Anyone know about pateller tracking syndrome?

[LanaTron]

In fall of 2012, my dd (now nearly 17) hit her knee on the side of a dishwasher.  There was never any redness or swelling, and it did not keep her from walking around, and she had no limp.  She experienced mild to moderate pain, but I figured it would heal on its own.  After some time, the pain did not get better, so I took her to the pediatrician, who sent her to an orthopedist.  He examined her, and said that she has patellar tracking syndrome... her kneecaps don't go up and down in the groove at the end of her femur, they go off towards the outside of her leg when she bends her knee.  He prescribed physical therapy, which we did, and a "J" brace, which we got.  He also prescribed orthotic inserts, but at that time, I didn't really understand what the patellar tracking had to do with the injury, and I didn't see why she needed the orthotics, so I didn't get them.  

 

After a few months, we go back to the orthopedist, and he fusses about the orthotics, which I then got.  At that point, it clicked in my mind that the patellar tracking issue was partly to blame for the initial knee injury...from what I understand, without the tracking problem, her patella would not have subluxated, and it certainly would not have continued to cause her pain for this long (nearly two years!).  He gave the orthotics 2-3 months to see if they would help, and then we went back.  At that point (2 weeks ago), she was having pain about 60% of the time, at about a 3-4 on a scale of 1-10.  That is only a little better than when she was in PT last fall, and her pain was 4-6 every day we went to PT.  

 

At this point she is scheduled for a CT on Tuesday, for both knees, and he is going to determine whether she is a candidate for knee surgery.  I don't know details from him just yet as to what type of surgery, although I looked it up on the web and it looks like there are a handful of procedures they do for this problem.  Some involve arthroscopic surgery, but one is pretty invasive and involves cutting into her tibia underneath the place where the patellar ligament (tendon?) attaches and moving that piece of bone along with the ligament, and reattaching it with screws.  This will allow the patella to track properly, and supposedly reduce or eliminate her pain.  I'm pretty sure this surgery is what he is evaluating for.

 

I am very reluctant for her to have major knee surgery for pain that is mostly manageable, BUT the pain gets worse if she stands for a long time, and things like long hikes with Venturing Crew are definitely out, especially since we do that stuff in the Texas Hill Country.

 

Has anyone had experience with this issue?  If so, do you have any advice, or can you share your story?

 

Thank you! 

 

 

 

 

 

[Tiramisu]

We never had this problem, but when we had another orthopedic issue with surgery recommended, we visited four different orthopedists. I'd recommend a second opinion.

 

At the same time, the best advice I ever got is from other moms. So, hopefully, someone here will have some helpful information for you. :)

[Only me]

When my daughter was 13 she was diagnosed with this. In her case her knees kept on dislocating. She had a lot of pain (so bad that she needed a wheel chair for Disney). We taped her knees every day and she did PT for months without improvement. She also had to quit sports in 8th grade. We decided to get a 2nd opinion.

 

The orthopedic surgeon discovered that it was actually her femur causing the problem. It was rotated 30 degrees more than it should be. Think of a twisted branch that keeps on getting worse as it grows. She went through rapid growth which made it worse. She had to have major surgery (derotational osteotomy). It took a year to recover and she needed plates and screws and months of therapy afterward but it helped.

 

The good news. She was on bed rest for a few months. She watched a lot of hockey. Unknown to us she promised herself when she was healed that she would learn how to play hockey. (She didn't even know how to skate) After about a year they took the plates and screws out. She had another 6 weeks of therapy. A little while before her followup appointment with the doctor she told us about the hockey. We said we would see what the doctor said. Well he was all for it.

 

So at 17 she joined a "learn to play hockey" class. She was with kids half her size and half her age and she learned how to play. About one month into the program we were approached by the manager of a girls high school hockey team whose team practiced right after her lessons. She had been watching dd for several weeks and noticed her determination and her quick learning. She offered a spot on the high school team for the following fall. So dd played with them her senior year and now just started her 2nd season with a womens team. So she went from not even being able to skate to being one of the top players on this team. Before her surgery it hurt to walk. After surgery she basically had to learn how to walk again. Now she is playing hockey!

