Patella Tendon pain post knee surgery

[shark_python]

Dear ALL,
Any help will be greatly appreciated.

I have a patient who is 47yrs old lady and has had Rt. Knee re-do arthroscopy debriment and lateral release - 01.03.2007. Had earlier arthroscopic Debridement - 25.01.2006. Surgeon notes says - Anterior knee pain syndrome with patella tilt.

Initially after post op she was seeing a physio and was doing fine but then suddenly stared getting pain in her patellar tendon on active contractionof quads. When I saw her she is not able to actively extend her knee and complains of shooting burning pain in anterior aspect of knee. There is NO tenderness anterior to the knee. Patella was stable and non-apprehensive. Full range of passive ROM with no pain. Pain only on active knee extension. Recent MRI - 21 June 2007, the specialist notes says mild to moderate patella tendonitis and surrounding lining. No other signs of abnormality, although little bit of irregularity on the outer aspect of knee where the lateral release was done. Meniscus and all structures fine. The specialist again sent her back to physio and said wil not give any injection at this stage.

We have been trying to to concentric and eccentric work on her knee, but very gradual and minimal improvement. Also tried Hydro. Can any one please share their expertise in this condition. I would really aprreciate this. I have informed the patietn that I am placing her case in this forum and hope to get an answer for her.

Thank you to every on out there.

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[Canuck Physio]

Hello,

For pre physio, or short term symptomatic relief I would highly recommend cryotherapy.

In particular a rub on gel that does not contain ibuprofen as an active ingredient.

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I would have to say that the above product works wonders in that case. Ibuprofen is known to inhibit soft tissue repair mechanism, so it is very important to also consider timing of therapy in relation to medical treatment.

Vane, JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol 231: 232-235, 1971.

In terms of the pain, I think you're probably best set up to examine her knee alignment. Are there any significant postural problems? Genu Varum, Valgus? Hyperextenion at the knee? Muscle wasting? Patella Mal-tracking? Or are they microscopic changes related to degeneration?

It's very difficult to say post surgery.

Hope some of this will help

[physiobob]

Can you recreate and palpate any posterior structure that is painful?

Was their any erosion to the underside of the patella or the articular surface on the femur. When in range is her anterior pain? Does unloading the tendon with strapping tape reduce the pain? i.e. can you definitely say the pain is from the patella tendon.

Furthermore is the pain the same now as it was pre-op or is this a new pain? She might be back to the original pain. Check for neural tightness/restriction in the area and at the proximal tib/fib joint.

mild to moderate patella tendonitis

This was probably there pre op as well so might not be worth much. In terms of eccentric work - this is generally good for an tendinosis e.g. of the Achilles. It might only be aggravating things here as the patella tendon might already be failing. Get the client to work more and think more about the ankles and hips, glutes, soleus and hamstrings. Then focus less on the knee itself as it is just a small hinge that in general moves when the other joints more to keep the center of gravity balanced. I always think of it as a door hinge. If someone swings on the door repeatedly the hinge fails. But there was not problem with the hinge. Get what I mean?