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NOT Osteoarthritis of the patella

 Poster: A snowHead
Poster: A snowHead
is apparently what I've got. Sad

I broke my knee a year ago at the SOPB, and then had an arthroscopy in November, hoping that would sort out the ongoing problems. Apparently the consultant surgeon sent a report to my GP in January but it obviously wasn't thought necessary to let me know the outcome.

But today I had an appointment with the surgeon and told him I am still having a lot of trouble with my knee 'clunking' and that it is very painful on extension. So much so that I've had to stop the physio I had been doing for about six weeks. He matter of factly said "well of course you have, you've got osteoarthritis grade 1 of the patella". So now I know. Sad

I told him I was going on a ski holiday in just under two weeks, and he implied that I might be able to ski, maybe with a knee brace, but my muscles and ligaments around the knee are very weak at the moment.

So - to ski or not to ski at the EoSB? Brave or stupid? or both?

ps. I already had one non-skiing ski holiday at Christmas and that was hard enough, two might be unbearable Toofy Grin


Last edited by Poster: A snowHead on Thu 18-04-13 8:57; edited 1 time in total
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
RachelQ, Oh no. Why on earth couldn't they have told you sooner! At least he didn't say No way to skiing.

Have you been doing straight leg raises still if not they should be fine to do, do them with your toes pointing straight up and rotated out by 45 degrees. You should also be ok lifting your leg while lying on you side. I am trying to pick on the ones which I have been told which should still be OK to do, though now you have a diagnosis your physio should be able to give you exercises which will help strengthen your leg.
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Well, the person's real but it's just a made up name, see?
RachelQ, Oh No!!! That really is a poor show from your GP, can't help with the dilemma, but I know you'll want to give it a go, so probably a bit of both.

Hugs xx
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Quote:

Apparently the consultant surgeon sent a report to my GP in January but it obviously wasn't thought necessary to let me know the outcome.

This sort of thing seems to happen too often. I saw a consultant (eyes, not knees) recently and asked for his report to come to me as well as the GP, and that happened. But maybe if I hadn't asked (or perhaps if I hadn't been paying!!) that wouldn't have happened.

How very annoying. and upsetting. A friend of mine has just been diagnosed with arthritis of her left hip - though her right is fine, it seems. She's too young for a replacement. What can they do about patellas?
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NickyJ, thanks, I've just made an appointment to see my physio on Thursday morning. Then one week and 1 day to get fit! Before I had to stop exercising I was doing quite a lot of one legged squats with weights, and a bit of rowing, and using a dynaband to do sit squats etc, so quite intense, and probably wrong for the diagnosis.

holidayloverxx, thank you for the hugs - mutual! Smile

pam w, it's very frustrating - I'd just assumed they'd let me know the results. rolling eyes It seems there's not much they can do about patellas, probably other than knee replacement, and he didn't mention the possibility of that. He's talking about an injection of durolane next time I see him, about three months time. I googled it and it seems to be WD40 for the joints! I still feel too young for all this to be happening, but it's probably the accident that caused it all. Or maybe the other way round.
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RachelQ, given your timings I would start the straight leg stuff ASAP. Maybe google to check but I can't see it agrevating the knee and building up your quads can only be a positive surely?
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Then you can post your own questions or snow reports...
RachelQ, Sad .
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
RachelQ, sorry to hear this Sad

Hopefully Johnathan Bell will be along to give you a bit of advice.

My hubby has patella trouble. He is having surgery next week (Fulkerson Osteotomy and lateral release of the patella). He has OA of his patella caused by the fact that it has been maltracking and so the back of the patella and the end of the femur have worn Sad This procedure is apparently the best chance he has of a decent return to function, if it's unsucessful he will be looking at a total knee replacement. It is possible to also have just a patella replacement but I'm not sure the outcomes are that good.

Have you got a ski mojo? Hubby has been able to ski very successfully with it on two trips this season (even though he can't currently do much else in the way of exercise)and now won't be without it, worth every penny spent on it he says.

