First of all is patellofemoral knee pain a symptom and not a disease. Trochlear Dysplasia means a shallow or flat groove for the kneecap. You might have an MRI that says trochlear dysplasia, but it is likely you have no symptoms from this. Nevertheless are a few patients troubled by severe chronic patellofemoral pain and trochlear dysplasia. Trochlear dysplasia increases the cartilage forces in the knee joint. Some of these patient might be helped very well by a trochleoplasty surgery since the cartilage is unloaded. Read more on the page for anterior knee pain, the page for trochleoplasty and the page for trochlear dysplasia
Eventually get a second opinion from another patellofemoral surgeon - not just a standard orthopaedic surgeon. You are also welcome to book at Skype or Whatsapp consultation with me for 150 euro prepaid. I need to see you MRI before the meeting. (contact me on [email protected]). Another solution is to accept the pain and reduce your level of activity to a lower level. The knee surgeon, Scott Dye, has for years spoken for the 'functional envelope'. This could be a solution for you. Eventually you can do some reading in the following special issue incl a paper from my hand.
I have published a case report on arthroscopic trochleoplasty for chronic patellofemoral pain and trochlear dysplasia. Unfortunately have no one else yet published on this. I am aware that several other patellofemoral surgeons in Europe perform these surgeries. The have the same good experience and I hope the soon will publish their results. Until then this is very controversial to perform trochleoplasty for patellofemoral pain when the is trochlear dysplasia
Left you see a axial view of a 36 year old women. She had severe anterior knee pain for 20 years. During her patellofemoral arthroplasty surgery there were no cartilage left in the patellofemoral joint. If she just have had a trochleoplasty when she was younger, this may have given her 20 years without pain and likely this soulc also have prevented the development of osteoarthritis
Chronic patellofemoral pain
Back in 1998 we did a follow-up on patients having anterior knee pain.We found, that about half of the patients continue to have light to moderate pain for years. About one out of 10 continues to have severe chronic pain. You can download a PDF copy here. Later have these findings been confirmed by several others.
There are 5 types of plicae in the knee. The two most well-known plicae are the mediopatellar (medial) plica placed on the inner site of the kneecap and the other one is the infrapatellar plica (ligamentum mucosum) placed in the front of the knee. All the five plicae have no known functions, but they are residuals from the fetal life.
An impact on your knee or a wrong use, can cause your plica to get inflamed and then it gets swollen. The medial plica are known to catch between the kneecap and the femoral condyle and this typically causes symptoms of inner site pain and catching. The Infrapatellar plica is attached to the Hoffa Fad and moves significantly when your knee straightens and bends. Sometimes scar tissue in the infrapatellar plica can cause anterior knee pain based upon scar tissue in the plica makes it shorten up.
First of all the treatment focus rest and anti-inflammatory medicine (NSAID or steroids). When your plica has restored it self, a physiotherapist can help by restoring balance and correct movement patterns to prevent recurrence. Sometimes those treatments are not sufficient and your plicae may have to be taken care of by arthroscopic surgery. Here it is very easy to remove. Some call the Infrapatellar plica problems arthrofibrosis and call the procedure arthroscopic removal of the plica - anterior interval release. Personally I do not think this is arthrofibrosis, which is a much more serious condition giving you a stiff knee.
The three other plicae are the Suprapatellare plica that occasionally can give rise to pain above the patella in the Quadriceps tendon. The Laterale plica, that can cause outer site pain. And finally there is a plica that is localized in the rear of the knee and act as valve in front of a Baker cyst.