This first post will give the background and what it took to get where we are today. I think it is important to know the symptoms and other possible diagnoses that were considered.
Background:
My daughter is a soccer player and has played since she was 4 years old. In October of 2009 (club season) she planted her left foot to take a shot on goal when she was hit from the side and her knee "buckled." DD (darling daughter) felt the knee buckle and a sharp pain just on the inside, lower kneecap. We saw the knee give and noticed her limping. She came off the field just after the foul and began icing the knee which swelled quickly. After a short rest she felt better, still in pain but tolerable, so she finished the game.
In the weeks following DD took soccer lightly and tried to rest the knee. She iced it, took anti-inflammatory medications and stretched it a lot. She said the knee still hurt but seemed to be improving slowly.
December 2, 2009...High School season had begun...another game, another collision in the box this time with the keeper. The keeper ran into the side of DD's left knee. DD felt a sharp pain but kept playing. In the next couple of days following the collision DD's pain increased, repeated swelling around kneecap and an occasional popping and/or cracking sound would happen which was always accompanied by a sharp pain.
DD went to the athletic trainer at her school to have the knee taped. The athletic trainer did not like the way the knee looked and instead had her ice and rest. After a couple days she told DD she would be unable to participate with the high school team without medical clearance. The asst. coach who is a medical doctor was asked to evaluate the knee and worried about a possible MCL injury so we were told to go to the Orthopedist.
First Visit to Orthopedic Surgeon:
Off we went to the first appointment with the Pediatric Orthopedic Surgeon. He was concerned with the swelling, pain and location of the tenderness. This doctor felt the MCL was fine but was fairly certain DD had a torn meniscus. He ordered an MRI and put DD on crutches and in an immobilizer until the MRI could be done. The immobilizer was due to increasing pain. DD was in pain all the time and the knee was popping often, swelling a lot, but it was the pain that was becoming unbearable.
MRI was done December 26th and the results were given at a follow up appt on December 28th. At this point we were told the MRI "was for all intents and purposes normal." DD was told to begin physical therapy immediately and have a follow up appt in a month.
Physical Therapy:
In the first physical therapy appt the therapist told us DD seemed to have a sprained MCL based on his physical examination. He had DD do exercises, stretches and so forth with that in mind. PT caused the pain to increase. DD did not feel she was improving and the popping/cracking with pain continued...sometimes up to 3-4 times a week.
Follow Up Appt with Orthopedic Surgeon:
Four weeks later we returned to the surgeon having had almost no success with Physical Therapy. At this time we were told that is was possible DD had problems with her Medial Plica. "
A medial plica is a remnant of an embryonic partition in the knee, and runs along the inner aspect of the kneecap. About 50% of the population has this remnant and the MRI did show there was a plica. Unfortunately the MRI does not show injury or damage to the plica so the only way to know for sure is to undergo Arthroscopic surgery to "look." At this time we were told we needed to see another surgeon since ours did not do this type of surgery. Plica removal is Arthroscopic surgery with a 3-4 week healing time and would prevent this injury from reoccurring in the future.
Second Orthopedic Surgeon Visit:
On February 9th we had our appt with our new Orthopedic Surgeon. He took X-rays on the knee and review the MRI and PT comments. He then did a physical exam on DD's knee and questioned her thoroughly about exactly what happened when the injury occurred and what symptoms she was having now. After all that we were told he did not believe she had an issue with her Medial Plica. He said it was very clear she had sustained a traumatic injury to the knee and sustained a "subluxation" on the knee cap - also known as a Patellar Subluxation or Kneecap Dislocation.
A subluxation means that the kneecap manages to get out of the socket partially, then comes right back into place. Often people will complain of pain and clicking. These people will often feel their kneecap shift around as well. This is the source of the popping DD was hearing which was following by sharp pain. The doctor upon examine could feel how "loose" the joint was and that the kneecap was "floating" around and not stable. The subluxation had damaged her Medial Patella Femoral Ligament (MPFL).
Two Options:
We were given two possible options to treat the injury.
First we were told DD could continue PT for another 3-4 months to strengthen the Quad and hamstrings to compensate for the injury. The MPFL would never be normal but PT could offer a surgery free option. We decided against this for two reasons. First, the 5-6 weeks of PT up to this time had offered no relief whatsoever and the kneecap was still dislocating regularly. Second, upon researching the option we came to find that PT alone following a traumatic injury of this type has a 44% failure rate and the only stories we could find showed athletes with traumatic injury almost always had to have surgery at some point due to continued problems with the joint.
Second option was surgery to replace the MPFL. This is the option we have chosen. This surgery has a 94-96% success rate (depends on source) for a full recovery. We felt this was a much better option and thus far both in our research and questioning others all agree this was the better option for long term.
The actual surgery is called a Left Knee Arthroscopic Lateral Release, and Open Medial Patellofemo. Surgery is scheduled for March 23rd 2010.
I will post again with specifics on the actual surgical procedure...
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