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

Post by andreafiumi »

Hi bacalamuntoni what is your problem w/ the knees? what the doctors said?

Dear The_KNEEguru --> have you shown the images to someone who can interpret them? If you want to email me at [email protected]. Let me know

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

Post by The_KNEEguru »

I regret the surgeon I mailed did not add anything you did not know.
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

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

Post by andreafiumi »

Is someone in this forum can easily explain why moderate cartilage degradation (grade II) can bring to me to suffer in this way (mean every day from 2 years)?
I honestly don't understand guys...
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by vickster »

Did you read the posts from SuspectDevice about loss of tissue homeostasis and chronic inflammation.
Unfortunately, there’s not always a clear correlation between decree of cartilage wear and pain.
Do you get relief from medication or cryotherapy (icing) plus complete rest (other than light ADLs?)
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Dear Vickster,

thanks for the post

some food for thought and evidence:
A) I stopped to bike ca. 1 year ago - the sport i do are swimming with the pullbuoi (to avoid potential stress on the knees) and do some walks
B) I used to do daily streching and strengthening exercises, i take superflex 6 pills (Chondroitin sulfate, Glucosamine HCI, Metlisulfonylmethane)
C) i used to do every 6 months acid ialuronic injections or similar
D) Take ice and put voltaren 2% creme every 2 days
E) I do office base job

I read many articles of the theory you mentioned (tissue homeostasis ).. very interesting but
1) I don't understand if the theory of tissue homeostasis and chronic inflammation can be applied since i don't do anything of exercise (apart some walks)
2) the theory is interersitng but it remain a description of potetntial causes without (it seems to me reaing the contents) any scientific evidences of what chronic inflammation means in term of chemical elements and what tissue omeostasis means in term of sceintific elements - this theory nowdays it seems to me (surfing on the web across the sceintific literature) remained same as 15 years ago no other scientists started from this to evolve it

at the end i think we are at low knowledge in science (despite all the efforts), not understood well the mechanism at the basis of pain.
For example my father has a grade IV hip arthists without pain (bone over bone) , incredible !

I only experience a lot of noise and pain in my knees, pain that also extends to my thigh and quadriceps, lately also in the goose foot and hip area.

any comments, suggestions, idea?
thanks
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by SuspectDevice »

andreafiumi wrote: Sun Feb 18, 2024 7:54 pm Dear Vickster,

thanks for the post

some food for thought and evidence:
A) I stopped to bike ca. 1 year ago - the sport i do are swimming with the pullbuoi (to avoid potential stress on the knees) and do some walks
B) I used to do daily streching and strengthening exercises, i take superflex 6 pills (Chondroitin sulfate, Glucosamine HCI, Metlisulfonylmethane)
C) i used to do every 6 months acid ialuronic injections or similar
D) Take ice and put voltaren 2% creme every 2 days
E) I do office base job

I read many articles of the theory you mentioned (tissue homeostasis ).. very interesting but
1) I don't understand if the theory of tissue homeostasis and chronic inflammation can be applied since i don't do anything of exercise (apart some walks)
2) the theory is interersitng but it remain a description of potetntial causes without (it seems to me reaing the contents) any scientific evidences of what chronic inflammation means in term of chemical elements and what tissue omeostasis means in term of sceintific elements - this theory nowdays it seems to me (surfing on the web across the sceintific literature) remained same as 15 years ago no other scientists started from this to evolve it

at the end i think we are at low knowledge in science (despite all the efforts), not understood well the mechanism at the basis of pain.
For example my father has a grade IV hip arthists without pain (bone over bone) , incredible !

I only experience a lot of noise and pain in my knees, pain that also extends to my thigh and quadriceps, lately also in the goose foot and hip area.

any comments, suggestions, idea?
thanks
My understanding is that loss of tissue homeostasis is a biochemical issue brought on by a physical issue (cartilage damage, too much stress on the joint etc.). Basically you get an overload of inflammatory 'chemicals' in the joint (e.g. cytokines) which keep things chronically inflamed, even with very minor activity.
My knees also had quite moderate physical damage (one meniscus repair, on left knee low to moderate patella chondromalacia on both knees) but the symptoms were horrendous, way beyond what the damage should normally produce in terms of pain & symptoms, especially the constant burning and hot kneecaps. This was the chronic inflammation talking.
I tried many of the things you did, but only 5-6mths on Celebrex combined with careful trial and error of exercise/activity fixed me. Strangely, some quite 'heavy' gym stuff (deadlifts, sissy squats 2-3x/week, 3x10 reps, up to 40kg) were ok, but cycling, running, crouching, kicking with swimming were terrible.
Once the Celebrex started to deal with the pain/burning/heat, I was able to slowly ramp things up in the gym & start kicking again in the pool. Then I added cycling. BTW if you can afford an E-bike, that is a great way to come back to cycling. Running was the last thing I could handle and took years to get some back. Also, on the bike avoid grinding big gears when you start back. Keep a gear where you can easily maintain a cadence of 90-100.

Edit to say, you are right, this type of pain is not understood well. My orthopedic surgeon admitted that. And yet the Dr Scott Dye tissue homeostasis theory has been around for 20yrs and the profession does not seem to embrace it? I'm 100% sure his theory was my problem and his treatment regime fixed it.
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Thanks so much for your post SuspectDevice

It is important for me to be not alone in this journey...