 

Now I don't mean to get you worried. My daughters case was pretty severe. Also most likely it is just your daughters knees but I completely agree with getting a 2nd opinion. If we hadn't they probably would have done the knee surgery on her which probably wouldn't have helped much due to the fact that not only was her knee not tracking right but her leg was twisted further up. I hope you find some answers. I know it's frustrating.

[In The Great White North]

Dd had that a few years ago and the PT said to do the exercises "for the rest of your life".  He also gave her some tape to use when exercising to help it track correctly, changed the way she runs and had her ice it after exercise.

 

Why did she stop PT if it still hurt?

 

I would get a second opinion too.

[gingersmom]

My daughter had patellar tendinitis that took years to go away. We did orthotics, pt, bed rest, etc.

 

She actually had to give up ice skating for two years.

 

I would not rush to have knee surgery at such a young age. Definitely get a second and third opinion.

 

Has she tried acupuncture?

[Momof3littles]

I am posting from a hs conference. I worked as a PT prior to having my kids. I subluxation my patella in college while picking up some heavy luggage. That put what is known as a valgus strain on my knee. Strengthening a small but "lazy" muscle called the Vmo sometimes helps. Did they work on that in therapy?

[mrsrevmeg]

My husband has had some issues with knee tracking. His doctor did not recommend surgery for it. Therapy, yes, orthotics , yes, knee brace, yes. The brace that the doctor prescribed would not stay on his leg but he had more results from this: http://www.amazon.com/Mueller-Jumpers-Knee-Strap-Red/dp/B000F5R4R2/ref=sr_1_2?ie=UTF8&qid=1402763793&sr=8-2&keywords=knee+strap . I would think a second opinion would be worth it.

[Reefgazer]

My DD was playing basketball and heard a "pop" and went down (didn't twist her leg any).  Doc said give it 1-2 months, but it still hurt, she limped, she complained her knee was moving around (huh?), and she can't straighten her leg.  So we got sent for am MRI and the doc said she has a bruise under her knee that causes the patella to go "off track"; didn't even know that was possible.  We got referred to an orthopedic surgeon and have an appointment later in the month to decide on surgery, braces, PT, whatever.  I don't see how surgery, braces, PT is going to help a bruise, though, which is the underlying cause of her issues.

In fall of 2012, my dd (now nearly 17) hit her knee on the side of a dishwasher.  There was never any redness or swelling, and it did not keep her from walking around, and she had no limp.  She experienced mild to moderate pain, but I figured it would heal on its own.  After some time, the pain did not get better, so I took her to the pediatrician, who sent her to an orthopedist.  He examined her, and said that she has patellar tracking syndrome... her kneecaps don't go up and down in the groove at the end of her femur, they go off towards the outside of her leg when she bends her knee.  He prescribed physical therapy, which we did, and a "J" brace, which we got.  He also prescribed orthotic inserts, but at that time, I didn't really understand what the patellar tracking had to do with the injury, and I didn't see why she needed the orthotics, so I didn't get them.  

 

After a few months, we go back to the orthopedist, and he fusses about the orthotics, which I then got.  At that point, it clicked in my mind that the patellar tracking issue was partly to blame for the initial knee injury...from what I understand, without the tracking problem, her patella would not have subluxated, and it certainly would not have continued to cause her pain for this long (nearly two years!).  He gave the orthotics 2-3 months to see if they would help, and then we went back.  At that point (2 weeks ago), she was having pain about 60% of the time, at about a 3-4 on a scale of 1-10.  That is only a little better than when she was in PT last fall, and her pain was 4-6 every day we went to PT.  

