Management of a difficult knee problem

Area of Science:

• Orthopedics
• Sports Medicine
• Physical Therapy

Background:

• Chronic disabling patellofemoral pain and instability significantly impact patient function and lifestyle.
• Recalcitrant cases often present diagnostic and therapeutic challenges, with treatments sometimes exacerbating symptoms.
• Understanding the underlying source of pain is crucial for effective management.

Observation:

• A 40-year-old patient presented with bilateral patellofemoral symptoms, including severe right knee pain and left patellar subluxation, alongside left hip pain.
• Initial magnetic resonance imaging (MRI) revealed marked patellar tendon redundancy, leading to patella baja (infera).
• The patient experienced severe functional limitations, struggling even with basic ambulation.

Findings:

• After two years and ten physiotherapy treatments, the patient demonstrated remarkable functional recovery, resuming tennis after 25 years.
• Follow-up MRI confirmed complete resolution of patella baja (infera), suggesting improved quadriceps function.
• Resolution of subchondral bone marrow edema at the lateral patellar facet was also observed, indicating reduced inflammation.

Implications:

• This case highlights the significant effectiveness of persistent physiotherapy in managing complex, chronic patellofemoral pain and instability.
• Clinicians should persevere with challenging musculoskeletal conditions, as substantial patient recovery is possible.
• Successful management leads to profound improvements in patient quality of life and functional capacity.