tightening the patella ligament-anyone?

[mom2hunangirls]

First, I know it's not called the patella ligament. :)  My daughter is a dancer (14yr old) that has had her knee cap pop out of place twice (and so they think it will be problematic, even non-dance).  I'm trying to find anyone with some experience with having the ligament tightened to prevent this in future. Or lessen the likelihood.

It seems a common suggestion in her situation. I just can't find anyone to actually give me "real" experiences with the tightening surgery.

Anyone?? It's a long shot but the surgery date looms and I need advice!!!!

[Desert Strawberry]

 

i had repeated subluxations of the patellas, way back in the 90s when tightening surgery was very experimental. I had lateral releases instead, because I had a severe misalignment. It helped a lot. 

[itsheresomewhere]

Get a couple of opinions on it.  My patella dislocates a lot( started about your DD’s age)  and I looked into it last year when it was getting bad. According to several specialists but one, I am one of the worst candidates for it. I have some structural issues that means I will dislocate it again within the first year.  This also explains why PT is a fail for me. Did they do any PT for it yet along with an MRI?  Also, ask if they took X-rays of both knees to check for issues that would make the surgery not work.  What desertmom has done, I know a few who did it.  They either had great success or it worked for a bit. 

 

I am very active (TKD, ice skate, Zumba,etc) but wear a special brace to stabilize the knee cap.  It has helped me quite a bit. My main goal for me at my age is to keep the muscles in the best shape I can until one day I get knee replacement. PM if you have any questions. 

[Amber in SJ]

My dd has Ehlers-Danlos/ Hypermobility and often has subluxations as well.  Her doctor has let her know that once dislocated the ligaments are never the same and are prone to repeated injury.  Because of the connective tissue problem she is not a very good candidate for the surgery so right now she is supposed to be focused on strengthening the muscles around the joint.  She also wears a special brace to stabilize the joint when she is exercising, doing her PT or working.  

Dh dislocated his shoulder playing high school football way back in the late 80s.  Since that time he has had problems with it.  That sucker can fall out of joint if he sleeps on it "wrong."  He works out daily (P90X & Black Fire) to keep the muscles strong to prevent random dislocation.  He does occasionally have a problem while he is playing hockey if someone crashes the net.  Nothing like seeing the goalie writhing on the ice like an overturned turtle while he tries to pop his shoulder back in place.  Anyway, 20 years ago we discussed ligament tightening surgery after a particularly spectacular dislocation.  His doctor said that it would help for some time, but the recovery PT is difficult and in all likelihood the dislocation problem would return within 2-3 years of the surgery and he'd be doing the same thing he does now, so we declined.   

I would try to get more than one opinion.

Amber in SJ

[RootAnn]

Huh! I have a kid who has had a couple patella subluxations. I had no idea it could keep happening (or get worse - eek!). Those of you who have a brace, did you buy it over-the-counter or is it some special doctor thing? (If over-the-counter, can you link the type?)
She's not overly active in terms of sports and such, but it would be nice to have something to help it happening when she is doing lots of physical activity (like running around the playground, even). 

What little I read said exercising your inner thigh muscles is supposed to help. Anyone know if that is true? If so, Dr. Hive, do you have recommended exercises?

[Myra]

After visits to pediatrician and then a sport orthopedic specialists there was still no firm diagnosis or treatment plan.  However,  at one of his soccer games, a parent approached me, introduced himself as a chiropractor, and mentioned that he thinks my son is exhibiting symptoms of Osgood-Schlatter syndrome.  After making an appointment at his office and a thorough examination/x-rays etc. , my son was fitted with a custom knee support.  The pain was lessened immediately.  

I am not diagnosing your kiddo, but just offering what worked for my son's knee pain.

 

Good luck,

Myra

 

[itsheresomewhere]

31 minutes ago, RootAnn said:

Huh! I have a kid who has had a couple patella subluxations. I had no idea it could keep happening (or get worse - eek!). Those of you who have a brace, did you buy it over-the-counter or is it some special doctor thing? (If over-the-counter, can you link the type?)
She's not overly active in terms of sports and such, but it would be nice to have something to help it happening when she is doing lots of physical activity (like running around the playground, even). 

What little I read said exercising your inner thigh muscles is supposed to help. Anyone know if that is true? If so, Dr. Hive, do you have recommended exercises?