 

At this point she is scheduled for a CT on Tuesday, for both knees, and he is going to determine whether she is a candidate for knee surgery.  I don't know details from him just yet as to what type of surgery, although I looked it up on the web and it looks like there are a handful of procedures they do for this problem.  Some involve arthroscopic surgery, but one is pretty invasive and involves cutting into her tibia underneath the place where the patellar ligament (tendon?) attaches and moving that piece of bone along with the ligament, and reattaching it with screws.  This will allow the patella to track properly, and supposedly reduce or eliminate her pain.  I'm pretty sure this surgery is what he is evaluating for.

 

I am very reluctant for her to have major knee surgery for pain that is mostly manageable, BUT the pain gets worse if she stands for a long time, and things like long hikes with Venturing Crew are definitely out, especially since we do that stuff in the Texas Hill Country.

 

Has anyone had experience with this issue?  If so, do you have any advice, or can you share your story?

 

Thank you! 

 

[LanaTron]

Dd had that a few years ago and the PT said to do the exercises "for the rest of your life".  He also gave her some tape to use when exercising to help it track correctly, changed the way she runs and had her ice it after exercise.

 

Why did she stop PT if it still hurt?

 

I would get a second opinion too.

 

She wasn't really given specific exercises to do at home.  I mean, I asked if there was something she should do, and they said, "oh, yeah," and gave her a sheet of paper, but it seemed offhand, and it didn't seem crucial.

 

Why did she stop PT?  Well, that's a good question, now that you ask it.  I'm so clueless about this type of thing.

 

At the end of the number of sessions approved by the insurance--or maybe the number prescribed by the doc??--it was the holidays.  I think it was a little longer before we went back to see him, and that's when he got pissy (sorry for the bad word) about me not getting her the orthotics.  But he did not say for her to continue PT, either.   :confused1:   

 

And although he mentioned taping at one point, he never actually had anyone do that.

[LanaTron]

When my daughter was 13 she was diagnosed with this. In her case her knees kept on dislocating. She had a lot of pain (so bad that she needed a wheel chair for Disney). We taped her knees every day and she did PT for months without improvement. She also had to quit sports in 8th grade. We decided to get a 2nd opinion.

 

The orthopedic surgeon discovered that it was actually her femur causing the problem. It was rotated 30 degrees more than it should be. Think of a twisted branch that keeps on getting worse as it grows. She went through rapid growth which made it worse. She had to have major surgery (derotational osteotomy). It took a year to recover and she needed plates and screws and months of therapy afterward but it helped.

 

See, she's not had an actual dislocation.  Only the one subluxation (not quite as severe), and only that because she hit her knee.  Her right knee does not bother her.

 

He has mentioned this, about possible rotation of the femur... or tibia?  I can't remember now.  I think that is one thing he wants to evaluate with the CT?  

 

I am bringing dh to the next meeting with him, because I feel like there is a disconnect between what the doc is saying and wanting to do, and my understanding of what is going on.

[LanaTron]

My husband has had some issues with knee tracking. His doctor did not recommend surgery for it. Therapy, yes, orthotics , yes, knee brace, yes. The brace that the doctor prescribed would not stay on his leg but he had more results from this: http://www.amazon.com/Mueller-Jumpers-Knee-Strap-Red/dp/B000F5R4R2/ref=sr_1_2?ie=UTF8&qid=1402763793&sr=8-2&keywords=knee+strap . I would think a second opinion would be worth it.

 

Thank you!  She told me today that the brace does help when she is marching (she's in band).  But not so much if she has to stand a long time.  I'll look at that strap.

[Truscifi]

I have issues with my patellas tracking to the outside that contributed to my torn meniscus that required surgery. The tracking issues for me at least are due to underdeveloped adductors in my thighs, as well as a plica. I had a very good physical therapist who really worked with me to help figure it out and gave me a specific regimen to do at home daily. He was very frustrated when insurance wouldn't approve any more pt because he (and I ) felt I still needed a lot of work to lower the risk of reinjuring my knees.

