Chronic patella maltracking pain?

[junebug800]

Previous to the last six months I never had any knee pain. I knew I had some weakness since I had dislocated my right knee when I was 13 (it swelled up but I made a full recovery). I did also have what I would call some "wobbles" where I would be maybe be just walking or hit a small wet spot in the ground and feel like a jerking in my movement. My knee would hurt for a moment but then I would be fine. For exercise I would typically walk or bike ride, nothing hardcore at all. Starting in about December of 2013 I started doing some HIIT exercise. I started with only about 10 minutes and eventually by Mid July 2014 I was up to almost an hour but it was combined with stretching and strength. Never any pain. One day in July I was doing a squat challenge with a friend at work and I felt a firm pressure on the lateral side of my left leg like where the ITB is. On my way back up the stairs it became an actual pain. For the next week or so I felt ok but still had that pressure and the leg felt weaker somehow. I bought a brace and went for a mile or two walk about a week after the initial incident. When I came home both knees were BURNING. I iced them and when I woke up I felt better but with each day I was more and more uncomfortable walking and had pain in both knees laterally and below the kneecap. While sitting on a recliner I extended by leg all the way and was shocked when I saw my kneecap track way out to the side. I flipped out and got an MRI which showed nothing except a 6 mm subluxation and shallow trochlear grooves.

The first ortho i saw said PT so off I went but after two weeks I felt like the pain was getting worse and I was getting nowhere with the tracking. I saw another ortho who also said PT and after two weeks there his Therapist sent me back to see him because I said I was in a lot of pain all the time. The ortho booked surgery for my left leg that had the worse tracking (both knees showed a visible to the naked eye J sign but the left was definitely worse). I had MPFL reconstruction and arthroscopy where he cleaned up some damaged cartilage on the medial side (ironically).

I've been doing PT for the left (operated) leg for about 4 months, PT for the right for about 2 and a half months. I still have not recovered my quad completely and let's not even talk about my non-existent VMO. Hips are tight. IT bands are tight (worse in the right) The left leg still has a J but admittedly it is less and the Dr seems pleased with it. No Trochleoplasty since he said the shallowness was not really that bad. I've now also developed what I can only think is nerve pain in my upper thighs and calves plus I still have the same pain I had before surgery. (Note: it did not hurt to extend my leg before surgery even with the crazy tracking but I don't know if the pressure from walking made it hurt)

at this point I am with a different PT and they are using EMS to try and stimulate my VMO on both legs plus trying to increase hip strength/flexibility and glute strength plus working on my ITB.

Standing in one spot for more than a minute is super painful and I can only walk what's required for my office job without screaming (so ie I have to use a scooter at the grocery store). I also feel pain sitting or laying down when it's reached a fever pitch.

Do i just need to give this more time?  I am seeing a neurologist on Tuesday about all the seemingly unrelated, but supposed nerve pain. I take Neurontin but I only felt a real difference once Elavil was added. 

[junebug800]

really? no one has pain from patella maltracking? 

[willrunagain]

Hi,

I am in a similar situation, so I feel your pain (literally). I'm 25 y/o male.  I never had any knee problems in my 10 years of running and I even ran D1 cross country in college.  I was diagnosed with runner's knee/patellar maltracking 7 months ago.  I did PT for 4 months with no improvement. I got an MRI in that 4th month.  The only problems that showed up were induration and stranding in my hoffa's fat pad and my suprapatellar fat pad (No evidence of chondromalacia).  Diagnosis was confirmed as originally thought. My original OS said it must be patellar maltracking.  Two weeks ago I finally got a second opinion.  This OS told me I have cartilage damage on the back of my kneecap and wanted to schedule a scope to do a carticel biopsy.  I was super surprised because the MRI report said in bold terms "NO EVIDENCE OF CHONDROMALACIA".  However, I have read that MRI's aren't particularly accurate at discovering articular cartilage defects, so I have scheduled the scope for 2/18/15.  I am hoping my doctor is wrong because cartilage damage on the back of the kneecap could mean I might never be able to run again, at least at a competitive level.  If the cartilage damage is confirmed, I'm looking at a very serious Cartilage implantation surgery with a lengthy and difficult recovery.  Long story short, you might want to get a second opinion and consider an MRI/scope if you haven't had one.