knee problems advice...

[benb]

I've seen knee discussions here in the past so I thought I would ask. My doctor's got me a bit torn.

I think we all hear about cycling related knee pain. I've had a little bit of that (tendonitis), but that is not what this is about.

I have had several episodes of knee pain (much worse then anything from cycling) and my doctor has basically said I have some kneecap problems and my kneecap is too free to move laterally. It's a combination of being overly flexible and a past injury. (My other knee is also flexible but has been very bulletproof) My kneecap doesn't dislocate or anything at all like that, but in an examination the doctor can move it more then normal.

So basically he wants me to have surgery, and gave me a ton of restrictions today on what activities I can do. (Sports wise, not daily life) But I can bicycle to my hearts content. He claims I would have needed surgery long ago if it were not for cycling, and he can't think of anything better to do then cycling. No PT or anything like that, as my leg muscles are all in great shape and he doesn't think I've got imbalances to correct. So he said to come back at the end of the 2010 cycling season and see him and we'd consider the surgery. (4 months rehab) He's saying cycling is great, but when I'm older (I'm 32) I'm going to have problems from this if it's not corrected.

I'm curious if anyone has had an experience like this before. I've never had surgery and I guess I'm paranoid.. I'd be really pissed if this wasn't a success and I ended up worse... the injuries are always from other sports besides cycling, and I'm happy to just stick to cycling. (I'm not really happy to be restricted in the weight room though, or not go snowboarding or ice skating) He's a very good doctor though, and was trying to reassure me that if the surgery is a success I'll pretty much be able to do anything I want sports wise.

Anyone else been in a position like this?

[EDS]

Is this doctor a sports med guy? I would get a second opinion if I were you.

[thwart]

Usually patellofemoral (kneecap) problems are addressed first by physical therapy and other methods, and in some cases surgery if that fails.

You might be the exception that proves the rule, but I'd agree with the above; I'd get a 2nd opinion.

[benb]

He is a sports medicine doctor... I've been seeing him a long time and he's never told me I needed any surgery before so I doubt he is jumping the gun. He isn't pressuring me either, he said I could wait as long as I wanted and some day I would "know it was time". The only other thing he said is if it flares up again he wanted to see me immediately.

I'm not sure this is a normal tracking thing. Say I am riding.. my kneecap tracks normally.

It's more of an increased risk thing from any sport which involves twisting & bending as far as I can tell. Basically "you should take care of this or risk a traumatic knee injury".

But yes, a second opinion seems wise.

[dekindy]

The only experience I have had with this was a lady co-worker that jogged. Her doctor attributed to her quads not being strong enough to keep the knee cap aligned so there appeared to be a known muscalur cause.

I would be interested to know what he is going to correct. Is it a scoping procedure? Sounds like not if recovery is 4 months.

What kind of problems if not surgery? The recommendation for most knee surgeries seems to be put it off as long as you can stand the pain. I am sure there are exceptions that other damage may be caused if it goes to long. I does not sound like your doctor is saying that in your case.

[benb]

After reading a bit more last night I'm really skeptical and will definitely be seeking out a second opinion. I have the MRI data I can take to any other doctor.

What he told me I had was a poorly tracking patella. I believe the surgery is "Medial Patellafemoral Ligament repair."

But the thing is I went to see him for pain which didn't start in my patella or have anything to do with walking up stairs, squatting, etc.. my entire knee was swollen so at one point I did have pressure under my patella, but that sure did not seem to be the cause. He had me do some squats and stuff barefoot with the swollen knee so maybe it wasn't tracking right while swollen.

This repair seems to be targetted at people who have had chronic kneecap dislocations and have gotten to the point where they have chronic pain. If I told him I can squat greater then my bodyweight in the gym pain free, can ride my bicycle as much as I want pain free, it becomes hard to believe my patella is so messed up. I've also definitely never had a kneecap dislocation.. (it sounds awful, like something you will never forget)

I'm also skeptical I could be doing long term damage when I have no ongoing swelling or pain. Before I went to the doctor I thought I had just gotten a mild knee sprain.

[Kane]

I have not examined you but if I did, I would be suspicious that your meniscus is involved. Swelling of the knee is a meniscus problem. Try googling 'ART' rehab. Look for a pt or chiro to do deep tissue work to your quad, hamstring and calf muscles. Stretch your rectus femoris quad muscle in a lunge postion, (This is an important area for any knee pain). Strengthen your quads with a leg press machine and wall squats with a ball behind your back and your feet spread greater than shoulder width. Fish Oils 3000 mg for anti-inflammatory benefits. Glucosamine Sulfate 1500 mg for the cartilage.

I have managed a lot of knees and prevented a lot of Surgeries for my patients.

My favorite knee Surgeon is Dr. Montgomery in S.F. @ St Mary's. he is a Harvard fellow and a cyclist. Take a trip to S.F. and get a second opinion. He is an excellent surgeon that I trust. I have used him as a referral source for 12 years.

Good Luck,

Kane