left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Mal-tracking, lateral release, medial reefing, tibial tuberosity transfer, patellar arthritis, patellectomy, plica, patello-femoral braces. For patellar fractures, see Board on 'Bone Breaks around the knee'.
The_KNEEguru
Administrator
Administrator
Posts: 2477
Joined: Mon Jan 01, 2001 3:01 am
Location: United Kingdom
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by The_KNEEguru »

Dr Gomoll has published several papers on TT distalisation - eg https://pubmed.ncbi.nlm.nih.gov/30263901/
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

TT distalisation, as per my understanding, is an invasive procedure - typically it is done in youngs when patella uses to dislocate lots of time
Reuqires at least if i am not wrong 6 months of stop (3 full stop plus 3 of rehab) like a prosthesis

I have patella alta but ortopedics didn't suggest to me to do this. My patella according to them is not so instable to suggest this
What doctors said to me regarding riding patella is: why now you should have this problem of patella alta if you have lived 52 years with it witout any issues? (effectivly this is true...)
on the other side honestly i didn't have any improvments from all the other terapies they suggest to me (infiltration, steminan cell, debridment...)

If i have the certainty to solve my problems i will try also tt distalization ; noone of the ortopedics indicated to me this (only 1)

Also because i am experiencing pains to both the knees (where for sake of clarity the left one provides to me the majority of pain)
So situation is not clear - the only thing i know is that i feel general instability and pain.

Pain also when i stretch/extend the left leg and put my feet like a hammer (or) when i contract the quadriceps muscles and the leg muscles in general. When i stand on sofa with the leg strech above the , i feel some pain internally on the knee that run till the sopra patellar zone

Diagnosis is still not exact in my case but for sure i am continually try to learn and find a solution that permits to me to restore a little bit
User avatar
vickster
Administrator
Administrator
Posts: 5182
Joined: Fri Jan 01, 2010 11:12 pm
Location: Surrey, UK
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by vickster »

Given your location in Europe, would you be prepared to travel to get a further opinion from Lars Blond who is a patellofemoral specialist in Denmark, might be worth reaching out for a virtual consultation with your history and imaging in the first instance?

https://www.kneeguru.co.uk/KNEEnotes/kn ... lars-blond
https://larsblond.com/
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

why not ?
I 'd ask for a video call if possible. better to try than not to try!

I publish here the image of the effusions of my left knee (blank area). AS you can see these are typical signs of inlammation. Anyone can comment on these (eg what represent, ...) ?

many thanks
andrea
Attachments
knee effusion
knee effusion
Slide1.jpg (150.67 KiB) Viewed 1581 times
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

vickster wrote: Wed Oct 04, 2023 4:48 pm Given your location in Europe, would you be prepared to travel to get a further opinion from Lars Blond who is a patellofemoral specialist in Denmark, might be worth reaching out for a virtual consultation with your history and imaging in the first instance?

https://www.kneeguru.co.uk/KNEEnotes/kn ... lars-blond
https://larsblond.com/
Hallo i just booked an appointment with Doctor Lars Blond for end of this week
Hope this can help
Many thanks for the information regarding doctor Blond
User avatar
vickster
Administrator
Administrator
Posts: 5182
Joined: Fri Jan 01, 2010 11:12 pm
Location: Surrey, UK
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by vickster »

Let us know how you get on :)
The_KNEEguru
Administrator
Administrator
Posts: 2477
Joined: Mon Jan 01, 2001 3:01 am
Location: United Kingdom
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by The_KNEEguru »

I don't feel you have given enough 'slices' of the MRI to offer a good opinion. The bright white is the effusion, as you have pointed out. The one wall of the trochlear groove appears abnormally shallow, and you have mentioned trochlear dysplasia. See /KNEEnotes/knee-dictionary/lateral-troc ... tion-angle
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Some updates
- i had the call with Mr Lars Blond (225 € on-line consultation)

Dear Andrea Fiumi
You do not have patella alta.
Your patellofemoral pain could be secondary to either hyperpressure and a lateral lengthening surgery (not lateral release) might help – depending on clinical examination.
Your knee inflammation could be due to a lateral plica and in that case you might have improvement – eventually just temporary by one, two or up to tree steroid injections.
The patellofemoral surgeon the I mentioned is named Dr. Paolo Ferrua in Milano.