Some additional elements
- i went to Lyon 3 days ago to visit Doctor David Dejour that is the most important european knee surgeon and specialist of patella-femoral cases
- he basically visited me and...

Recognized i have crepitus on patella when blend the leg --> he said it is not worrying at all
Touch me on meniscus , patella --> no pain
Saw the MRI (i posted them on the forum) --> he recognized some small defects but nothing for which some surgery was necessary
I explained to him all the symptoms, what i already did , the medicine i took etc. etc...
The fact that both ialuronic and lipogems/steminal cells did not bring any benefits strengthened in him the opinion that it is a problem of some type of musculoskeletal imbalance, not well defined
He also saw some effusion from MRI putting low to zero importance...

At the end he prescript of doing
- 3 times a week for 15 minutes on the exercise bike at zero resistance
- 2 times a week 45 minutes of specific strengthening and stretching exercises --> that's about ten exercises, each of which is used to contract the muscle and then stretch it (30 sec and 30 sec)
All for 3 months then according to him an improvement must arrive

I honestly don't believe this is the right direction simply because i used to do stretching for many months (every day) without any important results
So i don't think that following these exercise and some light bikes can be so different from what i already done

The visit convinced me one again that surgeons and doctors are able to handle and manage something that is really visible (e.g. loss of cartilage, recurring patella dislocations,..) but they are basically close to ZERO when trying to solve something more comnplicated and not clear since the images doesn't express and comminucate a problem.
For this reason i am now more depressed than before ... even the most imoprtant doctor in europe doesn't know how to manage my case
This means i am without any possibility to recover from pain / inflammation for the rest of my life
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

here the link to the exercise to be done for patello-femoral pain by david dejour (lyon ortopedic centre)

https://lyon-ortho-clinic.com/media/ima ... tobock.pdf
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by AnonGator »

Hello Andrea,

I also have a constant pain as well in one of my knees so you are not alone in this struggle. However my history is a bit different than yours - I’m in my 30s. I traumatically landed on that knee 4 months ago and have seen some of the top surgeons in the USA and all have diagnosed me with patellofemoral pain syndrome. They say I have a healthy knee and my X-rays and MRIs are clear. The only option for me is PT and NSAIDs which have helped a little bit but not significantly.

I have some more follow ups at end of March and I’m going to push for ultrasound and bone scan to see if there is anything else going on. But after much research I do believe the most likely explanation as to be that I have a loss of homeostasis in my knee, in-line with Scott Dye’s theory. So when i have the opportunity in the next few months im going to experiment with a resting protocol for 2 weeks straight and see if there is any improvement in my knee.

If 3 different ortho’s told me that my knee is structurally sound, and PT has not progressed me in 3 months, then the only non-surgical option left to do is rest.

I’ve read Paul Ingraham’s book on PFPS and it has provided a lot of support for Scott Dye’s research and was the most informative book I’ve read on PFPS.

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

Post by andreafiumi »

Many thanks AnonGator

Few questions:
1. homeostasis Is something that the surgeons you consulted have pointed out/suggested or it is your hypothesis? In my experience of 10 doctors , none spoke about it
2. ultrasound and bone scan --> ultrasound why? If you did MRI ultrasound is really needed? What is bone scan? I don't know this

The theory of homeastis can help to DESCRIBE it but .....what is behind it? Which are the elements causing pain? Is cartilage, legaments, what?
Why happen at certain age and not before?


A little extra
- when i am under stress or i feel some pressure --> the pain around my knees increase a lot. This happen for example when i have a period of high work demand.

What about nerves and muscle involvement to explain knee pain? Could be something to look? I am really exaust of the poor results achieved and the lack of science in knowing how to help me

I need to test something new guys , help .. some suggests/directions to follow?

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

Post by AnonGator »

Andrea,

Check out Scott dye’s writing and videos and let me know your thoughts.

The pain is potentially coming from “Inflamed synovial lining and fat pad tissues, retinacular neuromas, increased intraosseous pressure, and increased osseous metabolic activity of the patella all have been documented as contributing to the perception of anterior knee pain”

Scott dye research: https://journals.lww.com/clinorthop/ful ... _a.16.aspx
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by andreafiumi »

Many thanks!!! I ll check


- when i am under stress or i feel some pressure --> the pain around my knees increase a lot. This happen for example when i have a period of high work demand. --> someone experienced this as well

What about nerves and muscle involvement to explain knee pain? Could be something to look?

Are there specific examinations to do to check the level of inflammation of the knees? ? Excluding MRI are there tests to do to find such agents like citochin,...?
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Re: left knee: patella alta+former dislocation--> incessant pain, also neuropathic

Post by The_KNEEguru »

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

Post by andreafiumi »

I am referring to these:
1) how evaluate the grade of inflammation of the knee? which are for example the blood analysis to do (if exist,),.... --> if we speak about inflammation of the knee i expect that there are clear examinations that demostrate the inflammation right? which are these exams? do you know?

2) are there some mechanisms of muscles that impacts on knee pain? why my knee pain when i stressed increase?

3) is it possible that inflammation, synovial liquid could press over the nerve strusctire of the knee bringing pain sensation?

Someone on the forum is able to respond to these questions?
Many thanks
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