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Author Topic: Loose bone between patella and trochlear groove  (Read 996 times)

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Offline mabr2015

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Loose bone between patella and trochlear groove
« on: April 06, 2017, 03:40:48 PM »
Hi, I'm new here. I am a 19 year old female athlete.

I have been having problems with my right knee for a little over a year now. Almost constantly (walking, climbing stairs, just standing..) something in my knee area moves around to where I know it's not where it's supposed to be. Sometimes, if I move the exact wrong way at the exact wrong time, it will move so it cannot get back in place. It will stay that way for anywhere from a few hours to several days. It is very, very painful and my knee becomes very swollen and warm. I have always assumed it was a subluxation when it moves and I can get it back in place if I straighten my leg and tense my muscles, and a dislocation when it kind of gets stuck for a while.

In mid-February I had a particularly bad one of these to where I could not bend my knee at all without shooting pain, and I was basically stuck in bed for a week. While it was still dislocated, I went to see a doctor who took x-rays and confirmed my patella was dislocated. He then referred me to an orthopedic surgeon, who took additional x-rays and an MRI. This doctor then told me my trochlear groove is very shallow, my patella rides high, and my MPFL is very stretched out. I did physical therapy for 4 weeks with no improvement and additional dislocations, so when I came back he said I was going to need to have surgery. Ironically, he had to take time off for his own knee problems, so he had to transfer me to a new doctor.

This doctor is significantly younger, and she requested new x-rays at my appointment. She agreed with the fact that my trochlear groove is shallow and that my patella rides high, but she doesn't think my patella is dislocating. In the x-rays she took, she found a rather large loose body between my patella and my trochlear groove. Because cartilage cannot be seen in an x-ray, I am assuming this is bone. She seems to think that this might be the only thing causing my knee problems, but I don't understand how that makes sense.

The loose body found is pretty large, and it was not present in my previous x-rays or in my MRI. Obviously it doesn't belong there, so something had to have happened to put it there, right? I talked to another doctor (not an orthopedic surgeon) about it, and the only thing that makes sense to both of us is that bone chipped during one of the "dislocations" between my MRI and my last x-ray. Is that reasonable?

I'm having surgery to remove the loose body and for her to fully exam the anatomy of my knee on April 12th. I'm sorry, I know this is long, but I am just so worried and confused. I really want to fix this problem at the root and be done with it. I don't want to be back in the doctors office 6 months or a year later having the same problem - I want to take care of it now and be done with it. Especially now that I've hit my medical insurance deductible and I'm going to be off school for the summer.

Please let me know what you think and I would really appreciate any advice on how to handle this. Thanks so much!

Offline sbugs

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Re: Loose bone between patella and trochlear groove
« Reply #1 on: April 22, 2017, 08:13:39 AM »
Hey,

about two years ago I was in the same situation as you - although they only saw a piece of cartilage floating around in my knee on MRI. I decided to let it remove (two doctors said I should because it would damage my joint - one said I could wait and try PT). I think with bone the destruction might be even more - so it seems reasonable to take it out. Did your doctor say where the piece of bone is missing? On a patella facet or the femur? This could be a hint on whether you were dislocating or not. Did your MRI reveal any cartilage damage?
I am now in the miserable situation that I think what I have mistaken for subluxations might as well have been the cartilage behind my patella (patella painfully jumping from the side into the groove again, with then gives the feeling that the position is now 'right'). because I still have this feeling after my mpfl reconstruction - and it's much worse than before. I used to be a very sportive person too (esp. mountain climbing) and now I can barely walk stairs. of course my case might be bad luck and I'm also not a doctor but looking backwards I would not even have removed the piece of cartilage (they didn't find it at surgery and then said: the joint might have broken it down already during the lockings). this is different with bone - I think it could really damage (still - not a doctor - but from what I have read). so let an experienced knee surgeon (one who specializes at patellofemoral problems; I really think the joyce of the right surgeon is a key issue!!!) take it out - talk about not removing any (stable) cartilage before surgery. many studies show that debridement does not necessarily improve things - and with me they tore and thermally burned down lots of healthy cartilage  >:(. the doctor can assess your instability and trochlear groove during the arthroscopy. I would really try to do lots and lots of therapy (> 6 months!!) before and see if subluxations improve (although if you have trochlear dysplasia (please google and compare the pictures with your xrays/MRI) another surgical intervention (like trochleoplasty and/or mpfl reconstruction) might be necessary. don't loose hope - once the painful locking is over you will hopefully be able to do your exercises and gain strength again.

Good luck - Stef
born 1987
since 2000 bilat patellofemoral issues, pain/swelling
very sportive: seemed to improve
03/2015 LK:  MRI revealed loose body 7mm
06/2015 LK: arthroscopy to remove loose body -> chondropathy gr II-III; feeling of instability
10/2016 LK: MPFL recon: pain, mechanical issues since then