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Author Topic: PFPS knees (bilateral)  (Read 109 times)

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Offline Lucy1979

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PFPS knees (bilateral)
« on: August 05, 2022, 02:48:12 AM »
Hello. Just wanting some advice. I've had bad PFPS for the last 2 years. Prior to that I did get anterior knee pain but was able to do lots of sports at a high level. Looking back now, I should have stopped but I was very functional and performing well.
The knee pain got to the stage where walking was difficult/standing for any length of time/stairs etc.
I could feel a flap on the right knee and after waiting a 18months and doing physiotherapy decided to have an arthroscopy last Apri. They shaved a small chondral flap and noted a fissure, the rest of the knee was fine. After the surgery, the recovery was terrible. I needed crutches for 6 weeks and nearly 4 months later the knee is worse and I have a subtle limp. The right leg muscles have severe atrophy and I am doing quad sets/straight leg raises/ electrical stimulation to try and gain this back. Functionally I can do very little as I am overall much weaker. I am doing very short walks on the flat and physiotherapy. A surgeon I saw yesterday said that PFJR were not good for this condition as the pain generator is often the soft tissues and also most then need a TKR. He said a TKR had about a 30% chance of working. This then leaves the question: what is possible? I also have malalignment- bow legs right greater than left. He did mention a possibility of a femoral derotation osteotomy- he wasn't particularly keen and neither am I. I feel personally that all my problems are in the PFJ. The soft tissues feel fine.
This is an amazing site with a wealth of information and I just thought I would reach out to this community for any insights/comments/suggestions. I feel pretty desperate about my situation honestly.

Offline Dave33

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Re: PFPS knees (bilateral)
« Reply #1 on: August 05, 2022, 03:22:55 AM »
I'm sorry you're having such a bad time with it. PF pain is incredibly frustrating.

Bit of a strange comment from the surgeon -  if there's chondral damage isolated to the PF compartment, I don't see what a full replacement would do to alleviate pain that a PFJR wouldn't. You'd be resurfacing healthy compartments for no reason. But hey, I'm no expert, maybe there's some logic there I'm missing.

Tough call regarding next steps. If it was me, I'd probably try to get more opinions from experienced orthopedic surgeons and see if there's any consensus in treatment.

all the best

Offline Lucy1979

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Re: PFPS knees (bilateral)
« Reply #2 on: August 05, 2022, 08:38:29 PM »
Thanks for the advice. I feel like I can't actually cope with how I am. The chondroplasty ended up being a bad decision but I don't see how it would help anyway now as the joint surface is not fixed. I am struggling with activities of daily living and have had to stop working. I am in Canada.
I think all the injections don't have any evidence base.
Do you know a good surgeon in Canada who I can get advice re PFJR? I've been looking through posts and I see some have good results. I am in the same camp as many as an ex avid athlete.
I'm getting frustrated with physiotherapy advice. I have the mindset and will do whatever asked of me but everytime I do physiotherapy, I seem to either make things worse/no change. I'm using electrical stimulation to the quads and am considering blood flow restriction therapy- I'm not sure it's going to make any difference. I find building the quads to be impossible with this condition.

Offline Robert Lloyd

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Re: PFPS knees (bilateral)
« Reply #3 on: August 05, 2022, 11:59:46 PM »
I could feel a flap on the right knee and after waiting a 18months and doing physiotherapy decided to have an arthroscopy last Apri. They shaved a small chondral flap and noted a fissure, the rest of the knee was fine.
Did doctor discuss MACI, Novocart, Denovo, Biocartilage, etc?

Quote
After the surgery, the recovery was terrible. I needed crutches for 6 weeks and nearly 4 months later the knee is worse and I have a subtle limp.
I had the same experience with a minor chondral debridement at the Steadman clinic in Vail, Colorado.

Offline Lucy1979

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Re: PFPS knees (bilateral)
« Reply #4 on: August 06, 2022, 01:48:34 AM »
No discussion re the procedures you mentioned. I can look into them. I get the impression they are not very successful in the PFJ.
Did you eventually get some strength back in the knee after your chondroplasty at Vail?

Offline Robert Lloyd

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Re: PFPS knees (bilateral)
« Reply #5 on: August 06, 2022, 05:54:48 AM »
No discussion re the procedures you mentioned. I can look into them. I get the impression they are not very successful in the PFJ.
Sometimes they are highly successful.

