Please help a newbie!

[funkymunky]

Hi People,

I am sorry if this is an obvious common problem but please help! The basics of my problem is that I dislocated my knee about 15 years ago. Ever since has problems with subluxing and grating on the knee. My tracking is not right and have been through physio.

I had an mri & arthroscopy ad he concluded...

1. Cartilage was wearing badly behind the kneecap & was grating
2. The 'trochular' groove did not seem deep enough
3. My kneecap seemed larger than most!
4. The meniscus area was fine.

He suggested I try another lateral release first. The other option was a year long rehab and this is what he told me. Please excuse the laymans terms but does this sound familliar to anyone:

1. Take some tissue from my leg & grow a membrane.
2. Take my kneecap off, drill lots of minute holes in it and cover with the membrane to allow blood to flow through the holes and stimulate cartilage growth.

then....

3. Reshape my kneecap and 'dig' out my trochular groove so it is deeper.
4. Take some more ligaments from leg and then wrap the knee in to make it 'solid'

Does this sound liek anything anybody has heard of?

Many thanks,
Nick

[fawn2388]

LATERAL RELEASE.

DON'T DO IT. You ARE NOT the reasoning behind the lateral release. GO to an other surgeon This surgeon is suggesting too completely hiprocratically to each other. Go to an other surgeon. NOW. i wouldn't trust this surgeon. NEVER ever get a surgeon on one opinon. And one that is suggestion two radically (and hiprocratically and meant for opposite reasons)

[brianne]

To help interpret what has been suggested to you.

1. This sounds like an ACI or other type of cartiledge implant procedure. I do not know too much about this, but there are plenty of people who have had this procedure.
2. This sounds like a mirco fracture. This is supposed to increase blood flow to the region and help to stimulate tissue growth.
3. This would be a trocheoplasty. This is a specialist procedure and from what I have been told the results are mixed. MAKE SURE you have a specialist if you are even thinking about this procedure.
4. This sounds like it might be an MPFL recon. This is to repair the structures that have been damaged as a result of previous dislocations. Again this is a specialist procedure.

If your OS is suggesting a Lateral Release that tells me that your OS does not have enough experience to deal with your issues. PLEASE PLEASE PLEASE see a Patella Femoral Specialist. This makes a world of difference and can be the difference between a permanately damaged knee and a successful recovery. If you are located in the US I can recommend several PF specialists.

Good luck with everything.

[hugo]

I have shallow patella, but I don't know to what extent I have trochlear dysplasia. I also have grade 3/4 chondromalacia. I'm seeing a new OS that hopefully will get to the bottom of my tracking problems.

To make a long story short, I had an LR+medial plica last year. It provided some pain relief compared to my other virgin knee, but apparently my patella is still subluxating and both my knees have become more unstable and weak. I think it's because my first OS neglected my knee's structural problems. He recently told that nothing can be done about dysplasia, which is not true.

My new OS thinks the dysplasia should be dealt with and he wants me to do another round of CT scans to look at it. It's only been my second consultation with this new doc and what I like about him is he is honest in saying that until he knows what the real problems are and thinks it over he won't operate...

To be honest to me the thought of messing with one's structure of the knee to correct dysplasia is a bit daunting, I have no idea of the success rate of these type of procedures and possible complications that could arise. So these procedures should probably be reserved for the best specialist doctors.

My advice to you is if your OS wants to do an LR he should at the very least inform you that since you have shallow throchlea he will not be able to predict the results and an isolated LR may not be what will fix your knee. I don't know if doing LRs while ignoring structural problems is such a bright idea.

It's really tricky and we and even some doctors don't have all the answers.


As far as physical therapy goes, you should stick with it. Strong balanced muscles help stabilize your knee to some extent, but since you have some structural problems and cartillage wear I don't really know if by itself it will resolve your issues. But not doing anything to keep your muscles strong is a no no. The trick is building strength while not aggravating your knees.

BTW how long have you been in PT? Is it helping?

[lis1]

Nick

The drilling is microfractures. They have a varied success and i am one who it did not work for, but there are plenty of people who it did work for.

The other is ACI - similar to OATS and MOSAICPLASTY all of which have stringent and long rehabs. Am having OATS myself in 6 weeks.

As for the lateral release - why does he want to do that, it doesn't seem consistent with what is going on with your knee and i would question his reasoning behind that, although he could have very good reasons for doing it.

If he wants to address the tracking through the LR then think about it carefully and get expert advice on whether this is the right thing to aid your knee.

Lisa