 

I would definitely get a second opinion and try to get more specifics about why she is having tracking problems, and maybe try more pt before surgery too unless there is an injury in addition to the tracking problems.

[Truscifi]

Oh, and I have a Palumbo brace. It is pricey but they have a Y strap thing that only they do that is very good for holding the kneecap in place.

[LanaTron]

I am posting from a hs conference. I worked as a PT prior to having my kids. I subluxation my patella in college while picking up some heavy luggage. That put what is known as a valgus strain on my knee. Strengthening a small but "lazy" muscle called the Vmo sometimes helps. Did they work on that in therapy?

 

I don't know.  But I guess I could call and ask them?  Or get a copy of her records.

 

What type of exercise is done to strenghten that?

 

Thank you.

[LanaTron]

My daughter had patellar tendinitis that took years to go away. We did orthotics, pt, bed rest, etc.

 

She actually had to give up ice skating for two years.

 

I would not rush to have knee surgery at such a young age. Definitely get a second and third opinion.

 

Has she tried acupuncture?

 

Thank you.    

 

No acupuncture, but she's been to a chiropractor.  While she was having the PT, she started having a lot of problems with muscle spasms all up and down the outside of her leg, and in the hamstring area.  She could be just sitting and suddenly have a spasm.  The chiropractor helped with that a LOT--it is pretty much gone now.  He was doing myofascial release, adjusting her back, and using an electrical stim thing on her quadricep.  He thinks that he can end the knee pain with those things, and her doing continued exercises, like on an elliptical.  BUT while she was seeing him her actual knee pain did not improve.

 

Maybe we are expecting too much improvement too quickly?  I mean, she was consistently at a 4-6 last fall, and now is pretty consistently at a 3-4.  So, I could read that as very slow improvement.

[LanaTron]

My DD was playing basketball and heard a "pop" and went down (didn't twist her leg any).  Doc said give it 1-2 months, but it still hurt, she limped, she complained her knee was moving around (huh?), and she can't straighten her leg.  So we got sent for am MRI and the doc said she has a bruise under her knee that causes the patella to go "off track"; didn't even know that was possible.  We got referred to an orthopedic surgeon and have an appointment later in the month to decide on surgery, braces, PT, whatever.  I don't see how surgery, braces, PT is going to help a bruise, though, which is the underlying cause of her issues.

 

When I first took dd to the pediatrician, she mentioned bruising under the patella as a possibility.  And she said that bruising like that can take a long time to heal.

 

But my dd has NEVER limped or been unable to move her leg.  No pop, only a "blunt trauma impact" type of thing.  I think the MRI showed nothing (but I'm not 100% sure), as did the x-ray the pediatrician originally ordered.

 

Hopefully, your dd will not need surgery.

[LanaTron]

Thank you all for your replies!  Her CT is Tuesday, and her follow up with the orthopedist is July 3.

 

The ortho was not only pissy with me about my failure with the orthotics, he was very pissy with me on our last visit because dd mentioned the chiropractor, and because I said that he seemed unsure of what was causing her pain.  He was quite nasty, actually, and I felt bullied into moving forward with the evaluatioin for surgery.  I've always felt like he came into the room the first time with the diagnosis of patellar tracking before he even examined her... mainly because she does not have problems with her knee, she just injured this one with a blunt trauma-like injury.  He did show me that it happens on her knees, so I believe him that it happens, but I'm not 100% sure how THAT is the thing causing her pain in her knee, and not just something like tendonitis or ???

 

SO we will definitely seek a second opinion, especially if he ends up recommending surgery.  That seems drastic for the level of pain she has--she goes to school fine, although it hurts some to go up and down stairs, and with the orthotics and the brace, she does marching band just fine, too.

 

How do we do this?  I assume I need to go back to her PCP for another referral??  Do I need to get her records from the orthopedist, or will the next orthopedist's office do that?  Anything else I should know about what I need to do for the second opinion?

