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Author Topic: patella baja and PT  (Read 2614 times)

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Offline LP

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patella baja and PT
« on: April 25, 2004, 06:54:47 AM »
Has anyone had success with a physical therapy program for patella baja?  If not, and surgery had to happen, what kind of results has anyone had with surgery (what kind?) to correct the baja problem.   It is two years post op and baja problem was identified by OS but no options offered for fix and now being told it is too late to fix so just continue with aggressive PT program.    Would sure like to beat the odds and gain more strength in that knee to do stairs (down) again.  Any ideas, encouragement, welcome!

Offline Heather M.

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Re: patella baja and PT
« Reply #1 on: April 25, 2004, 09:51:30 AM »
LP,

You will find a ton of information about patella baja and the various surgeries/PT routines that people have been through to treat it in another section.  Soft tissue healing problems.  That's because patella baja is almost always caused by out of control production of scar tissue following trauma or surgery to the knee.  I know that's how I got it.

Anyway, definitely read through the posts there done by people dealing with arthrofibrosis, frozen knee, scar tissue, and patella baja.

As for your options, I'm afraid that there's not a lot of good news on the topic if you have had the patella baja for more than 6-12 months.  That's because the patellar tendon tends to shrink, contract, and in general lose it's suppleness and elasticity.  This creates a pull from below and furthers the whole patella baja situation.  

It's a very difficult condition to treat.  In fact, it's probably one of the worst orthopedic complications you can have--dandy, eh?  That being said, there are things to be done that can improve the situation.  Good PT is essential, as if it is done improperly then you are going to grind up your patellar cartilage and cause lots of pain and swelling.  This in turn will inhibit the quad muscles due to the body's response to pain, which can worse the baja as noted above.  I've had some relief from taping the knee in a U-shape from below.  There are several knee braces out there that can provide inferior pressure to push the kneecap up and unload it.  Read through some posts to get an idea of what can be done in terms of exercise and PT.

As I said before, the very best thing you can do is to see an orthopedic surgeon who has a LOT of experience with patella baja.  Did you hear back from Dr. Steadman's office yet?  You may want to see the PT's who work out of the hospital at Vail and get some ideas from them.

To answer your question, there are several of us who have had surgery for the condition--but so far we are all still a work in progress....the problem seems to be the patellar tendon length.  If surgery is done to lengthen it or graft on donor tendon, the same type of traum, swelling, scarring and contracture can happen all over again.  So the risk is ending up exactly where you started off.  Dr. Steadman strongly recommended against tendon lengthening procedures in my case, due to my history with swelling, scarring, and infection.  The other option is the change the knee mechanics to compensate for the tendon's shorter length.  It has not been a resounding success so far, though only a couple of people have had it done.  All are still struggling.

I wish there was a magic bullet and I could say 'do this exercise and you'll be fine,' but that's just not the case with this condition.  It's tough, stubborn, and very painful.  So far mine has resisted every effort to address it, though I have certainly improved in terms of function and ROM.

Heather
« Last Edit: April 25, 2004, 10:00:04 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ~*Heather*~

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Re: patella baja and PT
« Reply #2 on: April 25, 2004, 02:47:59 PM »
Heather M is right on her post in every aspect. I first came to this board (by her reccomendation) asking about patella baja about a year ago.

I ended up with it from a complete quad tendon rupture going undiagnosed for 4 months. When I finally DID have the surgery to correct it (8/03), the tendon was very scarred and instead of trimming it to locate healthy tendon, he just did the attachment. Didn't take long for the patella to fall after that, maybe 2 months if that, about 10/02. I'm not sure if the scarred tendon stretched out or if there was not accurate tension in both directions to keep it stabilized...really a thing of the past now since I can't change it.

The OS I had at the time kept telling me it was atrophy causing my patella to be obviously lower than the other one. He said I had to work harder at PT to get the quad strength needed to pull the patella back up. I then moved to another state and listened to this old OS. I did every strengthening exercise that my knee would let me do...nothing helped. I had unfortunately not done my own research at this point.

I finally wanted another opinion as nothing I did on my own helped. I was then diagnosed with patella baja and given a referral to a specialized sports medicine OS at Duke University (I live in NC). Honestly, Heather M. found me on another knee board and said it sounded like patella baja and directed me here. I later looked at this referral and it said PATELLA BAJA. I was like, she's a genius! :)  I was happy just to have a name for it instead of atrophy, but still to naive to understand this would possibly be permanent.

Last Septemeber, I underwent a TTT to change the mechanics of the knee and to compensate for the lacking tendon. During the same surgery I also had a quad tendon reefing to clean up the quad tendon repair. The scarred tendon was removed and then healthy tendon reattached with anchors in my patella rather than suture knots at the patellar pole as the first OS had done.

I chose the TTT because my OS thought since my first experience with tendon surgery (the quad) did not heal properly he didn't want to bother trying to get the patella tendon healed after using a cadaver graft.

The road has been difficult. I am still having a lot of problems and I'm freaked out that the patella is lowering again. I'm getting the atrophy speech all over again, so I'm going back to the OS who orignially diagnosed it to see what his opinion is and I'll go from there.

I will tell you since the TTT surgery, I do have less pain. My knee doesn't catch every step and it doesn't feel as though it locks anymore. My kneecap now pops in and out of the groove and that's painful. My turbercle must be severely calloused or something becuase I can't even touch it! I think my screws need to come out too. The shin pain is getting bad. SO I have a lot of issues still.

I still can't go down stairs, but I can go up. I actually kind of jogged the other day. I did a shuffle like jog with a severe limp. I only lasted a few steps each time. My quad was ripped up and knee was bruised the next day. I was given the okay to TRY it, but I don't think it's something I can continue.

