I appreciate that there’s now a rehab thread here.
So after my MRI and xrays were looked at, it’s been noted that I have Patella Alta and am slightly knock kneed. My patella is quite mobile when my leg is straight and my tendon is longer than usual from my shin to patella. The groove in my legs for the knee cap are not shallow. I don’t show bone bruising or have any tears or cartilage damage from my, what I think are, partial dislocations. The Dr. thinks I’m either actually subluxating from the description I give him or the cartilage might be loose in my knee, but I don’t show all the symptoms of the subluxating other than what I feel when it goes out. The Dr doesn’t want to do surgery until I do 4 weeks of PT and wearing a J-brace for when I’m active. After this, during the follow up visit, we’ll discuss possibly doing an MPFL reconstruction (he described it as putting a leash on the patella) OR, when he opens it up he can tug on the cartilage and see if it’s loose and just repair that. He said he’s not real comfortable doing the surgery without more solid evidence that is is actually subluxating because he wants to fix it the first time and not go in trying to repair the wrong issue.
Here’s my questions:
Have you worked with this issue much? Have you had good results from just PT?
I went to the PT today and essentially they want me to do 2 minutes of stretching on each leg every day because the muscles are tight and he feels the muscle/tendon that wraps around and connects to my kneecap is pulling it out of place and causing misalignment. Moving forward he wants me to do more specific knee strengthening that I can work into my gym routine, which I’ll be shown on my next visit. Is static stretching likely to improve this?
Is specific strengthening likely to improve this? As per the thread quoted above, I’ve strengthened my legs through LP and the issue has persisted.
Hey! Apologies for delay in response. Just read through your prior thread. Yes, subluxation of a patella can happen and the recommended surgery by the ortho is usual treatment.
To you questions regarding PT. I’d have to disagree with point number 2 and stretching isn’t likely to help with this.
To your 3rd point, how is this effecting your daily life, if at all. Is it having a major impact from a symptomatic or functional perspective?
Typically with subluxation of patella you can visibly see the patella “mis-groove” and then move back over during knee flexion and extension.
The subluxation happens intermittently and isn’t something I can make happen to try to watch it (maybe I could but the pain from past experiences makes me very nervous to even consider it). When it has happens I have seen the movement of the kneecap popping back into proper place as the leg straightens. It happens so quick I am never truly watching for it.
The major impact is that I’m always nervous about it happening again. It’s keeping me from doing a lot in the gym because I don’t know the next thing that’s going to make it happen. When I am kneeling, like sitting on my calf muscles, over time the knee feels like it overstretches and feels unstable when I go to use it again.
I understand how this can be a fearful process. Difficult to state the symptoms you are experiencing are correlated to patellar subluxation or not without an examination. Either way, I’d argue you need to be able to do the things you want to do on a daily basis; despite the fear. Only way to accurately assess is do those things, but in a tolerable manner. Are you able to train still? Have you tried performing a lunge (since it sounds like one of the things that bothers you is full knee flexion)?
Yes, I just tried and I can do lunges. I have not been training since it seems my knee is more apt to go out after doing so. It seems fatigue contributes to its occurrence.