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Knee cap popping out of place laterally (subluxation)

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Knee cap popping out of place laterally (subluxation)

Old 07-16-11, 08:51 PM
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Knee cap popping out of place laterally (subluxation)

Okay, so that knee pain I keep posting about on here while riding? I think I figured out what's causing it -- and it's not the bike fit.

Short story:

My knee cap is sliding out of place laterally (not completely dislocated), and then when I bend my knee straight, it "pops" or "snaps" back into place. This constant popping in and out is causing minor swelling, which is the pain and fullness I'm experiencing. Has anyone had this, and how did you cure it?




Long story:

As you may have heard me mention fifty times in other posts, I haven't been able to run for 7 months because of medial bone bruises in both knees on the bottom of my femurs. I have still been able to bicycle, however recently I've gotten pain in the outside of my right knee (not where my running injury is -- this is different).

I couldn't quite tell if it was an IT band problem or a quadriceps ligament issue because the pain was kind of hard to locate. So I stretched, I foam-rolled, and I went through every bike setup I could, thinking something was weird with my fit.

For some reason, I never thought to associate the constant kneecap popping in and out of place with the pain or "fullness" I felt. You know when you get a shot, and you feel like that area has fluid in it? That's sort of what my pain (I lose that term loosely) was like.

Anyway, I finally put two and two together and think I figured out the reason this pain is occurring.

About 3 months ago, I was doing all sorts of knee exercises for my running injury -- the bone bruise -- because at the time I thought it was something other than a bone bruise. During this time I was also riding my cheapie Wal-mart mountain bike, and feeling no lateral knee pain.

Once I learned that the running injury was a bone bruise, I quit doing the exercises because for a bone bruise, you want to limit the amount of movement or stress in that area so that it can recover.

Well, a month or so after I quit doing those exercises, lo and behold, my kneecap starts popping in and out of place. The only difference I could immediately think of was that I had now gotten a road bike, and of course it had to be the road bike's fault. So I'd ride, feel pain, and then take a few weeks off and give it a try again.

The key insight came today when having not ridden for a week and a half, I suddenly felt the lateral knee pain. I thought "Now how did this come about -- I haven't even been cycling?"

So my conclusion is that the pain is due to my weakening quad muscles since I have been doing almost no activity related to walking or running in order to keep them strong. Anyone think this sounds reasonable?

I'm a little bit worried now though, because I read on a few websites that every time the kneecap slides out of place, it causes irreversible cartilage damage. But mine hasn't popped out to such an extent to cause extreme pain (unable to walk) like those websites say, so I hope I'm okay.

Well, in a couple of weeks I'll see my orthopedic doctor about my running injury, and I'm getting a new MRI so I guess I'll be able to see if this caused any permanent issues.

If you're still reading, I appreciate it so much! Bike Forums is about the only place I feel comfortable rambling on about myself because of all the kind advice everyone gives (you know, like HTFU). So thanks!
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Old 07-16-11, 09:01 PM
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Don't guess. Don't read websites. Go to a sports Doctor.
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Old 07-16-11, 09:03 PM
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Originally Posted by Machka
Don't guess. Don't read websites. Go to a sports Doctor.
Well, yeah... I mentioned that I was going to one (actually about 3) on a constant basis.
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Old 07-16-11, 09:08 PM
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I do knee/quad strengthening exercises for my chrondomalacia patella. You might want to try some.

https://www.sportmed.com/pdf/Chondromalacia.pdf
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Old 07-16-11, 09:12 PM
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Originally Posted by Velo Gator
I do knee/quad strengthening exercises for my chrondomalacia patella. You might want to try some.

https://www.sportmed.com/pdf/Chondromalacia.pdf
Chondromalacia patella? That's what I *thought* I had for 4 months until I saw an actual orthopedic surgeon. The first diagnosis I got was that my cartilage was worn all the way to the bone (Grade IV) and that it was permanent. The orthopedic surgeon dismissed this immediately fortunately.

Even though yours is a different injury, what specific exercises do you do? My trainer recommends closed chain exercises to limit impact on the bone bruise, but its always good to hear what works for others.

Last edited by Runner 1; 07-17-11 at 02:36 PM.
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Old 07-16-11, 09:16 PM
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Originally Posted by Runner 1
Chondromalacia patella? That's what I *thought* that I had for 4 months until I saw an actual orthopedic surgeon. The doctor I was seeing initially didn't exactly know how to read MRIs and he said my cartilage was worn all the way to the bone (Grade IV) and that it was permanent. The orthopedic surgeon dismissed this immediately fortunately.

What exercises do you do? My trainer recommends closed chain exercises to limit impact on the bone bruise, but its always good to hear what works for others.
Well, my orthopedic surgeon initially said things weren't tracking properly and my kneecap was misaligned. I wasn't having pain but kept hearing a click going up stairs. He said I could continue exercising as normal just adding in the exercises I posted and icing.

Unfortunately, over the past 3-4 days, I've developed a pretty bad medial pain (left side of the right knee). So until I can get back to to doc, no more running and probably just light cycling.
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Old 07-16-11, 09:32 PM
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Originally Posted by Velo Gator
Well, my orthopedic surgeon initially said things weren't tracking properly and my kneecap was misaligned. I wasn't having pain but kept hearing a click going up stairs. He said I could continue exercising as normal just adding in the exercises I posted and icing.

Unfortunately, over the past 3-4 days, I've developed a pretty bad medial pain (left side of the right knee). So until I can get back to to doc, no more running and probably just light cycling.
Aww, that's not good .

Hopefully it's not really Chondromalacia (actual cartilage degradation as confirmed by MRI or arthroscopy) but if it is, there's a lot of things you are able to do (I spent months researching it when I thought that was my injury).

My first doctor initially gave me cortisone injections. When that didn't do anything, he tried Synvisc, which also didn't do anything (since there wasn't any cartilage damage). But supposedly, both of these can provide a lot of relief for Chondromalacia -- even though they don't actually repair the damage.

In addition, Glucosamine Sulfate is frequently recommended. Studies are mixed on whether it helps restore cartilage or not, but it certainly doesn't hurt anything. I also read a book called Saving my knees that details one guy's theory on cartilage reparation. His idea makes sense (constant movement incites chondrocytes to form new cartilage) but I can't personally vouch for it.

And for worst case scenarios, there's microfracture, ACI surgery, cartilage grafts, and if NONE of those work there are experimental stem cell therapies that you can get in Europe that have promising clinical trials.

Like I said, I hope yours isn't really a cartilage issue, but if it is, the above about covers my research on the subject.

I hope you feel better.

EDIT: Actually, I just noticed the link you posted. I don't know how I missed that the first time. Your problem may actually be Patellofemoral pain syndrome, which means there is not necessarily physical damage yet. This is often confused with Chondromalacia and the two terms are frequently used interchangeably, but they have very different meanings and implications. PFPS is simply an umbrella term used to describe any sort of pain in that part of the knee, and could be the result of many different causes. Chondromalacia is diagnosed by X-ray, MRI, or arthroscopy, and requires actual damage to articular cartilage to be observed. Chondromalacia can actually be diagnosed without any pain being felt.

Last edited by Runner 1; 07-16-11 at 09:43 PM.
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Old 07-17-11, 09:15 AM
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I stopped riding for about 10 years in the mid '90s. I had always had problems with my patella tracking, but it got so bad that I could barely walk up stairs. Went through the local sports orthopedic surgeon and physical therapy, but the exercises they had me do hurt too much. I finally fixed it by swimming and wearing a Cho-Pat strap while riding
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