My brace was recommended by the ortho. I could buy it from him for about 150 or get it from amazon for 60.  I will send you the link later.  

 

Females are are more prone to this due to a patella misalignment issue.  There is a name for it and when I remember it, I will post it. 

[mom2hunangirls]

I feel a little better finding people who know what I’m talking about. But now a little more nervous about the surgery. 

Background: she had her first dislocation last year where a piece of bone was chipped off and now it’s a 1cm loose body in between her knee bones. So far there appears to be no cartilage damage. So that has to come out. 

Since she has hyperextension of everything she was prone to subluxations anyway. However, her alignment on that leg (knee cap) is not good. That won’t be fixed with the tightening. So he said “down the line” she may have to have that major surgery. 

But I’m getting concerned that we are staring at a year long recovery (to dance ability) and then she’s still likely to have it happen again. He knows she dances, wouldn’t he have told me it was a “no return to sport” type thing if it was an unrealistic goal?

Someone asked if she had pt. She did. They were trying to strengthen her thighs and basically all around the knee to lessen the chance. I think she could have worked harder on that. 

I don’t even know how to go about a second opinion! I know that sounds stupid. But in our area all the surgeons know each other and no one is going to disagree with their buddy. Is there an easier way that I just do not know about?

I’d really like someone that understands what her normal is so when they say she’ll be normal, they know what she’s thinking. 

This is hard stuff!

[itsheresomewhere]

If the alignment is not good then she will not have a good chance with the tightening.  If it were me, I would delay the surgery and get some different opinions.  You may have to travel outside of your area to get some opinions.  And just a thought on the PT, I was told that I just didn’t try hard enough during my different times doing it.  Now we know, no matter how hard I try, I would never get to what they consider normal thanks to some issues.  I might not be so hard on her for it.:) 

I had a piece of knee cap chip off.  It was never removed as it attached itself eventually to another area.  Would the surgeon be willing to just remove it if it was causing a problem?  

[mom2hunangirls]

9 minutes ago, itsheresomewhere said:

If the alignment is not good then she will not have a good chance with the tightening.  If it were me, I would delay the surgery and get some different opinions.  You may have to travel outside of your area to get some opinions.  And just a thought on the PT, I was told that I just didn’t try hard enough during my different times doing it.  Now we know, no matter how hard I try, I would never get to what they consider normal thanks to some issues.  I might not be so hard on her for it.:) 

I had a piece of knee cap chip off.  It was never removed as it attached itself eventually to another area.  Would the surgeon be willing to just remove it if it was causing a problem?  

I am trying to tell myself that she could work all day long and her knee cap will still be doing it’s own thing. 

The bone chip is situated right between her femur and tibia. So every time she straightens her leg there is a pebble in the way. It’s definitely got to come out. They are amazed she’s done pointe on it this long. And it was a good lesson in listening to your body. She told all the pts all along “it feels like something is in there, like it’s blocking my knee”. She was right!

So, anyone know a good ortho in the south east?

[Amber in SJ]

For a second opinion, I'd ask around at the dance studio if anyone there has had the surgery, how they felt it went & if they would recommend their surgeon. 

Even if your current surgeon knows she dances you have to be very specific with him about how often and at what level.  For example dd's dr knows she is involved in TKD, and said that would be fine after PT, but when we said she participates in a strenuous black belt level class 2X/ week, trains with a Jr. Olympic team 2X/ week, teaches a lower belt class 3X/ week and competes in tournaments several times/ year, he said, "Oh.  She might not be able to sustain that level of activity in TKD, even after the surgery."  But, remember she was not a great candidate for the surgery in the first place.

I will ask dd when she gets home from school what brace she uses.  I will say our experience with knee braces is the more straps the better for support, comfort & adjustability.  Never go with the ones that are just a sleeve even if they have special padding around the knee cap to "keep it in place."  There is simply not enough customization.

Amber in SJ

 

[Innisfree]

We have just been dealing with this again lately.

Both my girls have had repeated patella dislocations. Their orthopedist had suggested the lateral release for dd13, but just yesterday the new physical therapist said that would make matters worse. The ligament is already too loose, so further loosening won't help. She said the more complicated surgery to reattach the ligaments would eventually be necessary, but needs to wait until dd is at least 16 because it interferes with the growth plates. She said dd's muscles are already strong, so no need for further work on that. As a focus of physical therapy, she suggested practice falling safely. :-(

She did say the ortho we've seen is more of a shoulder guy, and suggested another knee specialist. Since she sounds like she really understands what's going on well, I appreciated all her feedback, and will follow up on her recommendation for the knee guy. So maybe a physical therapist could refer you to a good person in your area, too.