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Did you eventually get some strength back in the knee after your chondroplasty at Vail?
Seemed like two years, but yes.  I will be forever bitter about my experience with Dr. Steadman.

I don't understand why Steadman just did a chondroplasty on me when there were cartilage growth options available.

Greg Oden, a number one draft pick in the NBA went to Dr. Steadman for a microfracture and I feel that ruined his career.  There were ortho-biologic options available for Oden, but he chose Dr. Steadman unfortunately.

Hopefully, Greg Oden will be the last NBA player who had a microfracture.
https://www.sportingnews.com/us/nba/news/greg-oden-miami-heat-portland-trailblazers-microfracture-surgery-nba-amare-stoudemire-penny-hardaway/q8kigrtngvn1pp3m8bgvdv2q

Offline Lucy1979

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Re: PFPS knees (bilateral)
« Reply #6 on: August 06, 2022, 06:42:05 AM »
Interesting article. I didn't have microfracture, just minimal chondroplasty that has weakened my joint considerably and wasted the leg muscles. It's heartening to hear you did recover. I would never recommend anyone has a chondroplasty.
The OATS may be something for me to consider. It just seems that in the harsh environment of the PFJ, the success is not great (less than the TFJ). If anything, I feel like I would ask for a PFJR.
This site is a wealth of information.

Offline Robert Lloyd

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Re: PFPS knees (bilateral)
« Reply #7 on: August 06, 2022, 07:06:36 AM »
MACI has some amazing outcomes even in PFJ.

Surgeons are often careless and aggressive and that turns a simple chondroplasty into a recovery nightmare.

If any surgeon offers me a chondroplasty again, I'll ask why we aren't trying to regrow cartilage as well.

Offline Robert Lloyd

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Re: PFPS knees (bilateral)
« Reply #8 on: Today at 12:57:12 AM »
Lucy,

What part of Canada are in you in?
I'll see if I can come up with some recommendations.

I often wish I had obtained a physical therapy license.  I've had so many orthopedic surgeries that I feel no one is a better qualified PT than a patient who has lived through the recovery process.

Offline WaveyDave

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Re: PFPS knees (bilateral)
« Reply #9 on: Today at 09:56:47 AM »
Hi Lucy. Sorry to hear about your knee problems. Youíre certainly not alone, so common, and youíre in the right place! I agree with Dave that the comments made by this surgeon seem strange.

Modern PFJ replacements (done by doctors with good specific experience of this) nowadays seem to be much better and longer lasting than in previous years. TKR (especially custom made and again depending on expertise) have a good track record too and overall success rate of at least 80-90% I think, so not sure where this 30% is coming from.

If you havenít yet seen the PF work by Dr Scott Dye, take a look too. You can access his research papers free online and there are vids on YT. Guru members have found his research helpful (myself included).

PF issues are a drag and can take a lots of patience and time to resolve but I hope improvements come soon for you!

Offline Lucy1979

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Re: PFPS knees (bilateral)
« Reply #10 on: Today at 03:29:42 PM »
Thank you for the replies. I have been feeling desperate recently.
I am in Vancouver but would travel anywhere.
I have so many emotions about seeing surgeons and physiotherapists. They seem to think that the patient isn't trying hard enough with PT which could not be further from the truth.
When I said I had arthrogenic muscle inhibition due to anterior knee pain- they did not seem to get how difficult it is to build quads. One PT also wanted me to do weighted knee extensions. I said that the shear forces on the PFJ would be big and I thought a leg press was a better option and he said he knew what he was doing and to trust him. I didn't and I'm not sure the understanding is there.
I have read Dr Dyes papers and it makes a lot of sense to me, along with Richard Bedard/Paul Ingraham. I struggle with the envelope of function concept in my case though as I have discomfort with any movement. I am doing joint strengthening with a vertical incline plane/high rep low load movements.
Mentally, I've been floored by all this. I feel that even surgeons don't really understand the PFJ. They want to see bone on bone and major defects before doing anything. I feel that my whole joint surface is soft and not transmitting load. Definitely I have to persist with PT, especially as I am so weak after the surgery, but I would like some hope for surgeries.....















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