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Author Topic: Very Rare Laterally AND Medially Subluxating Patella, OS baffled *Gross Video  (Read 669 times)

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Offline JamieDeanne

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Hi Everyone,

I am back here after 6 years. I am a 30 year old woman, competitive horse trainer. 5'6, 120 lbs.

 I had an arthroscopic lateral release, chrondoplasty and an open MPFL plication (repair) on December 26, 2007. 6 weeks in an immobilizer, NWB, and then 8 months of rehab.

2 months into rehab, I herniated 3 lumbar discs and required an open discectomy and laminectomy, and since then, I have re-herniated twice more at all 3 levels and have had multiple discectomies and other spinal procedures.

I've recently been having recurring subluxations again, and this go around my knee has been locking and very painful, very different from the first injury before my first surgery. This time we decided on an MPFL reconstruction with a cadaver graft because my own ligaments are so stretchy. I am very flexible, remarkably so.

However, yesterday, in my pre-surgical appointment, I finally showed him how my kneecap doesn't just subluxate laterally, it also subluxates medially, he became speechless and is now cancelling surgery. He said "99% of patellar instability cases are ONLY lateral tracking subluxations. 99%!" So I am the 1%. He has never seen a case like me. He has a friend, Laurie Hiemstra who lives in Banff and is one of the leading experts on Patellar Instability and he is a friend, so he wants her advice on my case, and will send me to her if she can help me.

Apparently the MPFL repair won't work if my patella subluxates to the inside, because there is nothing holding it from "jumping the tracks" and popping out. And the lateral retinaculum is already severed from the first surgery so there's nothing opposing it from that side either.

So I suggested a trochleoplasty, which he immediately said has horrible outcomes because it causes very bad arthritic changes and pain, so for an active person my age it would not be a great idea. Then he left, came back ten minutes later and said it was probably my best chance. (WTH?!) Then he suggested a TTO with distal transfer at the same time, if she thought THAT would help. He said he had only done a handful of trochleoplasties, and I didn't ask him about a TTO. I don't want to switch surgeons. He is not even sure if I am a candidate for trochleoplasty, my last surgeon said my trochlea was fine, and my MRI said it was unremarkable. 

Any ideas, suggestions, thoughts?

This surgery is career ending, and when you make your life's career a simultaneous goal to ride in the Olympics for Canada one day on a horse you trained yourself, you don't make a plan B. So, I am terrified here, and willing to do anything.

Anyone ever had a patella that subluxates both ways, all the time? What did you do?

« Last Edit: December 10, 2015, 08:48:37 AM by JamieDeanne »
Don't Forget What Makes You Strong

Offline agbridge

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My 16 yr old son (competitive swimmer) just had ortho trochleoplasty and MPFL done last month on one knee and will get the other completed next summer. He is already looking at getting back in the water in a couple weeks (more pulling than kicking).  Lars Blond completed the surgery in Denmark and have nothing but good things to say about the experience. 

You may want to send him your xray and mri and get a second opinion. The problem we had was that there isn't much for options in the US/Canada for trochleoplasty.  I would rather go to someone who has had more experience with this surgery, even if that means heading to the other side of the pond. 

Just my two cents.