Tear in medial patellar retinaculum

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SamGreeman13
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Tear in medial patellar retinaculum

Post by SamGreeman13 »

Have been a runner since 2015 (cross country). In 2022 I was working towards a goal of breaking 20 minutes in 5km. I had increased my mileage to about 30 miles a week in December when one day during a run, pain on the inside of my left knee gradually got worse and I had to stop and limp home. Went to urgent care that day, got x-rays, showed no damage. Was diagnosed with patellofemoral pain syndrome. Was given some stretches and exercises to do, along with a knee brace to wear, and I stayed away from activity for a month. Started PT in February 2023 and continued until July 2023 (was going 2 times a week, 1 hour each session). Pain/discomfort slightly improved, and I was told that with a little more daily stretching and continuation of exercises, knee should heal within a couple months. Didn’t end up healing, and I haven’t been running very much since the injury. Maybe once a month at most, never more than 3 miles. For reference, I was capable of doing 10-11 miles in a day before injury. Pain usually occurs about 1 mile into any run and gradually worsens. Other pain triggers are prolonged sitting (such as in a car or plane) or prolonged standing (such as while working). I have been doing the exercises but the pain never improved after PT and even got a little worse due to my job as a cook at a restaurant (I basically stand up for 8 hours straight every shift). Finally in March 2024 I had an MRI which showed a partial tear of the medial patellar retinaculum. Had a follow up MRI with contrast that confirmed the partial tear. On April 22 2024, I received a diagnostic injection in my knee designed to numb the source of the pain/inflammation. I was instructed to go for a run while the numbing was in effect, which I did. I went 3.2 miles, and while the knee did feel weak and heavy, there wasn’t as much pain as normal. Once the numbing wore off, I began to feel discomfort in the usual spot in the knee, and it carried into the morning after. The doctor said before the injection that if I don’t feel any pain while runni by with the injection, then I would either get a cortisone injection or a PRP injection (likely a PRP injection since I’m only 24 years old). If neither of those worked or if my pain wasn’t relieved with the diagnostic injection, then they would do an exploratory surgery.

Wondering if anyone has had a similar injury and what their experience was? It’s been hard for me to see the light at the end of the tunnel especially since there was still some discomfort even with the diagnostic injection.

Other relevant information:
-the doctor who did the MRI said that it’s possible that the initial injury was worse than just a partial tear (potentially a patellar dislocation) but unlikely.
-I also go to the gym 2-4 times a week, and usually work out legs 1 day a month. Not much pain with that. Some instability but not pain like during a run
-in late 2021-early 2022, I went from 175 lbs to 145 lbs (which is what I weigh now, 5ft 10in 145l lbs) due to a change in diet (cutting out junk food/snacks/sugary drinks)
-in October 2022, I changed from harder feeling shoes (Nike Pegasus) to softer feeling shoes (Hoka Clifton)
Injured left knee December 2022 after increasing running mileage (30 miles a week).
The_KNEEguru
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Re: Tear in medial patellar retinaculum

Post by The_KNEEguru »

I would say you are making the right changes - weight, shoes, reduction of exercise. The body needs time to heal. It is right that an MPFL tear may be a leftover from a patellar dislocation that went back in, but it seems that your knee is currently stable....
tammel
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Re: Tear in medial patellar retinaculum

Post by tammel »

I hurt my right knee (and back) about a year ago. Actually almost exactly a year ago.

The injury happened as a result of biking up some very steep hills in a park using a lot of force on the pedals (like an idiot) which was bad enough but then on one hill I changed gears mid-hill which caused a very rapid easy acceleraion with my legs/knees in pedaling and I believe this combo... tremendous force + rapid easy acceleration - extreme opposites, basically injured my whole right side including right knee.

Initially, knee seemed ok.It was more just a realization that what happened couldn't be good. My knee didn't swell, and passive rom was excellent. Not much pain either other than mild ache below patella to the right.. I guess where the lateral meniscus is.

But then a day later, i got an odd pain in my quad. It felt "nervy" as opposed to muscular. I could walk fine. Later, reading about this, people who experienced a femur hairline fracture describe this sensation. I don't know if i actually had that but I mention it.

So then a few days later, I go to bed, still having this sensation somewhat, wake up, and my right quad no longer works. First I thought - mild stroke?

My muscular control of my quad just was gone. I had hurt my knee in past, many years ago, a severe bone bruise (recovered completely) on same knee, and my quad had rapidly wasted with this injury. But this was different. This time my quad was like wholesale have a nice day I'm out of here.

So, like when I suffered the right knee bone bruise years ago, this began having knock on effects on my hip, lower back and other knee. My lumbar spine has a congenital isssue called istmic spondlyloisthesis, which is basically a broken L5 vertabrae that slips forward slightly toward the nerve roots. It usually doesn't bother me if I don't bother it, but it really didn't like my quads behavior and it started generating nerve pain, which is nasty since there is no good position. In short, I was a mess. It was very hard to walk around or get comfortable and this greatly affected my mood.

