VMO and around patella pain vs. hamstrings

[kith1]

As nobody else (docs, physios) came up with a good explanation, I'd like to try here:

In Feb, I had the second ACL tear on the same leg while tomahawking with my ski still attached to my boot. It tore off right at the femur, ACL itself was intact. This was fixed (together with the meniscus) by reattaching the ACL to the femur (Healing Response technique). This technique was also used the time before that. Before the operation we had agreed on using the semitendinosus, if needed, but they told me that they could see that the procedure had worked very well the last time they did it (same people doing the operation as well).

Rehab went very well, I was back to mountain biking in no time. Strength on the leg is excellent. Stability was excellent, but I developed movement patterns avoiding a specific movement... because:

Since the second op (but not during rehab after the first op) and through rehab I never got rid of a nasty pain in the VLL and VMO, as well as on the medial side of the leg below the knee.
There is only pain when I quickly squat down single-legged with my body over my toes. The quicker the eccentric movement the worse. If I squat down in slowmo, it hurts alot less. Also depending on the day, walking down stairs hurts.
It does not hurt at all when using legpresses or doing lunges with weights, for example.
The is no swelling and nothing to see on the ultrasound.

The pain is not always in the same place. Sometimes it's only the VMO right above the patella, sometimes the whole VMO, sometimes around the quadriceps tendon and VLL, sometimes even the biceps femoris plays a part.

And yes, this movement is part of skiing....

Docs and physios tried strengthening, but it didn't take. I got stronger, but the pain didn't go away.

I went skiing two weeks ago, but every turn with heavy loading of the affected leg was hell. I stopped after two hours and went home. On the next day, I was surprised to find my knee feeling much better than before skiing and I had considerably less pain while walking stairs etc, but I didn't try going out skiing again, because I was too afraid of the pain. Also the pleasant effect didn't stay that way for more than a few days...

Now my physio's new (and last) plan is to aggressively stretch my really short hamstrings (like 4 times a day) which I started doing two days ago. I think it's a little bit better now, but this might only be my imagination

So,
ANYONE ever had, seen, diagnosed a similar condition? Have to had good experience treating too short hamstrings?..anything, please?

-chris

[illeceSealo]

Im looking for a shop with a wheel dyno to see where Im at, also is there any good tuning shops around the twin cities?

[Vinman]

tight hamstrings are one of the most common causes of anterior knee pain. Also if you have lost any knee extension from your injuries/surgeries that could also be playing a part in your knee pain. GO with the hamstring stretching for several weeks and see if it helps.

[kith1]

you're sooo right.

pain in the VMO disappeared completely after the daily routine of stretching and (70%) skiing with a brace, although I guess the brace is mainly for my head and not the knee.

Get up. Stretch. Go skiing. stretch. eat. stretch. go to bed. repeat.

My bad luck seems to continue, though...
Last saturday my knee started swelling up after skiing for no reason at all. Had a good day on the mountain, no falling or twisting or anything.
It simply started to build up fluid which I only noticed while doing the evening stretching routine. Maximum swelling was on the same evening. Since then the swelling has gone down only little bit
Didn't go skiing since then, because I want to wait until the effusion is gone. Trying to ice it down and take some NSAIDs.

My theory would be that after all this time without skiing the knee has to get used to it again and cries "overuse" right now.
Funny thing is that although it's swollen, the knee feels more stable and quite strong right now that before and for the first time I can do full squats on the bad knee with only a little tightness in the patella tendon.

-chris

Have a good new years eve everyone! 11 hours to go over here...

[kith1]

Just got back from the MRI session.

Radiologist says the swelling (which I had for over a week now) is because of the damaged articular cartilage on my femur behind my patella. See image:



I just have absolutely no idea WHY the cartilage should suddenly be damaged . The MRI one year ago did't show it, and the guy who did the surgery also didn't see it then.

On the good news side, the menisci and the ligaments are where they are supposed to be, which means the ACL reattached itself correctly after the last surgery.

[Vinman]

this could have been part of your original injury or could be secondary to tight hams and lack of full knee EXT placing too much strain/pressure on this area during rehab.

[kith1]

I'm on Suplasyn now (which is the same as Suparts or Synvisc), getting 1 injection every week for 5 weeks. One more to go next week.
I've been told that it might take as long as 4 weeks after the last injection to get a noticeable effect from it.
I also kept up my stretching routine. This had the effect that the pain is now located rather around the knee itself instead of the VMO and not so vague anymore.

Let's see if I'm able to ski in 3 weeks...

[kith1]

Massive improvement. The swelling has disappeared completely and there is no new swelling after working out on the spinning bike for an hour.
Walking stairs is almost back to normal, at least going down stairs.

The only thing I still can't do is squats, because it starts to hurt at around 20 degrees...

Nots sure if this is because of the Suplasyn or rather the 4 weeks rest

[kith1]

Soooooo, here's the update.

After seeing a number of doctors I was strongly encouraged to get the stretched out ACL fixed... Which I did on May 19th. Same leg hamstring graft.
The guy who did it does 70% patella, 30% hamstring and would have normally recommended patella, but in my case opted for hamstrings, because of the condition of the cartilage on the back side of my patella.

During the operation it turned out that the ACL with its synovial lining could be moved all around the knee and didn't have any function at all anymore.

They also removed a 8x5mm flap of cartilage in the trochlea which was moving around and did microfracture in that place.

I'm now 10 weeks post op and progressing nicely. Some movements which hurt before – even with twice as much muscle on that leg – don't anymore. Especially the pain I described above is gone. Hope it stays that way.