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Knee & Hip Problems Message Board


Knee & Hip Problems Board Index


Hi All,

I am hoping someone can give me some clarity on what is going on with my right knee. About two months ago I got up from a sitting position, moved a little, pivoted on my right foot and felt/heard something pop in my knee. I had just had carpel tunnel surgery a day or two before so I was already taking anti-inflamitories and icing my hand, so I iced my knee as well at that time. After two months there has not really been any improvement. I am not in a lot of pain but my knee feels pretty unstable and I seem to have intermittent swelling. I went to my Dr. who then referred me to an orthopedic specialist. I saw him on Monday, April 22. He took my history and did some manipulation and found that I had a positive Lachman test which is apparently an indicator that the ACL is torn. I had an MRI that Tuesday and heard from the Dr. on Thursday. Here is what the MRI report says:


Patellofemoral joint alignment remarkable for lateral patellar tilt. Grade 2 chondromalacia patellar apex and medial patellar facet evident. Similar changes noted along the central trochlear cartilage without fissuring or erosion.

Moderate-sized effusion evident without loose body.

Prepatellar soft tissue swelling evident.

Chondral surface of the medial femoral condyle demonstrates grade 3 chondromalacia and chondral delamination along weighbearing surface.

Conclusion:

1. Intermediate-grade patellofemoral chondromalacia with suprapatellar effusion and no evidence of loose body.
2. Evidence of patellofemoral maltracking.
3. Prepatellar soft tissue swelling.
4. No evidence of meniscal tear or cruciate injury.


The Dr. seems surprised by the results because he thought I had a torn ACL. He explained that my patella is not tracking properly and that the cartilage on the back side of my patella is worn, as is a spot on the femur where the kneecap contacts it (I think I have that right). I understand all of the terms used in the report but I am unclear on what it all means together. It took me a minute to get with the conversation after he said the problem wasn’t the ACL. He recommended multiple things such as exploratory arthroscopy, a lateral release, and/or a medial patellofemoral ligament reconstruction. He also talked a little about physical therapy and that it could help, but it certainly wouldn’t hurt. Yesterday (April 29) I had my first PT appointment and the PT is convinced she can ‘fix’ the maltracking problem with therapy and a brace. And of course the Dr. wants to fix it with surgery. I know there are more problems than just the maltracking but I am not clear as to what those are and if realigning the patella through PT is the only thing that needs to happen. Like I said, my biggest problem is instability. I can walk a straight line just fine but when I turn my knee feels unstable and like it is going to give out. The earliest I could have surgery is June 21, so I will try PT in the meantime and probably have the Dr. do at least the exploratory surgery. Does anyone else have any relevant information/suggestions/experience that they are willing to share with me? Anything would be much appreciated.
ozfan79, thanks for the info. That helps a lot. The PT made lateral release sound like something horrible and to be avoided at all costs. It made me feel like something would be wrong with me if PT didn't work. I am not afraid of surgery - I have had multiple surgeries on various parts of my body and they have all been successful, but maybe it's a problem that I don't think surgery is that big of a deal. I just don't want to be impaired when there is something that can be done to fix it. I am glad to hear that yours was successful.
Lateral release is the least invasive surgical option that can fix maltracking issues. My physical therapist didn't think this type of surgery would be successful for me because I have cerebral palsy. The therapist said my muscle spasms would probably pull the kneecaps out of place after the surgery. I am 5 years post op and my kneecaps are both dead center in their grooves. My orthopedic surgeon is extremely pleased. Please keep me updated on your situation.





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