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

[The_KNEEguru]

Dr Gomoll has published several papers on TT distalisation - eg https://pubmed.ncbi.nlm.nih.gov/30263901/

[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

[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]

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

[andreafiumi]

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

[vickster]

Let us know how you get on

[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]

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]

Well that is not too far away. Let’s hope that gives you some relief.

[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