I tried rehabbing it all on my own at first but it just got worse. So finally, months later, i visited a knee doctor/surgeon thinking that i may have a lateral meniscus bucket handle tear. I thought this because even though passive rom was ok, active rom was terrible, especially extension. and I felt a kind of blocking sensation towards lateral meniscus. I think i was also catastrophizing a little since this is a condition that often requires an arthroscopy to either excise or repair the errant piece of meniscus and I would never be cleared by cardiology to do it since they want me to do cardiac stents first and I'm not on board for this. So I would be stuck in a hard place. PT or bust.

So I finally saw a knee surgeon, did xray etc and he thought based on physical examination and testing that my right knee was fine. No meniscus tear (and definitely no bucket handle tear) with good passive rom. He did think I was kind bent in posture with flexed knees. He thought my back could have nerve compression going on knocking out the right quad and referred me to see back surgeon.

So I saw a back surgeon and did lumbar spine xray and we did some older xray comparisons of lumbar spine (I had old ones on my phone) and he said there was no progression of L5 slip and, testing my muscles, he though my back was mostly ok, I was just having a kind of flareup. He thought my right knee was kind of bent, and mentioned contracture (which frightened me) but when he checked my passive extension, he thought it looked much better and i have some guarding going on, and he thought maybe there could be a knee injury. He, like the knee doctor, gave me a pt script.

I begain working extra hard on extension, to avoid contracture, even though passive extension looked good. I believe this aggravated my back condition.

So i saw a good PT, and we combined both knee and back physical therapy, and she also thought my right knee was good and my back was generating the main problems. I thought the knee injury caused the back to go wacky.. basically the reverse. So the PT did help my back a little (a lot of hands on) but my quad was still strange. She suggested i do a right knee MRI to put my mind at rest since I still felt there was meniscal involvment. She ended up leaving the practice and a replacement PT was a little more aggressive and I wasn't liking it - a back doc told me a long time ago if I'm not feeling happy with a pt with my back issue, quit PT. So I did.

So I was a little better (back-wise) after this but not by much. Still difficult to walk around and my body was just totally off. So 2 months later, I saw knee doctor again and he rexamined me, and he still felt knee was mostly ok. He wrote me a script for right knee MRi so we could rule it out.

I had to wait a bit (a couple of months) to do the MRI because I wanted the MRI done in an extremity scanner and there are not many of these machines around. I couldn't lay down flat because of my back issue so I wanted this machine, which I used before when I had the bone bruise. This way they could also do a comparison.

With this machine, basically you just sit in a chair and stick your leg in. I could even wear glasses (with metal screws) and its not a problem. Also i have a cardiac stent and it was not a problem (in general it isn't).

Meanwhile over the past few months post-PT my back and leg and knee were continuting to improve and I became more hopeful.

So I saw knee doc again for MRI review after and initially he read my old one (from a severe bone bruise from 7 years ago) without realizing and he was alarmed. But then we figured it was the old one (lol) and he read my current one.

So the MRI showed partial tear of the medial patella retinaculum, prepatellar bursitis with some minor edema, some apparently relatively minor chondromalacia on lateral and medial patella, and patellar tendinopathy. My patella looked fine otherwise. Knee doctor thought these were relatively minor injuries, with mostly rest being the answer. He thought I may be walking too much and doing too much stairs (120 + flights a week). So he gave me a script for PT to have on hand if i wanted to do it but he thought especially for the partial tear that rest (not too much activity) is the answer.

Interestingly, a small osteochondral lesion seen on old MRI with bone bruise was now gone.

So now my knee and back are still improving and I am much better than i was. No back or knee pain and my quad is much better. I'm trying to take it easy and look at it as a month to month thing. Every month there is a little improvement. I think probably within 3 months or so I will hopefully be good. Knee doc said if not better in 3 months we could do a cortisone shot but at this point I don't think that will be necessay. As an aside, I have decided not to bike again, since I feel it is too easy to get injured with it, from falls or getting doored or like how I did, being too aggressive. I have also decided to not be so aggressive with activities (lol).

Sorry for my long story, Just wanted to share my experience. The whole thing really shook me to my core. I'm grateful to be doing better. I didn't think it would be possible at times.

I think what the Knee Guru said is correct. You have to let the injury heal and it takes time. Sometimes it can take a long time. This is something i learned with the bone bruise in the past.. which took more than a year to heal, and mainly because I believe I re-hurt it by doing things that were not letting it heal. I would say be careful with aggressive activities. Maybe avoid running or jumping or things that put a lot of pressure on the knee until it is much better imo.

But in any case I hope you and everyone heals from their injuries.
Last edited by tammel on Fri Apr 26, 2024 12:28 pm, edited 9 times in total.
SamGreeman13
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Re: Tear in medial patellar retinaculum

Post by SamGreeman13 »

Thanks for the advice; I have my PRP injection scheduled for Monday. Obviously I’m pretty nervous, and really hoping all goes well. Just really hoping that I can finally recover
Injured left knee December 2022 after increasing running mileage (30 miles a week).
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