Patella baja is life altering. As Heather mentioned, time is your enemy. The longer is goes undiagnosed....the harder it is to fix. My patella tendon is less than an inch long now. My quad is very weak and my knee buckles occassionally.

I am also going to start pain management and possibly another round of PT. I am almost 8-9 months post op and still hurting, but better.

I don't mean to be such a negative story for you, I'm just trying to let you know that sometimes surgery is offered, but the chance of patella baja returning is always a risk. I wouldn't have changed my course of treatment as of yet. No regrets.....if it returns, at least I had a few months pain relief : )

My thinking sure has changed since I first found this board! Good luck to you and let us know how things go. We all benefit from the stories/histories of each other and our OS's when it comes to this nasty condition.

Janet is the only other one I can think of offhand that also has patella baja. I believe she ended up with it after a quad tendon rupture as well. There are no surgical options for her so she can really help with the exercise part. She had a very trying PT schedule, but to my knowledge she got her strength up. I admire her for that! If she doesn't see this post, you can PM her and ask, she's always so helpful.

Probably should make this clearer....I had the quad tendon repair 8/02 onset of patella baja around 10/02. I was diagnosed with patella baja around 5/03. After all the nonsense of referrals, scheduling, and the surgery scheduling....I had the TTT surgery 9/03. So all in all, I was diagnosed and surgically treated within a year's time.    

Hugs,
Heather B.
« Last Edit: April 25, 2004, 02:59:45 PM by Heather »
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Janet

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Re: patella baja and PT
« Reply #3 on: April 28, 2004, 03:55:18 AM »
LP:

You have gotten so much good information from the "two Heathers." (We have an ongoing joke here about how many Heathers there are.) You should definitely look at the Soft Tissue section. You will learn so much, and that can only help you ask the right questions and get the best care possible.

Yes, I also have patella baja. There is no "cure," and I have been told that there is no surgery that can help (at least in my case).  It occurred sometime following a quad tendon rupture. I'm not exactly sure when. But I had my first surgery for scar tissue 6 months post-op, and nothing was mentioned about the patella baja then. My guess is that it happened sometime after that surgery. All I know is that I went from a ROM of 70 to 115 after the scar tissue surgery, then was back to 90 ROM six months later. My OS kept saying there wasn't anything wrong (but didn't take x-rays or order any other tests).

I finally changed to a knee specialist who immediately diagnosed the patella baja and scar tissue. I eventually had another surgery with her and had some improvement, but I was still pretty debilitated, having only about 50% functional ability and lots of pain. That OS gave up, and workers comp made me go to a physical medicine doctor who basically told me it was all in my head. (Sorry this is so long....but it's a long story and I'm condensing it as much as possible.)

I eventually ended up with the arthrofibrosis specialist I am with now (on my own, WC gave up on me). He agreed that there really isn't anything that can be done for the patella baja. There aren't good options, and he feels that anything he does would be a "huge, messy" surgery, and it wouldn't be that much help. But we did do another scar tissue surgery last year, and I have had some good improvement since then. We are now looking at other non-surgical options to help with the pain.

There is so much more that can be said. Read through the soft tissue section below (give yourself a few days or weeks to do it....there is so much info there you won't be able to take it all in at once). Then ask some more questions and we'll try to help you along. Good luck. Don't give up hope! It is really important to find an OS who specializes in arthrofibrosis. This is very rare and most doctors don't know how to recognize it, let alone treat it.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline missmyknee

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Re: patella baja and PT
« Reply #4 on: April 28, 2004, 06:28:26 AM »
Hi LP


I think Heather B and I are the only ones who have had surgery to correct the patella baja. I don't think either one of us regrets having the surgery. I did 6 mos of PT before surgery was done to strengthen the quad muscle and VMO. They were atrophied from 4 surgeries to repair leg fractures which had caused the baja. But it didn't improve the mechanics and didn't decrease any pain. It was intolerable to walk around any further without the surgery. I am much better after it, but still am battling problems with scar tissue and the permenent damage done to the backside of the patella from the baja. I'm glad I had the surgery. My doctor was the only one in my city that did this type of surgery.

It's always good to do PT for several months before considering surgery.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline LP

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Re: patella baja and PT
« Reply #5 on: April 28, 2004, 07:00:15 PM »
Pam, Janet, Heather, Heather:
Thanks for your replies.  I will read everything on this website - a time-consuming chore! but I will get thru it!  The information is invaluable.  As are your replies.  Thank you all.  We are waiting for an appointment with Dr. Steadman in Colorado at one of his clinics there.  I did not know there was such a doctor as an  arthrofibrosis (scar tissue??) specialist but would appreciate names, especially in Colorado.  Is Dr. Steadman a specialist in scar tissue?  Thanks for the name of utah dr. - any others?   Scar tissue obviously the cause of problem and post op care has been poor and frustrating.   ACL surgery with 1/3 cut patella graft - wishing now it had been cadaver graft - tendon has scar tissue at donor site and atrophy.   PT programs are still intensive after 2 years.  Current PT  making miniscule progress.  Next up - going to two PT's who worked with athletes.   Still can't go downstairs or walk uneven ground.  Knee buckles fast and it's hit the dirt - anywhere, anytime, embarassing, dangerous, painful.  Health care plan long ago maxed out for knee.   Please keep us in mind and prayers.  We're struggling with this so badly and trying to find work in new field, too.  Thank you.

Offline Janet

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Re: patella baja and PT
« Reply #6 on: May 02, 2004, 04:09:07 AM »
Dr. Steadman is one of the best. You are definitely going in the right direction if you have an appointment with him.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.