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Author Topic: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?  (Read 485 times)

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Offline jackituriello

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Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« on: February 12, 2020, 03:52:19 PM »
hi all! im new here but i have some questions that apparently canít be answered by my doctor, so i figured some of you that have experienced something similar could help me.

little backstory: i have been in chronic pain for ~5 years and starting a year ago, i was finally able to do something about it. i was diagnosed with patella alta and pfps in the right knee. they said it could be an alignment issue so i got referred to a podiatrist and got flat foot surgery and everything was fine until i went back to all my usual activities and going back to work.

honestly, didnít really like the first orthopedic to begin with but liked this doctors office so i got a second opinion from a different orthopedic at the office. basically, he told me the same things as the last ortho and it seemed like he explained it better, but also seemed like a ďgo awayĒ diagnosis because something still didnít add up to me. he just told me basically to quit my job (im a ski instructor but the season is almost over anyway) bc i was causing myself more pain on purpose so it was my own fault and ďdo some more physical therapy and itíll strengthen your muscles and push your patella back down and the pain will go away.Ē i did a month of PT, for my knee specifically, before the original foot surgery and it seemed to have made it worse, but right now he said itís gonna be 3/4 months of PT but wants to see me back in a month.

so when I went down to the PT office 30 minutes later, my therapist was telling me that my bones themselves didnít look aligned. when i flexed my ankle, it flexed out to the side, i had knocked knees, and when i stand my knees touch but my feet are a few inches apart. i had noticed that before I was knock kneed and brought up to the dr that maybe it was a malalignment (spelling? lol) issue and he brushed it off like nothing. but what the PT is saying makes sense.

Iíve already been in pain for so long and PT doesnt seem like itís been helping me. should i find another doctor to go to that isnít going to throw some random diagnoses at me and call it a day with some PT, like at a different dr office? should i stick with the PT and see if it helps, has anyone else had this experience? or has anyone else done the PT to push the kneecap back down and it worked/didnít work?

 i hate to think im doctor shopping but itís so tiring when a doctor seems like they donít believe your pain and give you a crap excuse for treatment. Iíve been in this for too long, i just wanna live pain free.

EDIT: the xray they looked at the second time around was from March of last year, they didnít take new ones, and I never had an MRI done or anything so they didnít do much testing except poking and pinching my knee, also it doesnít dislocate or anything (which Iíve seen in other threads) and obviously Iím not begging for surgery or anything but I was just thinking maybe thereís a misdiagnosis here? or something else that could help other than JUST PT

any help or input would be appreciated!
« Last Edit: February 12, 2020, 03:56:35 PM by jackituriello »

Offline Vickster

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #1 on: February 12, 2020, 06:02:55 PM »
Why haven't you had an MRI just to confirm that there's nothing structural amiss with the inside of the joint?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
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RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
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Offline jackituriello

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #2 on: February 12, 2020, 06:45:17 PM »
Why haven't you had an MRI just to confirm that there's nothing structural amiss with the inside of the joint?



they havenít offered the option, because they seem to think nothing is wrong. well, other than my kneecap being too high. it just seemed like a ďgo awayĒ diagnosis to me.

Offline Vickster

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #3 on: February 12, 2020, 06:53:13 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?
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 jackituriello

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #4 on: February 12, 2020, 08:07:12 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?


im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Offline Userhere123

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #5 on: February 13, 2020, 04:15:54 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?


im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Hi,
I am also diagnosed with the same issue. i didnt injure anywhere. It started with knee burning pain and swelling above the right knee. I have this burning pain for past 6 months. Going to PT for past 3 and a half months. No improvement.
I had an mri too.  did you find something other than PT which helps this issue?

