Advice please?

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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Advice please?

Post by journey_never_ending_ »

My daughter is 15 years old. She had knee pain for 4 years now. At first, they passed it down to her Acl which then moved to other ligaments. In June 2016, we were given a proper reason on why she was having knee pain. She has chondromalacia patella in both of her knees : Grade 4 in her left knee and Grade 3 in her right knee. She also has an torn mensucuis. Her left knee is terrible: the doctor has described it as being bone on bone. Her knees crack and pop and grinds all the time. He thinks she has osteoarthritis starting in her knees. She has also have Pt for a year and half to try and manage it. The doctor wants to do an osteotomy on her. Has anyone had this done before? How long will she be off school? How long will it take her to recover?
Brandon123
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Re: Advice please?

Post by Brandon123 »

Sorry to hear about your daughter's struggle, I don't know much about osteotomy but just wondered if they have tried hyaluronic acid injections (e.g. Synvisc, Durolane) as a first line of treatment before surgery?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment
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Re: Advice please?

Post by journey_never_ending_ »

Hi,

They wanted to do injections starting off, but when he looked at the x-rays he said he didn't want to do them as they were bad. My daughter has had a x-ray and an Mri scan. She had the Mri last year. They wanted to do another one in September, but no appointment had come through letting us know. I rang up and found out that they had cancelled it for no reason. Apparently, she doesn't need it now, but they are going to discuss her on September 4th in what they are going to do next. Just trying to get some answers before they give us a date for her.
Brandon123
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Re: Advice please?

Post by Brandon123 »

Ok, I understand. I still think it might be worth trying injections before surgery. It might not help, but there is not much to lose either. But let's see then what they say next week.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment
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SuspectDevice
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Re: Advice please?

Post by SuspectDevice »

I'm just trying to figure out how someone so young has so much damage in her knees?

At that age, I'd be thinking conservative, not something as drastic as bone cutting and re-alignment. The patella chondromalacia can improve with careful management and patience (i.e. not harsh PT!). The defects can fill in. The meniscus tears can also settle with the same careful management and patience. If she does need surgery on those tears, I'd be asking can they be repaired (sewn back together) rather than trimmed (because once they are trimmed, those areas are gone forever more or less).

The conservative approach may be a long road requiring the patience of a Saint, but unless the damage is very bad, and there is quite clear bone mis-alignment, cutting bones in a kid so young concerns me.

Knee cracking/popping/grinding is not a problem unless it cause pain when it happens. I remember having quite bad patella chondro pain around age 12-14 from rugby, but it improved over time. It waxed and waned all my life, but I never opted for surgery. I just figured out how to manage it - what activities to avoid, when to rest it, icing.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races
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Re: Advice please?

Post by journey_never_ending_ »

My daughter has had pt for over 1 and half-trying to manage the condition. Her physio made her do exercises and classes. She is constantly applying ice and heat to her knees and putting Voltrol on her knees. Right now, it has stopped her from doing pe at school- she just can't do it, she can't run because it impact her so much.

The popping hurts her as well. Whenever her left knee pops, her knee locks up and won't let her bend it. She has done stuff in physio to help with this, but even her physio has said it is not getting any better. Currently, her knee has popped and is now locked. She can't bend it and is limping everywhere. Me and her father are both at our wit's end with her. We can't take to a and e because they won't do anything, only tell her to rest it and things like that. Things she has already done. We live in the uk where the healthcare in my eyes takes a long time. In some people it doesn't, but with my daughter it has took a very long time to get where we are now. Knowing that this is her second hospital, we are getting more out of this than we did with the hospital.

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vickster
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Re: Advice please?

Post by vickster »

Where in the UK are you based? Can you get a referral to one of the specialist orthopaedic hospitals where there is perhaps more expertise in children. Alternatively a kneecap specialist like Jonathan Eldridge in Bristol?
Presumably private treatment is not an option which would increase choice and speed things up?
The locked knee sounds like a torn meniscus which will likely need surgery.
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone
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Re: Advice please?

Post by journey_never_ending_ »

She is under Manchester children's hospital.
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