Comments from an MD Radiologist with Patellofemoral Pain
I am satisfied with the progress of my patellofemoral issues. It has been 18 months now, and overall, I am doing well.
My local physical therapist had a slightly different philosophy than most I had worked with. His instructions were to work through discomfort, provided it did not go over my baseline pain. His focus was strengthening the muscles, at almost any cost (except new pain)!
Moreover, the focus was hip strengthening—as opposed to years of focused VMO strengthening--with the goal of overall lower extremity alignment improvement, so the femur did not collapse into the patella. I worked both legs equally to achieve symmetry.
In the end, the combination of effective muscle strength, and the mechanical advantage of the tibial tubercle transfer, helped a lot. I still have minor pain with certain activities, and will never run again....but the big thing is I no longer have discomfort with walking!! I had 8 years of damage prior to getting the tibial tubercle transfer, so any expectations to ever be back to 100% are unrealistic. However, the key thing is that I am now back to good lower extremity alignment with reduced contact pressure on the patella, so at least the daily deterioration has halted. I no longer have synovitis--that aggravating warmth in my knee.
For years my treatment had focused only on sampling new and stiffer arch supports, having certain surgeries (VMO advancement and lateral release) without adequate focus on therapy, PT programs that had me stop as I felt any discomfort, and targeted VMO strengthening…all with no success.
I think that with an aggressive PT program, +/- a correctly-timed surgery, success is possible. I hope that my story can help anyone else who may also have experience with patellofemoral issues.
Computational Comparison of Tibial Tuberosity Anteromedialization vs. MPFL Reconstruction for Patellofemoral Instability
John J. Elias, M.D., Andrew J. Cosgarea, M.D.
Medical Education and Research Institute of Colorado, Colorado Springs, CO
Orthapaedic Surgery, Johns Hopkins University, Baltimore, MD
Jeff Halbrecht, MD
**Please note that this is a very large file (27.3 MB), and includes an MPG video at slide #20. You must click in the video window to launch the video.
Karen M. Sutton, MD
Department of Orthopaedic Surgery, Yale University
Eveline Erni, M.A., P.T., C.M.A.
Dariusz Witonski, M.D.
Consensus Meeting: Firenze, Italy, May 26, 2007
John Fulkerson, M.D.
The author wishes to acknowledge Chris Powers for assistance with illustration on lower limb alignment.
Jack Farr, M.D.
ISAKOS: DonJoy Consensus Meeting: Understanding Patellofemoral Pain
Vicente Sanchis-Alfonso, M.D. , PhD
Consensus Meeting: Understanding Patellofemoral Pain
David Dejour, M.D.