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Author Topic: Suggestions for next steps (knee pain, grinding, maltracking, high TT-TG)  (Read 102 times)

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Offline alex12

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I'm 35 years old, male, in the UK, and had right knee pain for the past 8 months, that makes it difficult to walk, bend down, climb stairs etc. The pain seemed to start out of the blue but was most likely due to a significant increase in physical activity (lots of manual work in the garden).

I initially saw a physio who informed me I have tight hamstrings and my kneecap was pulling to the outside, so suggested I do various stretching and strengthening exercises. I've tried a few times to keep up with these but they always increase the pain so I stop.

I then paid for a private MRI which reported the following:
- Minor distal quadriceps tendon signal change around the insertion
- Small medial plica
- Lateral patellar tilt
- Minor lateral patellar subluxation
- Very subtle trace of high signal along the most superolateral aspect of the fat pad
- TT-TG measurement 2.2cm

The MRI report got forwarded to my GP, who informed me it's maltracking and there is no surgery for this, I just need physio to correct it.

For a couple of weeks last month I started to do a short walk most days (0.5 - 1 mile), with the hope I could build up to walking longer distances, but I think this caused a big flare up of pain.

I can now feel a grinding/rubbing through my knee cap, most noticeable when placing my hand on it, but I can also feel it by just moving my leg slowly in any direction. The MRI 4 months ago didn't report any cartilage damage, but I'm guessing this could be the start of it?

This prompted me to review the MRI report and look into the TT-TG measurement, which appears to be abnormal. It seems >15mm on an MRI is an indication for surgery and mine is 22mm. I have no history of dislocations though.

When it was just pain, I was willing to be patient and take my time trying to get over this. But now I have the grinding and have looked up what the TT-TG measurement means I'm very concerned it may be a more serious maltracking problem, and that I may be damaging the cartilage.

So I'm not sure what to do next now?

Should I see a physio again to see if there are different exercises I can try?

Or should I see an orthopedic consultant first to explain my MRI results to me?

Any advice would be greatly appreciated

Offline vickster

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  • Neelie knee!
If you’re in London, there’s a physio who specialises in patella issues, might be worth a consult location, time, funds permitting. She’s part of a larger team that includes surgeons too (Wimbledon).
She’ll be able to explain the MRI

This is her website
https://clairepatella.com/
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline alex12

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I had considered Claire based on your previous recommendations, but feel that it's a bit too far to travel at the moment (I'm in the West Midlands). Maybe I'll consider the trip further down the line if required.

Unfortunately I haven't managed to find a similar specialist like Claire closer to the Midlands.

Offline vickster

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You could maybe drop her a message and see if she can suggest someone closer? I’m not aware of any other patella specialist physios. You could see another locally, if there are any patella focused surgeons, could see which physios work alongside them? (There’s a patella specialist list https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery, there’s a Pete Thompson in Coventry)

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-peter-thompson?action

That said, Birmingham or similar to Wimbledon isn’t too bad a train journey :) (I don’t think she consults anywhere else eg central London)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone















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