Offline jackituriello

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #6 on: February 13, 2020, 09:59:40 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?






im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Hi,
I am also diagnosed with the same issue. i didnt injure anywhere. It started with knee burning pain and swelling above the right knee. I have this burning pain for past 6 months. Going to PT for past 3 and a half months. No improvement.
I had an mri too.  did you find something other than PT which helps this issue?


no, sadly, i have not. PT is the only option they have given me. mine doesnít necessarily feel like itís burning, but definitely like a deep aching pain and sometimes swelling right underneath my kneecap. did anything show up on your MRI? i thought about requesting one when i go back for the follow up and probably going for a second opinion somewhere else if they still are no help to me.

Offline Userhere123

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #7 on: February 14, 2020, 04:00:07 AM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?






im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Hi,
I am also diagnosed with the same issue. i didnt injure anywhere. It started with knee burning pain and swelling above the right knee. I have this burning pain for past 6 months. Going to PT for past 3 and a half months. No improvement.
I had an mri too.  did you find something other than PT which helps this issue?


no, sadly, i have not. PT is the only option they have given me. mine doesnít necessarily feel like itís burning, but definitely like a deep aching pain and sometimes swelling right underneath my kneecap. did anything show up on your MRI? i thought about requesting one when i go back for the follow up and probably going for a second opinion somewhere else if they still are no help to me.
Yeah. I had 2 MRI. MRI shows that patella alta and PFPS. I don't know what could resolve this issue? I am having the same burning pain for past 6 months. Going to PT too. That doesn't help at all. Are you going to PT? I think I have to change my pt. Going to PT for past 3 and a half months. Nothing helps. Only waste of time and money. Don't know what else to try to get better.

Offline jackituriello

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #8 on: February 14, 2020, 12:32:25 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?






im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Hi,
I am also diagnosed with the same issue. i didnt injure anywhere. It started with knee burning pain and swelling above the right knee. I have this burning pain for past 6 months. Going to PT for past 3 and a half months. No improvement.
I had an mri too.  did you find something other than PT which helps this issue?


no, sadly, i have not. PT is the only option they have given me. mine doesnít necessarily feel like itís burning, but definitely like a deep aching pain and sometimes swelling right underneath my kneecap. did anything show up on your MRI? i thought about requesting one when i go back for the follow up and probably going for a second opinion somewhere else if they still are no help to me.
Yeah. I had 2 MRI. MRI shows that patella alta and PFPS. I don't know what could resolve this issue? I am having the same burning pain for past 6 months. Going to PT too. That doesn't help at all. Are you going to PT? I think I have to change my pt. Going to PT for past 3 and a half months. Nothing helps. Only waste of time and money. Don't know what else to try to get better.


yeah, i am. i did it for a month last time and it seemed to make it worse. i just started up this next round and he wants me to do it for 3-4 months. he scheduled a follow up for a month so I guess weíll see how that goes but i donít think itíll help based on last time, and by what everyone else was saying. when i go back should i request an MRI? or should I get another second opinion at a different doctors office? finish the 3 months of PT? im at a loss on what i should do.

Offline Vickster

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #9 on: February 14, 2020, 12:34:47 PM »
There's a list of PF specialists here, Scott Dye is recognised for his interest in PFPS (San Francisco, may be able to talk by phone)
https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

There's lots of other useful info around various knee issues in the learning portfolio
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 Userhere123

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #10 on: February 14, 2020, 01:29:52 PM »
There's a list of PF specialists here, Scott Dye is recognised for his interest in PFPS (San Francisco, may be able to talk by phone)
https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

There's lots of other useful info around various knee issues in the learning portfolio
Where is the learning portfolio?
I am new to the forum. I couldn't find it.

Offline Userhere123

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #11 on: February 14, 2020, 01:33:12 PM »
I'd get another opinion from a patellofemoral specialist and request an MRI too. What country are you in? Whereabouts?
Have they done full leg X-rays and also checked your hips at the same time to assess for any alignment issues?






im from the US, Pennsylvania specifically. sadly, I tried looking up any advanced orthopedic specialists and there arenít any close so Iíd have to travel to the next state over in New Jersey. the closest PF specialist is in NY 1.5hrs away. theyíve only done xrays on my ankle and knee, and MRI on my ankle but nothing else. should i request an MRI when I have my 1 month follow up or should i find another specialist/advanced specialist and request one there?

 thank you for your help by the way! itís been very frustrating trying to figure this out when no one around me has experienced this kind of chronic pain and the doctors seem stubborn.