Good luck.
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Sorry to hear that Rachel, maybe we have 2 good legs between us!! I see the surgeon next Tuesday and as he already told me I have slight damage to my articular cartilage caused when I tore the lateral meniscus, one of the questions I had written down to ask is what grade it is, I suppose slight means grade 1! He has already told me it will cause me problems in the future, so the hospital physio has spoken to my sports therapist I am using and said the most important thing for my knee is for my quads etc to be as strong as they can be, because this will help protect my knee in the future.
I am luckier than you because even though is is only 6 wks now since the op, I am working the knee reasonably hard in the gym with not much discomfort, it's very hard to do the exercises to improve the strength if it bloody hurts!!
I will be sking at the EoSB, mind you not sure if you can call what I do as skiing!! Don't think I will be skiing all day every day as it is still early days the physio knows I'm going but he told me not to tell the surgeon! So long as we can just get from bar to bar we'll be fine!!!


Last edited by You'll get to see more forums and be part of the best ski club on the net. on Mon 8-04-13 20:54; edited 1 time in total
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Quote:

the most important thing for my knee is for my quads etc to be as strong as they can be

does the "etc" include hamstrings?
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Hi. I have had ostenil injections several times which I understand are similar. I self funded them at a cost of about£300 per injection. They helped, but I wasn't certain how much. Cortisone helps a lot, but damages the joint in the long term so is only a one or two time treatmet, usefuln for reducing inflammation and pain so you can do strengthening exercises to build up the muscles. I skied 30 days this season, 40 days last year. I am 56 and have absolutely no cartilage behind my patella so it's bone on bone all of the time.

Getting fit and strong has made the most impact, losing 20 lbs(i now weigh about 9 st so it was necessary in my case!) has also helped. But I manage it. I avoid slushy heavy snow, will download at the end of the day and if I get the thought in my head 'maybe I should stop soon', I stop. That thought entered my head for a reason, so i am never afraid to do a short day.

I ski most of everything, steeps, ungroomed, ets., but just really try and avoid heavy snow. I still live for my skiing and hope to be doing it for many more years!
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And love to help out and answer questions and of course, read each other's snow reports.
pam w, I suppose so, at the minute all they keep talking about are quads but the exercises I am doing include single leg balancing ones so all the small muscles around the knee become as strong as they can to keep the knee in the correct position. I will ask the question tomorrow when I have my session at the gym.

Rachel just remember those words of wisdom from Del Boy in Only Fools and Horses - "He who dares, wins!" , "He who hesitates... don't." See you soon...
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RachelQ, Sad Sad
Some strong painkillers for the week?
Very happy to do some gentle pootling with you, interspersed with long periods of drinking and sunbathing*, if that's any help?

*I wish!!! Just returned from Cornwall, which was arctic!
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 You know it makes sense.
You know it makes sense.
RachelQ, sorry to hear that. I don't have any advice to offer just wanted to send my best wishes. The not skiing is a killer. Good luck whatever you do.
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Otherwise you'll just go on seeing the one name:
RachelQ,

Saw the thread, will come back Tom. Lots of stuff interesting stuff to follow up on.
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RachelQ, go skiing but within the limits that your knee tells you. Mojos are great.
With your great technique pootling around will be easy and little strain on ligaments. The problem comes in falls., bumps and lumpy crud.
Ive been hitting the gym hard for 4 months now and although much fitter the pain in vatious arthritic bits is pretty awful and no better than when I started. No cure for worn out bits, but it's not the end of the world.
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lynnecha wrote:
I still live for my skiing and hope to be doing it for many more years!
That's me in a nutshell! snowHead I am a snowhead after all! Very Happy And you saying to finish early and not ski the heavy slush is just what MrQ and I have just been talking about.
Thank you all for your kind and helpful comments. And yes, Pedantica "gentle pootling with you, interspersed with long periods of drinking and sunbathing*, if that's any help?" is a lot of help. Very Happy
I've always been quite fit, at least up until March last year and am longing to get back to exercising of any sort. If I can ski a bit in a couple of weeks I'm very aware it will have to be in small and gentle stages (that nice long blue Pluviometre run might be just the thing - I ski it in my dreams Very Happy ).
Just6, look forward to skiing to a bar with you, and Sarah, best wishes for your husband's op next week. Very Happy
Frosty the Snowman, I think a mojo will be part of my ski attire in the future! Might have to buy baggier ski pants Toofy Grin
Jonathan Bell - "Lots of stuff interesting stuff to follow up on." - I'm intrigued, and looking forward to hearing from you.
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RachelQ, Just over 7 years ago I had a fall and damaged my knee. A 6 month wait for the first operation. I then had the same poor comms between the surgeon and the physio. Weeks of impact type exercise when it was actually going to do me no good.
At the follow up, I was advised Grade 3+ was my diagnosis, and I suppose it still is.
I was told if I was over 60 I would have been considered for a knee replacement. Basically I am decrepit! Toofy Grin