[Katy]

Um, I had that, and I had a couple knee surgeries (for ACL & cartilage issues, not the tracking).  I was also told I'd have to exercise for the rest of my life. The more I exercised the worse the tracking issue got.

 

My physical therapist said I should never do a seated leg extension, but I was in so much pain every time I exercised that I ended up going to the athletic trainer at my University and asking for advice.  He said that my tracking issue was caused by my outer quads building up faster than whatever the muscle was on the inside of my kneecap, and it pulled it out of alignment and caused a tracking issue. He gave me some ankle weights, put them both on the leg with the issue, had me turn my leg out as much as I could and then do a seated leg extension. He said it would build up the muscle on the inside of my thigh (sorry, don't recall the name of the muscle), and pull my kneecap back into alignment.

 

I was in so much pain I decided to try it (despite the PT's advice).  In less than 10 minutes I felt a little better.  After a week I didn't have that pain anymore.

 

I'm pretty active generally but I don't do most of the PT I was told I'd need to practice forever.  I still get occasional tracking pain though, and pull the ankle weights back out again. Between that and stretching out my quads I haven't needed that surgery yet.  Obviously the reason for her tracking issue might vary, but if it's a muscle imbalance I'd try the exercise first.

 

Also, always get a second opinion for orthopedic issues.  I walked around with a torn ACL for three years because the first surgeon I consulted said it couldn't possibly be that, because "grown men would rise up off the table in pain if that's what's wrong with them."  Eventually I severed it, but in a different place.  My surgeon noted I'd torn it previously in a different area.

[Katy]

I found my second opinion by asking my PCP for someone else.  I said the first doctor was condescending, rude, and sexist and the PCP laughed and promised to send me to someone really nice.  He did.

[Only me]

Actually a good doctor would want you to get a 2nd or even third opinion. We liked our 2nd opinion doctor but since it was such a major surgery he recommended a 3rd opinion. (The first opinion was actually in the same practice but didn't catch the problem ). The 3rd opinion doctor was good but wanted to defer treatment to the 2nd opinion doctor since he knew that doctor had performed the surgery before and was good. It is a somewhat rare surgery. A good doctor should not afraid or upset for you to get another opinion especially considering surgery. We found the first doctors through the pediatrician and the 3rd one through insurance. I'm not sure what kind of insurance you have. We have a ppo and didn't need a referral. We just called the 3rd doctor and said we wanted another opinion. We did bring records and the MRI from the other doctor.

[Jan in SC]

Ok- maybe I can help.

 

Did the doctor mention trying a lateral release first? Did the doctor take an xray with her knees bent, looking toward her feet? If so, look at the xray and see the her patellas tilt outward.

 

My ds has patellar tracking issues. He has had a lateral release on both knees. It is a procedure that open the tissue on the lateral side of the knee. It is an outpatient procedure that is done arthtoscopically.

 

As someone mentioned, improving the VMO will help keep the patella in place, but sometimes the tissue is so tight that the quad and vmo are unable to gain strength because of the lack of space. The lateral release will reduce the pull of the patella. My ds got to the point of running out on the baseball field and collapsing because his knee would buckle. He was always in pain.

 

So, he is 6 weeks post op on leg #1 and 2 weeks post op on leg #2. Will it prevent the huge surgery in the future? We don't know, but he already feels better. He does pt twice a day on his own and goes to pt twice a week.

 

Feel free to pm with really specific questions, otherwise I'm happy to answer more in this thread.

[Momof3littles]

On the issue of a second opinion, I would also call local outpatient physical therapy places and see if they can recommend a doctor or two for a 2nd or 3rd opinion.  Remember that they see the outcomes of lots of different surgeons, so they may give you some good names.

[PuddleJumper1]

I have way too much knowledge of this issue  :001_rolleyes:  I have had the big sawing and screwing surgery on both of my knees and can say without hesitation that it was the best decision I could have ever made. Yes - the surgeries are intense, the recovery is painful and therapy is grueling but I would do it all over again in a heartbeat. I had recurrent dislocations in both knees. I had the release surgery done on one knee when I was 14 but it did not solve the problem.  I did not know about the realignment surgery option until my 30s. It was life changing for me.

