Question about Patella Baja

[stgiles16]

I have an appointment on June 1st to see OS. I am concerned that I may have patella baja. You guys have been very helpful so far with information but I have a couple more questions for you.

1. Would patella baja make it very painful to tighten quads ( i mean that behind my kneecap hurts alot when I tighten my quad and use e-stim)?

2. Would patella baja also make it painful to do SLR and short leg extintions (cant do either because of terrible pain )?

3. Would patella baja make going up stairs very painful ( behind the kneecap pain)?

4.What are the chances ( I ask hopefully) that these symptoms are simply because my quads are not what they should be?

5. Does patella baja make you knee give way? mine does it at least 2-3 times a day (it is not painful but is embarassing)

Thanks for all of your help
Missy

[Heather_M.]

Missy,

The answer to all of your questions, I'm afraid, is yes. The scar tissue problem is very complex because every patient exhibits slightly different symptoms based on exactly where their scar tissue is located, but there are some general similarities in most cases.

Unfortunately, a lot of other things can explain each of the issues you describe, so that's why it's important to have a really good doctor to help you wade through the diagnostic process and not get sidetracked by red herrings. As you indicate in question 4, quad weakness can also cause some very similar symptoms. It can get very confusing.

A good way to help narrow down possibilities is patellar taping or bracing. If the kneecap is too low, pushing the kneecap upward and holding it in the correct position with tape should provide pretty immediate relief. Once you are properly taped, it should be possible to do the straight leg raises, quad sets, even step ups/downs without the constant, grinding pain. Then you can build the quad enough to *hopefully* pull the kneecap back up into the proper position permanently. See, there are several things that can lead to patella baja: extreme quad atrophy, ruptured quad tendon, patellar tendon tear, and scar tissue below the knee which traps the patella. So if atrophy is the problem, building the quad in the painfree range should help resolve the issues you're having. It's important not to work through the pain if you suspect patella baja, because that can actually cause worsening of the problem and complete quad shutdown.

Another way to narrow down the possibilities is to have a PT test your patellar mobility--if it is very good, then there may be other culprits. If the kneecap is glued down, scar tissue is the most obvious diagnosis.

As for the knee giving way, that does happen with patella baja--due to quad weakness and stress or the body's natural guarding response. That's because if you do actually have patella baja, there is constant strain and pressure being put on the quad tendon and quad muscles themselves due to altered mechanics. So the quad has to work way harder, trying to get the kneecap to move up and down in a normal way when the kneecap is abnormally trapped. My first PT said it was kind of like trying to move your car with the parking brake on--you're trying to accelerate, but the brake is making it tough to move forward so the revs shoot way up to make a very small amount of progress.

Good luck with your appointment. Be sure to write a list of questions and don't be blown off with "it's probably just quad weakness," or something. You may very well have weak quads, but that doesn't happen in a vaccuum. Something (pain and bad mechanics?) is keeping you from buiding your quads, so you have to get to the heart of that. It would probably be helpful to find a great PT who knows how to tape the knee to test and see if it helps you build the quads better (do this before you get to the OS so you can have some results or lack of them to bolster your argument). Not all PT's know how to tape the knee from below (inferiorly). I've had 5 PT's tape my knee, and only one could do it right. When done incorrectly (or with the crappy tape that doesn't have a lot of give and has to have a second layer of skin protection tape underneath) the taping can make the pain worse! I've found Kinesio tape to be the very best--it's extremely flexible and skin friendly, and so you don't need that white tape underneath to protect the skin. The tape most PT's use (which is really two layers of different types of tape) was WAY too stiff and actually increased my pain. The Kinesio tape is expensive and tough to learn how to use--it only sticks once, so you have to apply it correctly the first time and can't touch the adhesive with your fingers. But when done correctly, the taping cut my pain in half and allowed me to do my exercises without sharp pain. This is what really underscored to my doctor that I had a serious patella baja problem.....

Heather

[ken4971]

Really good info./ explanation Heather. On my July MRI it showed my patella tendon is short relative to the patella. I do have quad wasting, and am working on strength back with PT. My meniscus surgery was in Jan. How concerned should i be. I see my OS at end of month.

[missmyknee]

Hi Ken

Unfortunately, Heather has not posted since 2006.

I had patella baja and infrapatellar contracture syndrome from surgery to place an IM nail down my tibia. Here is my blog post about this:

http://www.kneeguru.co.uk/KNEEnotes/node/260

Here is a recent post about patella baja symptoms :

http://www.kneeguru.co.uk/KNEEtalk/inde ... ic=59260.0

Here is an interesting article discussing patella baja from an MRI :

http://www.radsource.us/clinic/1008

Yes, you should be concerned. Depending on how short your tendon is and how low the patella , this can result in damage to the contact areas of patella cartilage. As more time goes by, the soft tissues and tendon will continue to contract and changes to the tendon will become permanent. Strengthening the quad can help bring the patella back up if caught early. A free moving patella in all directions is key.

If scarring continues and changes to the tendon and patella become permanent , then a salvage procedure is all that's left. This is in the form of a special tibial tubercle transfer called a DeLee osteotomy or a patella tendon lengthening. I am the only one on this website who had a DeLee osteotomy done. Another poster named skibum9/ Sharon had the patella tendon lengthening. We both went on to have a TKR from the damaged patella cartilage.

Early recognition and treatment is key . Go to the arthrofibrosis section in the information hub and read everything over and over , so you can become proactive in the care and decisions you make regarding the treatment of your knee.

Pam

[ken4971]

OK ,Thanks Pam. I'm concerned how this is all going to work out. All this from a medial menisectomy in Jan.2012. And, the July MRI not only showed Patella tendon changes it Linear,intermediate to High signal, showing possible residual medial meniscal tear, that can be sorted out with an MR arthrogram.
So much reading. I'm just worried that my OS is going to say everything is ok, and see you.

Ken

[ken4971]

i guess the dr. will tell me lenght of patella tendon, and how low the patella is?

Ken, which i guess can be calculated from an mri. or do i need x-rays to compare to the good knee.

[missmyknee]

Hi Ken

Yes , xrays would be in adjunct to the MRI. Lateral views of both knees are needed to measure patellar height comparing your bad knee to the good knee. Review these links:

http://radiopaedia.org/articles/patella-baja

http://radiopaedia.org/articles/insall-salvati_ratio

http://radiopaedia.org/articles/blackburne-peel-ratio

You might have developed scar tissue from your surgery. How mobile is your patella? Can you move it freely back and forth in each direction? You might have scar tissue pulling your patella down. This kind of scarring is called arthrofibrosis. Read thru Dr Noyes tutorial on arthrofibrosis, it is excellent

http://www.kneeguru.co.uk/KNEEnotes/node/633

If your doctor hasn't got a clue, then you need another opinion. In cases of arthrofibrosis and patella baja , it is in your knee's best interest to see a doctor well versed in these 2 problems. Here is a list of doctors who are specialists in arthrofibrosis.

http://www.kneeguru.co.uk/KNEEnotes/node/427

Hopefully all this info will help you formulate a list if questions and knowledge, when you have your next appt.

Pam