Knee support periodically, as the support was not there following the operation.
Co-codomol and naproxin were prescribed, with hydrotherapy in place if the misguided exercises.
Eventually after months of wasted time I was referred back to another knee specialist. A privately paid for MRI scan showed the real damage. Then we have operation 2, this time as well as the meniscus being seem to there was a chondroplasty (surface scrape) to smooth and possibly prod it into a self heal. This had little noticeable effect. More physio and 6 months further down the line the treatment had reached the end of the line.
I then had a cortisone injection (very unpleasant) but that did seem to improve things marginally. Not a treatment they would do more than twice apparently and not one I'd go through again anyway!
So the end advice was 'if it hurts don't do it'. The suggestion of me hill walking walking again brought a smile to the consultants face, when I mentioned skiing he just shook his head! It took 2 years to get to this point on the NHS.
For me it's a question of managing the knee. I do go hill walking (rather infrequently and gently) and ski but no where near the level or with the effort I once did. I avoid bumps, drops, but the worst of all the corrugated frozen pistes first thing in the morning, AKA the piste outside l'Oxalys in VT!

BTW, I can highly recommend a SkiMojo. Without one I would not last very long, just a few hours would mean having the rest of the week off.

Strap it up, good pain killers, anti-inflammatories, voltarol, jacuzzi, sauna, ice, ski a bit, rest a bit and enjoy the mountains! Good luck, I'll be the one propping up the bar in VT or clunking along with the Mojo!

The advice from a good consultant may also help. Toofy Grin
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RachelQ, thanks for the good wishes for my husband Smile

3 recommendations on this short thread for a Ski Mojo, honestly my husband is currently walking with a bit of a limp and can't ride his bike, yet he could ski hard all day round the PDS last week. He has the latest version and you can't tell he's wearing it and he has only regular looking ski pants, but a good excuse anyway to treat yourself to nice new ski pants Laughing

Could try ibuprofen gel directly on the knee too.

Lots of luck Smile
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RachelQ,

Yours and others' post cover a lot of ground.

Not sure what grade 1 arthritis is. There is a cartilage grading system used on arthroscopy findings ( called Outerbridge grading) . If that's what he/ she refers to then your cartilage is showing signs of very minor damage , and the problem is quite possibly no where near as bad as it seems. It can still be very painful even with near normal cartilage due to maltracking. Try to find out more or pm me your scan report if you like.

If the cartilage is even partially worn through many of those will respond to non op measures. Some with exposed bone ( true arthritis or grade 4 on above grading ) will also respond to physio. I'm afraid quite a lot of Patella rehab fails. For this reason we have a consultant physio at our clinic who just troubleshoots failed patella rehab programmes.

The reasons rehab fails is because of :-

Treatments that don't work, these include ultrasound, interferential,
Poor compliance with exercise because exercises hurt, you don't bother to do them or the programme has too many exercises so they take too long
Failure to focus on the correct issues for example lots of quad exercise when what you actually need is gluts exercise. The most frequent of this category are "recipe book" exercise programmes
Failure by the therapist to ensure you are doing the exercises correctly or to the correct number of reps
Failure to address additional factors like tight muscles, foot position, posture

Injections

Cortisone is a rescue for a swollen knee the week before ski trip. It has no long term role.
Hyaluronic acid works in carefully selected cases but often tried in desperation with resultant poor results.