 

Having said that though - under no circumstances would I go into surgery with a doctor that had any kind of attitude toward me. If I can't trust him 100%+ there's no way he's cutting into me. 

 

Definitely get a second opinion. You need a new surgeon anyway. 

 

Feel free to pm or post - I'm happy to answer any questions I can.

[LanaTron]

Thank you all so much!  I am having a super busy time, so can't respond to each person, but I am reading everything and I really appreciate the support and advice and shared stories.

 

You all are such a blessing.

[LanaTron]

Long story, but we finally got dd's CT results and a follow up with the orthopedic doc. He is recommending the surgery for the one knee that would correct the torsion of her tibia. As far as I understand, this would involve, in essence, breaking her tibia and repositioning it with screws/plates so that it is less turned outward  :confused:. He also suggested that we could consider doing the other leg, the asymptomatic one, prophylactically.   :001_huh:  He said it would be at least 6 weeks and up to 12 months recovery. 12 months!! :eek:  He did say that it is a tough decision for all of us, even him.  He also said that people with this patellar tracking issue have a higher risk of having early-onset arthritis, and is suggesting that this surgery could prevent that. He did not give us any numbers, though, on what percentage of people end up with the arthritis, so that is meaningless to me. He said he has this problem, too, and had basketball injuries, and has a hard time getting down on the floor to play with his kid, etc. because of it.  SO I can see that he is trying to prevent other people from having the same issues he has had, but it sounds to me like a pretty drastic measure to try to prevent some MINOR lifestyle issues.

 

I also do not think he is in touch with the level of pain she has... It is not something that he routinely asks about when we go in there (like when my husband goes to the rheumatologist, "what's your pain level" is ALWAYS one of the questions from the nurse, and I would expect that from an orthopedist, right?) She sometimes complains that it is a 6 out of 10, but I honestly don't know if dd's 6/10 would be the same as mine or anyone else's. Does that make sense?

 

Oh, and BTW, I made dh go with us this last visit. The doc was MUCH kinder to me/us. My dh is Black, stocky, and has an intimidating presence, even though he's really sweet. So, either he had decided to be nice to me ahead of time, or figured out quickly that I brought in backup and was not going to be intimidated into this procedure.  :cool:

 

This knee pain she has is NOT keeping her from going about her daily life. She participates in marching band, which is pretty physical really. She gets up and down the stairs at school. She does not do these things with some pain, but she comes home happy and smiling from band practice most days. (she really loves band) She went canoeing and kayaking with Venturing Scouts in April, and did fine with ibuprophen. She is planning on windsurfing this weekend with Venturing. 

 

I know she has knee pain, but I am inclined to figure out how to help her cope with it rather than do this surgery.

 

I took her back to the pediatrician to get a referral for a second opinion. The pediatrician said that sometimes doctors get frustrated that a problem doesn't correct with more conservative treatment, and then start offering procedures. (Our pediatrician is very conservative with treatments, btw) The first doctor was through UTMB system; she is referring us to someone through Texas Children's Health system. She said that the TCH doctors tend to be more conservative, but it can take longer to get to see them because everyone wants to get in there.

[LanaTron]

UPDATE:

 

We saw the second orthopedist, this one at Texas Children's Hospital (which was crazy busy, by the way). She agreed with the first orthopedist that dd is a candidate for surgery, but she is referring us to a pediatric sports medicine specialist, still at TCH, who deals with this type of thing more frequently than she. She also ordered 8 weeks of PT for her, because she said that the next doc will do that anyway, and if she does have surgery, it will be good to have those muscles as best as we can have them before and then dd will know the types of things to do after to help heal and get back to normal quickly.