Hi,
I am also diagnosed with the same issue. i didnt injure anywhere. It started with knee burning pain and swelling above the right knee. I have this burning pain for past 6 months. Going to PT for past 3 and a half months. No improvement.
I had an mri too.  did you find something other than PT which helps this issue?


no, sadly, i have not. PT is the only option they have given me. mine doesnít necessarily feel like itís burning, but definitely like a deep aching pain and sometimes swelling right underneath my kneecap. did anything show up on your MRI? i thought about requesting one when i go back for the follow up and probably going for a second opinion somewhere else if they still are no help to me.
Yeah. I had 2 MRI. MRI shows that patella alta and PFPS. I don't know what could resolve this issue? I am having the same burning pain for past 6 months. Going to PT too. That doesn't help at all. Are you going to PT? I think I have to change my pt. Going to PT for past 3 and a half months. Nothing helps. Only waste of time and money. Don't know what else to try to get better.


yeah, i am. i did it for a month last time and it seemed to make it worse. i just started up this next round and he wants me to do it for 3-4 months. he scheduled a follow up for a month so I guess weíll see how that goes but i donít think itíll help based on last time, and by what everyone else was saying. when i go back should i request an MRI? or should I get another second opinion at a different doctors office? finish the 3 months of PT? im at a loss on what i should do.
Which doctor did you go to? Ortho?
I went to an Ortho and had 2 MRIs. Then started PT. After 2 months of PT, no improvement and pt suggested to go for second opinion. Then saw a sports medicine doctor. He told me to continue PT.  So, doing PT for past 3 and a half months. Nothing helped. Don't know how to move it further to get better.
I thought this forum will be of some help. But this doesn't . No reply for my posts too.
If you find any solution that's working for you, please let us all know. It might help everyone who is having this issue.

Offline Vickster

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #12 on: February 14, 2020, 01:47:18 PM »
That link is from there
https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio
Linked at top of screen below site logo
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 Vickster

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #13 on: February 14, 2020, 01:53:01 PM »
Userhere123
Look for posts by a member called Suspectdevice through the search function. Heís been on a very long (years) PFPS journey and has posted about his experience, rehabilitation and advice.
A book called Saving My Knees by Richard Bedard has also proved useful to PFPS patients.
Thereís also info around PFS in the patella primer in the learning portfolio

Youíve mentioned a issue with the trochlear ridge showed on tour MRI. Have you discussed the implications with a specialist? It might be impacting the way your knee tracks in the trochlea and causing problems to the structures. Also the impact of the long patellar tendon and high position of the kneecap?
« Last Edit: February 14, 2020, 02:01:39 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 Userhere123

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Re: Patella Alta/Patella-Femoral Pain Syndrome; second opinion?
« Reply #14 on: February 15, 2020, 03:46:13 PM »
Userhere123
Look for posts by a member called Suspectdevice through the search function. Heís been on a very long (years) PFPS journey and has posted about his experience, rehabilitation and advice.
A book called Saving My Knees by Richard Bedard has also proved useful to PFPS patients.
Thereís also info around PFS in the patella primer in the learning portfolio

Youíve mentioned a issue with the trochlear ridge showed on tour MRI. Have you discussed the implications with a specialist? It might be impacting the way your knee tracks in the trochlea and causing problems to the structures. Also the impact of the long patellar tendon and high position of the kneecap?
I have been to 2 doctors and no one had talked about that to me. They said i have patella subluxation and alta. And prescribed me PT. So going to PT..I don't know the trochlear ridge position causing the issues. Pt is also not sure what's happening. They treating me for PFPS and alta. I don't know if my alta is congentinal. Don't know how to proceed with. Been to 2 ortho specialist.