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July 2020

Question:

My knees roll in, I have a shallow trochlear groove no instability, and surgically removed inflammation of the fat pad and synovial tissue. I have done everything to help from physical therapy to message to acupuncture and nothing has worked. Is there anything my surgeon can do like a Deepening trochlearplasty or align my legs that would help? 

- Florida (Patient)

 

Answer:

Sorry to hear that your knees are bothering you. I am going to assume you are a teenager since it sounds like you have had arthroscopy. I would also guess that you are having anterior knee pain, which is unfortunately pretty common in teenagers.
 
As you likely know, the kneecap (patella) is within the tendon of the quadriceps muscle and glides in a groove on the front of the thigh bone (femur). Instability is when the kneecap comes out of the groove (dislocates). Sometimes this is due to alignment problems, or a shallow groove, or a fall or injury in a sport. Most of the time a deepening trochleoplasty, where the surgeon makes the groove deeper, is indicated when the patient is having problems with instability where the kneecap keeps coming out, and when other surgeries (like tightening the ligaments that hold the kneecap stable) haven’t helped. You write that you are not having instability, so a trocheoplasty does not seem like what you need.
 
If your symptoms are due lateral subluxation of the kneecap without dislocation, then an extensor realignment may be better. This is where the surgeon makes a cut in the bone where the quadriceps tendon attaches and moves the attachment over so that the kneecap centers better in the groove. There are also other surgeries that correct alignment that I will talk about next.
 
You mention that your knees roll in. This can mean a couple of different things. If you are what people called knock-kneed (where your knees are a lot closer together than your ankles), realignment would involve straightening out your legs by taking out wedges of bone.
 
If your knees roll in because of a rotational twist in your femur or lower leg, and you are having anterior knee pain, then lining up the rotation of your legs better might help, and again that is surgery.
 
I am glad you have tried physical therapy, because that and medicines like Ibuprofen, icing and some braces often help teenagers get better with this kind of patellefemoral pain.
 
I would definitely consult back with your doctor and let them know you are still having some trouble. This is a problem that pediatric orthopedic orthopedists are really familiar with.
 
Good luck!

- Siobhan Murphy-Zane, MD



 

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All information on OrthoKids is for educational purposes only. For specific medical advice, diagnosis, and treatment, consult a fellowship trained, board certified pediatric orthopaedist.