Surgery

Operations to spare the knee ie not replace have unpredictable outcomes and some will make it worse. Lateral release quite often makes things worse.
Joint replacement should not be totally written off but of course if done young may require a redo. I wouldn't advise knee replacement just to allow skiing but it is certainly possible to ski ( one of my patients heliskiis on her bilateral total knees).Patella femoral replacement can be fantastic but it is still a joint replacement so the rules above apply. Patella femoral replacement can be done very badly, most frequently by non specialists who don't appear to understand the subtleties of the operation.

I'm afraid I am part of a profession that is notorious for poor communication. The only suggestion I can make is be more demanding, if that fails find another surgeon.

For your trip. Try anti inflamms, ice, ski for just a few hours, take day 3 off ( you're at your most fatigued) and stretch. Support bandage or knee sleeve can make it worse if tight and the kneecap is genuinely arthritic.
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Jonathan Bell, your time and help is very much appreciated. I will PM you, as I've been considering a private sector second opinion. No one I've seen since the injury over a year ago, including my current private physio, is a skier, and I'm sure it makes a difference.
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RachelQ, just up the road from me! Keep me posted - I'll provide lunch if I can and can certainly drive you from here to Wimbledon or Kingston if that helps.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Pedantica, thank you! That might just help me with my decision. Toofy Grin
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RachelQ, I'll be doing some pootling too I think, I still have a sore shoulder from my last trip, and don't want to fall again and make it worse, so I'm sure a couple of afternoons in the sun with a beer or two can be sorted. I've not planned any lessons or clinics this time.
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I have got lessons and clinics and will therefore need to be doing no more than gentle pootling between them, otherwise I shall peg out. Particularly on the Wednesday, I've got a private lesson 0900-1030 and an off-piste clinic 1100-1330: anything more than a gentle pootle and some judicious tippling for the remainder of that day would be foolish. Toofy Grin
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Pedantica, Laughing Laughing
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RachelQ, Pedantica, Hells Bells, I know I have a reputation for being the gnarliest and most relentless of all skiers... but as it's all in a good cause I will put my own wishes on the back burner and selflessly keep you girls company in the bar. Toofy Grin
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RachelQ, Do you want me to bring my mojo out with me? It is currently redundant due to improvements with my legs, so you are welcome to use it.
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Schuss in Boots, Laughing Laughing you're on wink .
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Hells Bells wrote:
Schuss in Boots, Laughing Laughing you're on wink .
Indeedy!
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Hells Bells, Schuss in Boots, Pedantica, we shall become the pootleHeads!
Schuss in Boots wrote:
RachelQ, Do you want me to bring my mojo out with me? It is currently redundant due to improvements with my legs, so you are welcome to use it.
Thank you kindly for that offer. Very Happy I'm seriously thinking about going down to Edge & Wax on Saturday and getting fitted for one, but if I don't I'd be most grateful - can I let you know?
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RachelQ,

I've pm'd you.
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Haha! Here's to the pootleHeads! Very Happy
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Cheers ladies Very Happy (although gentleman pootleHeads are welcome to join us too).
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pootleHeads rule Toofy Grin

RachelQ, Yes, of course you can. Let me know anytime up to Thursday night if you need me to chuck it in the car (text me to be sure I've seen I've seen the message though!), no probs.
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Quote:

Cheers ladies (although gentleman pootleHeads are welcome to join us too).


Well, personally I would look forward to that. Recovering from a broken patella in Jan and looking for some gentle pootling at the EoSB. Not even dared to book any lessons.
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neil_b, excellent, welcome to the happy band of pootleHeads. Very Happy
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After all it is free Go on u know u want to!
Pedantica, wonderful, glad to join the pootleHeads. See you all in VT.
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Pedantica wrote:
RachelQ, just up the road from me! Keep me posted - I'll provide lunch if I can and can certainly drive you from here to Wimbledon or Kingston if that helps.


Aaaah an invasion of Snowheads Very Happy
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Hells Bells wrote:
Cheers ladies Very Happy (although gentleman pootleHeads are welcome to join us too).
Excellent, can I join as an honorary pootleHead?
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