We've used braces, one bought locally at Dick's Sporting Goods, one fitted by a specialist and one ordered online. None have prevented dislocations even while the braces were on, but they do seem to provide some support.

[livetoread]

I had both knees dislocate frequently as a teen (early 80s) and had a lateral release on both. I quit gymnastics and took up swimming and had no further trouble until the last five years when one side has dislocated in inconvenient and very painful ways. I did some PT which focused mainly on the hip flexors and some on the quads. My issues are misalignment and hyperflexing.

I don’t have any advice on the surgery, but I would suggest finding a second opinion from a renowned specialist if you can. My dislocations have been life-altering, and having the tendency is a serious thing. I have been spared arthritis so far, but my sister, who also has the condition, is facing a total knee at 55 (and she is active and slim). It’s not something to mess around with, and non-specialists can mess around through ignorance.

[mom2hunangirls]

Thanks, everyone. I so appreciate the responses. 

I don’t know exactly what I can do. Traveling isn’t much of an option. Maybe I can just talk to a doctor about real risks/benefits...and pray, pray, pray for wisdom. 

[kitten18]

I would call any local Pilates studios (they are often owned by dancers/former dancers) and see if they can recommend a PT who works with dancers and then the PT might be able to recommend a surgeon. 

[itsheresomewhere]

Is this doctor also a sports medicine specialist?  See if you can get an ortho who is also a sports medicine specialist.  

You might give it a try with another doctor close to you. You could be surprised and find they might not agree with the other.  Don’t tell them who the other doctor is but you are seeking another opinion.  

[Katy]

I had this problem as a teen.  I also had a couple knee surgeries related to other knee problems and in rehab developed pain.  What finally helped was going to the athletic trainer at my college.   He said in my case the problem was my outer quads were building up faster than my inner quad, which caused what he called "tracking" pain by pulling my kneecap out of alignment. He gave me a 5 pound ankle weight and had me do leg extensions from a seated position with varying degrees of ankle turnout - 30 reps 3 times per day.  The pain was resolved completely in 3 days, though I still have to be careful if I suddenly increase leg exercise.  Sometimes I still pull out the ankle weights.

[Desert Strawberry]

On 4/12/2018 at 6:49 AM, RootAnn said:

Huh! I have a kid who has had a couple patella subluxations. I had no idea it could keep happening (or get worse - eek!). Those of you who have a brace, did you buy it over-the-counter or is it some special doctor thing? (If over-the-counter, can you link the type?)
She's not overly active in terms of sports and such, but it would be nice to have something to help it happening when she is doing lots of physical activity (like running around the playground, even). 

What little I read said exercising your inner thigh muscles is supposed to help. Anyone know if that is true? If so, Dr. Hive, do you have recommended exercises?

I've had maybe 20 braces over the years. Most were otc. The best was prescribed.

 

6years of thigh exercises did nothing for me. Surgery was the only  thing that   helped. Now I limit my activities because the next stop on this train is a knee replacement. I want to put it off as long as possible.

[Joules]

I'm not sure if it will help the OP, but I'm having this problem at 50.  I've been trying to get more active (cycling, dance classes, etc.) which doesn't agree much with a connective tissue disorder.  I've been to PT which helped, but what helped the most is when he taught me to use Kinesio Tape.  It was only slipping one direction, and I've learned how to use the tape to keep it in place.  It's so much better than the bulky brace.  

I just wanted to mention it for others with milder cases that might be reading this thread...

[Desert Strawberry]

On 4/16/2018 at 4:00 PM, Joules said:

I'm not sure if it will help the OP, but I'm having this problem at 50.  I've been trying to get more active (cycling, dance classes, etc.) which doesn't agree much with a connective tissue disorder.  I've been to PT which helped, but what helped the most is when he taught me to use Kinesio Tape.  It was only slipping one direction, and I've learned how to use the tape to keep it in place.  It's so much better than the bulky brace.  

I just wanted to mention it for others with milder cases that might be reading this thread...

Oh yeah! Kinesio tape is wonderful. I used it for fallen arches, my knees, plantar faciitis, heel spurs, shin splints.