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Author Topic: Gross divot on side of kneecap - knee pain 8 years post 2 knee surgeries  (Read 344 times)

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Offline ebee

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35 year old female, horrible chronic, deep pain directly under my knee cap since having my first knee arthroscopy 8 years ago for fat pad impingement. I deeply regret having had this surgery. My knee never recovered from that surgery, six months later I had a second arthroscopy where a lateral release was performed. This didnít help in the least, and Iíve had horrible chronic knee pain that has extremely limited what I can do since. Iím very active and exercise 6 days a week, and simply endure the pain but itís miserable. Iíve tried every form of PT out there to no avail. Iím considering seeing a knee surgeon again to see if I have any options. I noticed today that to the right of my kneecap is a large divot/sunken in area that doesnít exist on my good side...does anyone know what would cause this and is it cause for concern?

Pic: https://imgur.com/gallery/NgzGuPv

Thanks in advance for the help and advice.

Offline Vickster

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  • Neelie knee!
That certainly looks like something a highly specialist knee surgeon should look at. How long has it been like that? Has a specialist looked at it before? Or a PT?
In the meantime maybe dial back the exercise if it causes pain?
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 ebee

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That certainly looks like something a highly specialist knee surgeon should look at. How long has it been like that? Has a specialist looked at it before? Or a PT?
In the meantime maybe dial back the exercise if it causes pain?

I'm actually not sure how long it's looked this badly. But the pain has been ongoing since the original fat pad surgery, and there's really nothing I can do to lessen the pain. It hurts if I'm sedentary, it hurts if I exercise (though certain exercises definitely make it worse and I avoid those as best I can). It hurts all day, every day. Ugh. 

Offline Bagelsk333

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Hello!
I am so sorry for all of your pain. I have had similar issues and have done extensive research to try and figure out what was wrong with me. I had double isolated lateral release surgeries and have been on crutches ever since. The first day post-op my left knee started coming out towards the inside of my leg. It never fully dislocated but would slip to that side. Nothing like that has ever happened to either knee before. My right knee was also worse after surgery just not as bad. Both sides ended up developing a divot (not nearly as severe yet as yours but I have had it for 5 months). I was diagnosed to have Medial Patella Subluxation (a rare complication that can happen from LR and often is a result of being over released). It can be disabling which it was for me. I ended up having to get a Fulkerson TTO, microfracture and they had do an extensive repair on my Vastus Lateralis Tendon on my left. Once that heals, we will look to address the other side. Now to the part that I think can help you. I am no doctor but I have spend countless hours researching my situation and I believe you have something similar. I believe maybe your surgeon also over released you during your lateral release. I have no idea but it seems similar to this article I have read. My laymanís understanding is that if the surgeon cuts past the lateral retinaculum (the part they are supposed to release), they can severe the tendons that attach your quad to the kneecap. If this happens and it is severe and left untreated, major atrophy of the quad separating from the kneecap can happen. If yours has been that way for 8 years, it could explain why it is so deep. I will try to attach a picture of mine (very beginning stages) as well as the article. I believe this will explain a lot of your troubles if you look into it. I hope this is of some help to you. I wish you the best!

Here is a case study that reminded me of your picture:

https://onlinelibrary.wiley.com/doi/pdf/10.1002/0470011165.oth20

Here is an excerpt from one of the articles you might find helpful:

QUADRICEPS INSUFFICIENCY
Quadriceps insufficiency or weakness can occur as a result of excessive release of the vastus lateralis.  This can be a serious complication, as the patients often feel that the leg is worse off than before the
release. They may present with complaints of persistent weakness, which may manifest as buckling or giving way, and anterior knee pain. On examination, they may display a defect in the vastus lateralis extending proximal to the patella or curving around the superior pole of the patella toward the midline. Hughston and Deese^^ have reported on findings of atrophy and retraction of the vastus lateralis
muscle on examination. It was suggested by Marumoto et al^^ that the real cause of the poor quadriceps function may have
been a ďsurgically defuctionalized vastus lateralis muscle.Ē

Hope that helps. Definitely go see a doctor. Take care!

Offline Brandon123

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Bagelsk333,

I just wanted to say that you have done some excellent research on what could be the issue (from my own layman's understanding) for both yourself and ebee. Cred to you :)

Several PF specialists consider LR to be a problematic procedure, and nowadays prefer lateral lengthening as a better alternative.

https://www.sciencedirect.com/science/article/abs/pii/S1060187215000350

https://www.sciencedirect.com/science/article/abs/pii/S0749806311012667


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671865/
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline SuspectDevice

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My God, there are some terrible stories on here.

It just reinforces my opinion that knee surgery is a highly suspect procedure and should be avoided at all cost, esp. for chronic/overuse conditions where it seems to have a very bad track record.  I think it is a better option for sudden acute injury, but in other cases, all non-surgical options should clearly be exhausted with great patience before becoming an orthopedic surgeons guinea pig.

Bagelsk333, that is great work, you may have IDed the issue in the OP.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline Bagelsk333

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SuspectDevice and Brandon123 - thank you! Hoping Eber also sees the post and that my relentless quest for answers for myself helps someone else. I found out last week that it looks like I am not done yet and am needing more surgery &#128546;. Praying everyone on here has better luck than me in hitting the bullseye the first round. Take care!















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