Patella sublexation

[frwbeach]

  Just got back from a docs appt and a bit confused I had several ligament tears at a young age and at 36 had a ACL procedure with the patella tendon- since my first injury ( a patella fracture and ligament tears ) my knee has been prone to collapsing- the docs all these years said it was due to pain and muscle flexing- now last two docs have noted that my Patella has severe arthritis and much smaller ( worn away ) than my other knee. I complain that after exercise the knee swells and hurts terribly- yet they prescripbe exercise to strengthen muscles. In desparation I have read some blogs and it sounds like Patella getting in the joint and locking it and popping it when it collapse and not from  cartaledge pain and muscles going limp .  Both docs say at age 56 they would rather wait till 60 to do rplacement and this doc said knee cap must be replaced and thats not always real succesful in terms of comfort / pain and he would rather wait . I am falling regularly and dont know what to do-  

any ideas  and could this Knee cap be the problem all these years and the docs missing it because I had no acl from an early age and the  joint seemed to be unstable to them??  At a total loss right now .

[setrocr711]

I am a Soldier who had reconstructive ACL surgery (w/patella tendon) back in 1997. Since my repair and rehab, I have run in several marathons 10ks and ten milers. Recently on a short run (in cold temperatures) my knee felt very weak afterward, and I experienced new pain below the knee cap. It also became very swollen.  I took it easy for a couple of days and the swelling subsided, but now I have extreme knifing pain radiating up from my knee through my quadricep muscle when I bend my knee while sitting/squatting or lowering my body (to sit in a chair, for example) What is wrong? Anybody?

[frwbeach]

   I have been using a brace supplied by an Otho clinic out of state where my wife used to work. Since using this brace my falls ( knee collapse ) have reduced drastically- from 2-3 times a week to 2-3 times a month. The brace is dual purpose- inexpensive - but does offer some Patella stabilization.  x-rays show obvious knee cap deteriation ( less than 50 % of the other knee in size ) and an old MRI report said slight sublexation-  I have two questions untill I get a different referral from my PCP ( although the doc stated the obvious about the knee cap he did not even bother to allow me to show him what happens when I bend my knee and it wobbles and crunchs and did not even offer a brace solution to my falls )  
1. is there a brace designed specifically for the knee cap that may work better???
     price is not an issue if I keep falling I will eventually have more serious injuries than bruises and scrapes.

2.  The Doc ( who I am not returning to ) stated that knee replacements where the knee cap is an issue do not always work out the best. I researches this and have read many posts that  actually support what he said .  What is the difference between a routine knee replacement and one where 2/3 of the knee cap is gone????  Maybe my new doc will better explain this but am waiting until my next PCP visit to request a different specialist .

[frwbeach]

Thanks- between yourself and Dr Vinod I may have some solution. I actually  will be getting  an inexpensive knee brace that crosses the patella  from a PT where my wife used to work and some instructions similar to yousr and Dr Vinod .  He said if it helps with comfort and the falls perhaps my main problem has been the Patella and I may want to revisit the doc with those results. He also suggested waiting as long as possible for knee replacement so hopefully the brace helps- he did say there were more specialized Patella support braces available also- Can you recommend any if this one seems to help the situation???

[frwbeach]

Thank you .  I may see another doc , however dissapointed that I may be that I told this Doc I sometimes can duplicate the spot / angle of knee slightly bent with weight over the joint - where the knee would just seem to wobble back and forth and feel like knuckles cracking as happens when i fall and he did not even want me to attempt to show him- I have since done this once at home for my wife and she can hear it but also feel it on the top of my knee- its because of this it may not be the main bones but the Patella wobbling- we looked at the x-ray and the patella is off to the right and touching bone on the x-ray. The doc did say there were patella prcedures but they sometimes do not have great results so maybe he understood what was happening and just didnt mention that.   I am puzzled that he recommended  bike riding since that aggravates the heck out of the knee and makes it swell greatly.  Its almost like he doesn't understand that if I stand for 10 min-walk for 10  min ride a bike for 10 min my knee swells and I have pain for hours .  

PS I have begun laying down and tightening the Quad / Ham muscles and that may work sometimes when I tighten up the quad I get a slight popping of the knee cap but so far not bad pain just a little sting once in a while when it pops a little .

Sorry for the novel- anything you can add??  And Thanks.

[JTrempe]

Hello,

I am a physical therapist.  I would first say, do not do any exercises that cause pain.  The pain could be realted to the knee cap.  Apply ice (no heat!) 10 minutes at a time a few times a day.