- had also another visit in Florenze to Andrea Baldini

Bilateral gonalgia, more symptomatic on the left. for about two years. worsened in the last year. Previously dislocated patellar , about 10 years ago, on sn. Pain on loading, especially on walking uphill and climbing stairs.
Performed infiltrative therapy with hyaluronic acid and collagen. Last infiltration about a week ago, with little benefits
Previous arthroscopic surgery with bilateral lipogem therapy.
Autonomy for walking about 20 minutes.
EO: Crackling patella ++, with moderately lateralized sliding, anterior pain even with contraction
muscle
, no pain on facet joint palpation.
RX: grade ll/4 KL gonarthrosis bilaterally
MRI: Trochlear dysplasia with patellar chondropathy.
Diagnosis: patellar hyperpressure syndrome
Recommendations:
reinforcement of the vastus medialis oblique, according to the Mc Connel protocol ( see chirurgiarticular.com)
insole with medial vault support bilaterally
for physical activity, short Ottobock knee brace
Super flex 3 Biovea, 1 cp per di for 5 months, then one stop and new cycle
May try, if worsening, application of radiofrequency for geniculate nerves to reduce symptoms


- i have booked a radiofrequency for geniculate nerves to be done on 28 Nov

pain is always present i don't know how to manage....
The_KNEEguru
Administrator
Administrator
Posts: 2477
Joined: Mon Jan 01, 2001 3:01 am
Location: United Kingdom
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by The_KNEEguru »

Well that is not too far away. Let’s hope that gives you some relief.
Elce
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 28
Joined: Sat Jan 15, 2022 5:55 pm
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by Elce »

Hi Everyone,

I hope you find this research interesting.

'University of Basel delivers first biological implants for treatment of cartilage lesions and osteoarthritis in humans.The N-TEC current trials will focus only on patellafemeral OA, rather than full knee OA'.

They use nasal cartlidge cells not from the knee to repair knee cartlidge damage so only one operation is needed.

This is the link for the article: /www.eurekalert.org/news-releases/1008012
bacalamuntoni
MICROgeek (<20 posts)
MICROgeek (<20 posts)
Posts: 11
Joined: Fri Feb 03, 2023 9:40 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by bacalamuntoni »

Andrea go see Dr Vicente Sanchis-Alfonso in Spain he's one of the best patella surgeons in the world
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Hello

some updates
- I did on 28th November 23 in Pisa radiofrequency for geniculate nerves for left knee: ZERO benefits today
- I tried to contact Alfonso Vicente asking for a call but Valencia hospital said to me doctor doesn't manage visit remotly, so the only way is to fly to Valencia
- Following Andrea Baldini's* suggestions, i started 1 month ago to tale superflex-6 (strong integrator from USA, containing glucosamine, condrotine, msm,...) - he said to take it 5 months 1 capsule/die than stop 1 month than restart. At the moment no result also with this

pain is always present, some days lower intensity while others greater pain. Left knee (the one had patella dislocation) is suffering more than right but basically
- biking is something che exacerbates the pain in the following days so i stopped
- strong exercise same as above (like running) so i stopped
- pain in the quadricipites close to the knee anb the inner part of the left knee (retinaculum)

could someone explain to me these:
- why i suffer pain also on the left knee when do free-swimming even with stationary legs supported by the pullbuoi? it is really strange
- is anyone on this forum experienced the same sensations as me
- why i always feel popping and snaps when extend the legs?

(*) very known italian ortopedic super speiclaized in knee implants
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Now i also request a visit to David Dejour in Lyon . He is one of the most expert of patella in the world
I have pain also in the medial part of the knee - Pain in the Goosefoot tendon area, i don't know probably this is due to the patella doesn't work properly
The_KNEEguru
Administrator
Administrator
Posts: 2477
Joined: Mon Jan 01, 2001 3:01 am
Location: United Kingdom
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by The_KNEEguru »

@andreafiumi, I know you have the history of patella alta and patellar dislocation, but during any of the investigations you have undergone have any of the doctors you have consulted mentioned the possibility of a medial plica aggravating or causing your current symptoms? /KNEEnotes/knee-dictionary/mediopatellar-plica

You may be able to examine yourself for a medial plica (see History and Physical halfway down this page https://www.ncbi.nlm.nih.gov/books/NBK535362/.

Plicae may become symptomatic secondary to other damage inside the joint.
andreafiumi
MINIgeek (20-50 posts)
MINIgeek (20-50 posts)
Posts: 22
Joined: Thu Mar 02, 2023 11:15 am
Contact:

Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Dear The_KNEEguru,

Based on Lars Blond examination i don't have patella alta (let's say higher than normal).
I had only i time in my life a patella dislocation (left knee) 10 years ago then never happened anymore
During arthroscopy done in February 2023 on both knees to do debridement and insert mesenchymal cells (which gave no rusult) no plica was seen

I have these problems on left knee
- trochlea slightly dysplastic
- patella slightly unstable
- grade II patella chondromacia
- patella external hyperpressure

I used to have always continuous pain on the left knee:
- inside the knee
- in the area of the knee called the goose foot
- above the knee in the patellar tendon and quadriceps area

I typically don't have pain when discending stairs or downhill walking while i fee pain when running or walk strenuously uphill
I feel discomfort when walking
When biking i don't feel pain but after 1-2 days of biking my knees become inflamed and I feel a lot of pain and discomfort
Cracking and popping in the knee zone every time i stretch the leg put my feet like hammers

Dear The_KNEEguru i can upload the RX and additional MRI but basically the above points are i summary the situation
I tried exercises also but with limited benefits honestly

What do you think?
Post Reply

Return to “The patello-femoral joint”

Who is online

Users browsing this forum: No registered users and 1 guest