 04:43:38 AM »
A "quick" backstory...

My on-going knee issues started about 16 years ago when I was in middle school.  I still vividly recall running for a basketball and then collapsing with an excruciating pain in my left knee.  A year or two later I suffered another dislocation while roller blading.  At the time I was unaware of what was occurring.  In high school the dislocations began to occur very frequently (at least 5x per year).  In response to this I began physical therapy to attempt to target my VMO and combat my hypermobilty.  After this strategy resulted in no perceived improvements I had elected to have a surgery that consisted of Medial Reefing and Lateral release. 

Fast-forward to a couple of months ago…

I have spent the previous 10 years with constant fear of dislocations, mainly my left knee.  In a given year I will have 2-3 dislocations, typically resulting from walking on a slick surface or moments I am not consciously trying to watch my movements.  I am ~190 lbs, 5'10" and mountain bike / road bike fairly regularly throughout the week. 


Back up a few weeks ago…

On a recent mountain bike ride I clipped a tree with my shoulder and went for a brief flight, landing with my knee.  When I landed I dislocated my patella in the process and I believed I had only suffered one of my ‘typical’ dislocations.  After weeks of swelling and inability to sustain load on my leg, I knew something more serious had occurred.

The MRI results, shown below, indicated that my MPFL had completely been torn.  I now have an MPFL reconstructive surgery scheduled in a couple of weeks, with hopes this fixes my immediate issue and recurring issue.

At the time I was fairly confident this is the most logical path forward, but after reading several threads about MPFL reconstruction I am left with mixed emotions.  I am not certain my evaluation was as thorough as some of the ones I have read about, and I hope nothing is being overlooked.  But, maybe I just didn't exhibit signs to warrent other avenues at this time.


Given that my MPFL is completely detached, is there even a decision about how to proceed at this stage?  I assume even if this only resolves the “effect” and not the “cause” that I would have to have this procedure performed despite what the “cause” really is.

Initial Physicians Notes

Chondromalacia of patella   
Patellar subluxation   
Internal derangement of knee   
Medial collateral ligament sprain of knee, left

MRI Results

RESULTS:

Bone: No fracture, avascular necrosis or marrow replacement. Bone edema in the posterior lateral femoral condyle and distal lateral femoral metaphysis, favored a vascular phenomenon, as edema is too posterior for a recent transient lateral patellar dislocation. Similar less pronounced findings in the fibular head.

Cruciate Ligaments: Intact.
Collateral Ligaments: Edema-like signal in the deep and superficial margins of the medial collateral ligament, proximally, with mild thickening. Lateral collateral ligament complex is intact.
Medial Meniscus: Intact.
Lateral Meniscus: Intact.

Cartilage:
- Medial Compartment: Intact.
- Lateral Compartment: Intact.
- Patellofemoral Compartment: Intact.

Extensor Mechanism: Quadriceps and patellar tendons are intact. There is postsurgical change the along the soft tissues at the patellar attachment of the MPFL, with micrometallic artifact and intermediate signal soft tissue measuring 22 x 15 mm (consistent with posttraumatic and postsurgical change). MPFL is discontinuous with retraction towards the patella and no surrounding edema. There is postsurgical change along the lateral patellofemoral ligament with a small area of discontinuity best seen on series 8 image 13.
Joint: Mild lateral patellar tilt. Small sized joint effusion.

CONCLUSION:

1. Grade 1 or 2 sprain of the medial collateral ligament at its femoral attachment.
2. No meniscal tear.
3. Chronic complete tear of the medial patellofemoral ligament (MPFL) from the femoral attachment, with retraction toward the patella. Evidence of prior surgical change suggesting this is a chronic tear of a previously repaired MPFL.
4. Postsurgical change from prior lateral patellar retinaculum release.
« Last Edit: January 27, 2015, 05:04:42 AM by bike_buddy »

Offline junebug800

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 2
Re: "Complete Chronic Tear of MPFL"
« Reply #1 on: January 27, 2015, 09:53:13 PM »
I recently had MPFL reconstruction using a donor tendon on my left knee. It is definitely not a fun or easy surgery but it seems like it would be helpful for you. Ironically I never dislocated my left knee, but I had begun having some lateral pain and noticed that my kneecap had a CRAZY j-sign that anyone could see with the naked eye. The kneecap is tracking better now but 4 months later I am still weak in that leg. Do you have any pain in that leg now? From your MRI your kneecap looks like it might be tracking poorly or be subluxed.
Symptom onset: 7/2014
Positive "J" sign LK
PT for 8 weeks
L MPFL reconstruction/scope: 9/2014
PT for 2 years post OP
Continued PFPS Bilateral

Offline bike_buddy

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: "Complete Chronic Tear of MPFL"
« Reply #2 on: January 27, 2015, 10:08:49 PM »
I am now in week 7 since my initial mountain bike accident.  The first 2 weeks were very painful with me not being able to put weight on that leg.  Gradually the pain has gone down since then.  Right now I breaking up one 5-325mg hydrocodone throughout the day and I am able to walk with a compression brace on.

I am guessing that since my MPFL is completely detached, regardless of what I do in the future to fix other potential joint issues that may be occurring, I will still require an MPFL reconstruction before proceeding (I assume).

How long were you off work?  I have a desk job that requires limited walking, but I am still concerned about putting stress on the joint with driving to work and getting around.  I am anticipating being out 3-6 weeks, but the physicians office has started with only writing me out for 3 weeks.

Offline junebug800

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 2
Re: "Complete Chronic Tear of MPFL"
« Reply #3 on: February 06, 2015, 06:27:23 PM »
Good that your pain is going down. Mine never went away. As to work, I would plan on 6 weeks. You'll be in a brace for that amount of time and it goes from thigh to ankle to really not too comfortable. Depending on how quickly you recover your quad (which will pretty much turn off after surgery and especially since your brace will be locked for a while and you will be sleeping in it as well) you may be able to come back to work with just a cane or nothing. I was unsteady without the cane in the parking lot.

I have a desk job too and the dr said 1-2 weeks at first but I was still on crutches at that time and had to have my leg elevated whenever sitting along with ice and it's just all  hard to manage even in an office. Going to the bathroom becomes a huge production ,you get the idea
« Last Edit: February 06, 2015, 06:32:34 PM by junebug800 »
Symptom onset: 7/2014
Positive "J" sign LK
PT for 8 weeks
L MPFL reconstruction/scope: 9/2014
PT for 2 years post OP
Continued PFPS Bilateral

Offline bike_buddy

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: "Complete Chronic Tear of MPFL"
« Reply #4 on: February 06, 2015, 06:48:30 PM »
Thanks for the insight!  I have certainly been stressing out the last few weeks and hoping this surgery is the best way forward.  Reading these forums has raised a plethora of questions and concerns about other potential issues that may remain and cause my underlying dislocation issue.

I suppose at this point, since the MPFL is completely severed, this reconstruction is my best path forward and I will have to wait and see if there are underlying issues.















support