 

So, we've seen: 1. Orthopedist/sports medicine doc, 2. Pediatric Orthopedist... and now moving on to 3. Pediatric orthopedist/sports medicine.

 

Whew.

 

Interestingly, the ped ortho we saw yesterday took x-rays of her structure from hip to ankle from the front. DD is nearly knock-kneed on the leg with the hurting knee, but the doc said it was borderline. On that x-ray it is OBVIOUS that her kneecap is high and to the left of where it should be.

 

October 14 is when we see the new doc. HOPEFULLY we can get a solution that will not be so invasive as cutting into bone and moving things around. OR if this third doc thinks that is best, then hopefully dh, dd, and I can all feel peace about this procedure.

[Desert Strawberry]

I haven't read all the responses, but I would like to tell you my story :)

I was born with club feet that looked like this. http://www.newswise.com/articles/chromosomal-abnormality-found-for-inherited-clubfoot

 

It was corrected using hard soled shoes, which is no longer the accepted treatment, because my feet are ok, but my legs were still slightly twisted. 

When I was 13, I subluxed a patella. At this point, I'd never had a problem with my knees. It never got better. It stayed swollen and painful. For 2 years, we braced it, did various imaging tests, did therapies, to no avail. At 15, the other knee also started to hurt. At that time I was diagnosed with Patello-femoral syndrome, which runs in my family. 

4 more years of therapies did nothing. My patellas were rotated like this, but much more severe. http://www.jaaos.org/content/11/5/364/F2.expansion. The cartilage was being ground away. There was not much left. At 19, I was told to expect a knee replacement surgery in the next 5 years. 

I saw a few different doctors. We discussed multiple surgical and nonsurgical options. Eventually we settled on a lateral release. It wouldn't cure me, but it would stop or limit the progression of the damage. 

During this whole time, I was a competitive swimmer, high school and college. I took spring board diving, gymnastics and dance classes. I was an accomplished cyclist. I powered through the pain. I red shirted a year, had two surgeries, did intensive therapy with my trainer, and made a better-than-expected recovery. I was pain-free for 2.5 years. I finished my last competition season, started training for a triathlon, joined the military, went through boot camp, trained with marines, ran 10 miles a day, climbed mountains, and generally made the most of it. :) 

The pain did come back. With a vengeance. It's debilitating. I've been in remission for most of the last 12 years due to pregnancy and breastfeeding. But when I have flares, it's bad. No doubt, due to all the damage I did presurgery. 

I am 38. I am NOT a candidate for knee replacement. Not now. Not ever. I can't do everything I used to. But I had some great experiences that would not have been possible without surgery. For me, it was a second chance. Maybe it was a first chance. I got a whole new life. It was so worth it. 
 

That's my story. 

[LanaTron]

UPDATE (hopefully the final):

 

A huge thanks to those of you who suggested a second opinion!!  I don't know why I didn't think of that when we were being bullied into the surgery.

 

The pediatric sports medicine doctor said she is very reluctant to do that surgery on young people. And the more we talked to her, the more reluctant she became. She said she normally does that surgery on people who have multiple kneecap dislocations (dd has not had any true dislocation, only the one time where it slipped out and back), and normally only if it greatly affects daily life and keeps people from doing what they want to do. My dd walks up and down stairs at school, does marching band, etc. Granted she used a brace a lot this past marching season, but none of this kept her from doing the thing she loves.

 

She has had two more rounds of PT. After the first round, the therapist pointed out to dd how the kneecap was sitting closer to where it was supposed to sit. And I think that during the course of the two rounds, dd's daily pain level lessened even more. She has been approved by the insurance for more PT, but we are having to hold off because of all the end of school year insanity.

 

So... Hooray! No surgery, and much improved on pain and ability for my dd!  :hurray:  :hurray:  It just took finding the right doctor, and the right PT place. 

[PuddleJumper1]

Great news!! So happy your daughter is doing better and no surgery !!  :hurray:

[Desert Strawberry]

Great update!