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Author Topic: Confused about patellofemoral dysfunction diagnosis  (Read 626 times)

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Offline Amy689

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Confused about patellofemoral dysfunction diagnosis
« on: March 04, 2017, 12:14:07 PM »
Hi everyone, apologies for the length of this message. I recently injured my right knee whilst playing badminton and was hoping for some advice.

I went to change direction during my badminton game and twisted my knee a little and at the time felt something go within my knee. However, my knee didn't buckle and even though it felt a little painful, I just put on a knee support and carried on playing for another 45minutes as I thought it was nothing. By the time I got home, it had swollen a little and the pain had increased so I iced it and hoped for the best but when I woke up the next morning, I found I couldn't straighten it fully and wasn't able to bear much weight on it either. I went to the physio that morning who did some tests and thought I may have injured my meniscus but we waited a week to see if everything settled down. In the interim, I used crutches to walk since I couldn't walk comfortably otherwise.

A week later, since I still struggled to straighten without feeling pain at the back of my knee, I went to see a consultant who immediately diagnosed it as patellofemoral dysfunction and poor cartilage in my kneecap and that the badminton incident just aggravated it. However, I'm only 27 and have never had any problems with my knees before. We did an MRI to be certain and the consultant said everything looked fine, just some swelling below my kneecap, and I should just have some patellofemoral physio and cycle 30mins/day to rebuild the cartilage in my kneecap. I was hopeful about a quick recovery, given there appeared to be no meaningful structural damage but it's now 5 weeks post injury, I've been having physio sessions 3x week, as well as doing all the rehab exercises at home and cycling every other day to rebuild my kneecap cartilage and my knee still feels a long way from normal.

The good news is that I can walk unaided again, even though there's some awareness of my right knee and my knee does straighten now. However, whenever I cycle, my right knee feels stiffer afterwards, a little unstable and possibly even a little swollen. When I'm seated, I get some discomfort around the front of my knee and if I'm seated for >15minutes, when I stand up, I get a fairly sharp pain at the back of my knee. If I try to bear all my weight on my right knee with it fully extended, this also results in some pain at the back of my knee, some discomfort around the front and a sense of instability. I can't walk quickly as it's as though my right knee can't keep up with the movement and I start to get pain through it too.

Should I be worried that there might be something else going on too and get a second opinion or if I continue with the patellofemoral rehab will it get better? I'm confused about the patellofemoral diagnosis too because I thought that was usually more of a gradual condition rather than caused by a specific event? Any advice from all you knee gurus would be massively appreciated. I'm normally so active and this has completely floored me without any explanation that makes sense to me :(

Offline Vickster

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #1 on: March 04, 2017, 12:28:37 PM »
Unfortunately, knees can take months to recover from injuries or even tweaks. And patellowfemoral issues are the worst of the lot, very easy to irrittate with activity, even cycling.

These some good info here http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer

meniscus sounds like a potential culprit and small tears can be missed on MRI. What does your physio think to your diagnosis and recovery?

I'm assuming you have private HC given the speed and frequency with which you are being seen.you could get a second opinion (find a PF specialist physio if you aren't seeing one already, or see another consultant knee specialist, where are you in the U.K?)

Alternatively, given it's got better over the last five weeks, give it another couple of months and then see. You certainly want to avoid any sort of surgical intervention until a last resort

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 Amy689

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #2 on: March 04, 2017, 02:38:22 PM »
Thanks so much for your reply and the link-it's really helpful! It's also reassuring to know that recovery from even a fairly benign injury can take a few months so not necessarily indication of a more serious problem!

My physio was a little surprised by the diagnosis to be honest, but given the scan was reported to be clear, didn't question it further. However, now that it's 5 weeks later she seems concerned that I haven't made more progress. That's why I'm a bit worried...

I'm based in London and yep I do have private HC. I think you're right in that maybe I should give it another month or so and then perhaps seek out another opinion. Maybe by that time it will be materially better. I think I just find the whole diagnosis a little bit confusing since they can't actually pinpoint what happened within my knee to begin the sudden onset of PF issues

Offline Vickster

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #3 on: March 04, 2017, 03:48:55 PM »
If it's not better, perhaps try Claire Robertson at Parkside Wimbledon who's a PFS specialist. Did the surgeon look at the actual images or just rely on the report? I've had a shoulder tear diagnosed and repaired that wasn't picked up by the radiologist. They can be subtle but bothersome

There's a meniscus primer too
http://www.kneeguru.co.uk/KNEEnotes/primers/meniscus-primer
And a video
http://www.kneeguru.co.uk/KNEEnotes/videos
« Last Edit: March 04, 2017, 04:08:55 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 Amy689

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #4 on: March 04, 2017, 06:45:49 PM »
Ok, great! Thanks for the tip! I will look her up.

To be honest, I'm not certain whether he actually looked at the images properly himself or not. When I went for my follow-up after the scan, he just told me everything was fine and didn't show me the scans until I asked him to. So at that point he opened up the report and scans and quickly whizzed through it, more directing me to what the report said than actually talking me through the images. Then when I asked a question about some of the images, he seemed a bit taken off guard. Honestly speaking, because he was so quick to make a judgement in my initial consultation and then seemed a little surprised that I actually wanted him to show me the images, it hasn't filled me with confidence...

Also, poor you! Knee and shoulder surgeries! Hope you're recovering well!

Offline Vickster

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #5 on: March 04, 2017, 06:59:02 PM »
You saw him privately?  Sounds unusual to be so quick for a first appointment.  Was he a knee surgeon or a more general orthopaedic surgeon (assume he was a surgeon not one of the MSK specialists some of the insurance companies seem to want to point you towards in my experience)
Where in London are you?

I've not had knee surgery for a while, but I have just finished having some injections to hopefully settle down a deteriorating knee and stave off the need for any more ops for a bit!

Two shoulder surgeries last year  :(

I've not seen Claire Robertson, but another physio recommended her when we thought I had PFS (not actually the case it transpires - but a bone spur on one of the shin bones irritating soft tissues around it)
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 Amy689

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #6 on: March 04, 2017, 11:23:15 PM »
Yep, I saw him privately and yes he is a knee surgeon. To be fair, I'm probably exaggerating. He must have spent about 20minutes with me initially but did fewer tests than my physio, didn't think it was an issue that I found it hard to fully extend my knee or weight bear in an extended position and he said the pain at the back of my knee was just referred pain from my kneecap. The only thing he really latched onto was the crepitus in both my knees and decided my problems stem from doing too much cardio and no resistance/strength training so my muscles aren't strong enough (even though 50% of my workouts are resistance/strength training but he just assumed I only did cardio at the gym). I'm probably being unfair, in that I'm sure he knows what he is talking about and maybe it's obvious to him what the problem is and that's why he could dismiss a lot of the symptoms, but given it's not progressing as quickly as one would expect, it just makes me a bit nervous.

I'm based in North West London but work in the Blackfriars area.

Oh goodness, you've been so unlucky! Hopefully you're on the mend now and still able to do some of the activities you enjoy?


Offline Amy689

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Re: Confused about patellofemoral dysfunction diagnosis
« Reply #7 on: April 14, 2017, 10:32:34 AM »
Hi, just wanted to provide an update in case it ends up being useful for anyone else but I went to get a second opinion because my symptoms weren't going away and it turns out that I actually have a grade 2 posterolateral corner injury that was missed. I guess if it really doesn't feel right, it's always worth getting a second opinion! I'm hoping that I haven't done further damage by not knowing what the problem was because apparently I was supposed to have my knee in a brace for a month, which I obviously didn't! Is there anyone who has had a similar injury that could suggest what sort of time frame it took for it to get better and they were able to go back to sports? Thanks!















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