Broken Patella and Living with Chronic Pain

[Arzny]

Hi guys,
Apologize for the wall of text, but I am looking for some advice/ people to vent to.

I broke my patella almost 9 months ago after being kicked by a horse. My ortho at the time told me I would not need any PT after the injury healed due to the fact that I “was a kid and so active”, so healing would be “no issue.” However, my patella has never actually healed.

Fast forward 9 months later, and I am experiencing an extremely sharp pain at random times, as well as when doing certain activities (riding, walking up stairs, pushing on gas pedal, etc). This pain is accompanied by a dull burning on the inside of my knee. I was never checked for any ligament damage after the injury, along with several other huge mis-managements of this injury.

Recently I went in for a second opinion because this amount of pain is getting ridiculous, and if I cannot stand in the arena to teach a lesson, or ride more than two horses a day, then I do not have a good quality of life. They confirmed that my patella is still broken near the top, however, I was told by this doctor that since “‘it is just pain, and I can do what I want with it’, he will prescribe PT”, but not much else. I feel at this point that my pain is being ignored, and I really don’t know what to do. Any advice on dealing with these doctors, as well as how to deal with it while riding?

TL;DR: I broke my kneecap, its not getting better, and doctors are not offering ways to heal or reduce pain. Any suggestions?

Thanks in advance!

[Kyrabee]

:no::(.

Find another Dr. What is the PT this doctor proposes supposed to do? You need to be your own advocate and ask questions and be assertive (without being aggressive).

I have found that many orthopedic surgeons (through personal experience with lots of skeletal problems) are only mechanics…they lack people skills and are very short on information. NOT all. There are good ones that care. It sounds like you need to keep looking and find that one.

Good luck.
Susan

[horsegal301]

As someone who is 9 months out from a meniscus surgery gone wrong (more tears, flaps, effusions, yay!)… see another doctor and keep doing so until you find someone with an answer you like.

It is so hard to find a doctor these days who cares - they are so focused on getting older patients in and out that they barely have time to look at you and have a real conversation with you. I’m on my 4th. I contacted someone out in Colorado (totally across the US for me), because he was the one person people continued to ask about and I’m waiting for more info… I’m sick of waiting to find someone who cares. I can’t do anything and I’m not even 30!

Name is Robert LaPrade, you might want to see if there’s anyone at the Steadman clinic who specifically deals with knee cap issues if you’re near there… It might be worth looking into.

You should have started PT before, but it wouldn’t have done much if part of it was still broken. PT now still probably won’t help if it’s still broken. The dull burn you talk about sounds like arthritis. Can you ask for an X-ray and and MRI to see what’s going on with everything else in your knee? Knees are complicated.

I cannot stress enough the importance of continuing your journey in finding another doctor who cares. Write down ALL of your pain. Make sure you stress that this is something you can’t live with!!! because then they start to pay attention. When it affects your day to day abilities and quality of life, their ears start to perk a little bit more because that’s easier for them to do something and justify it with insurance. (Note - look into medical necessity/insurance and see how that works ) Don’t take no for an answer, don’t let the administrative assistants you talk to on the phone bully you around, write down the names and times and what you discussed with each person. Get your previous imaging and operative report from the surgery, bring all those to new doctor – make copies so that you have them readily available.

Riding? I wish I could tell you. I’ve attempted to ride twice since last March. It hasn’t worked out yet.

[Arzny]

@Kyrabee;8480442

:no::(.
What is the PT this doctor proposes supposed to do? You need to

Thanks Susan,
This is a second opinion. The first doctor has some huge mismanagement issues with the stitches and just not being a good communicator.

The PT is meant to be strengthening the muscle around my knee, as I still have some severe atrophy from being in the immobilizer for months. However, this PT is not treating the fact that I still have a broken bone, which he claims could mean that I was born with my kneecap like this. However, there are x-rays before this injury with my kneecap completely closed.

[Foxglove]

I second “get another opinion.” Due to various reasons, I have two artificial patella (patellae?)–I have no pain and my knees now work --they were pretty bad before (imagine stiff from hip to ankle). And I’d do a whopping lot of web research yourself so you know what’s out there.

FYI orthopedic surgeons (I know 4 --two are in my hunt club) are not the most warm and friendly people, in my experience. My daughter who is an OR nurse and for awhile worked extensively with the orthopedic guys at her hospital (no women orthopedist there) said they were, as a group, arrogant. Neither of the 3 who worked on me (shoulder, hip replacement, double knee replacement), had any kind of bedside manner --just looked at me, xrays, and discussed options --one even discussed options with a colleague as if I wasn’t even in the room --but he’s a great surgeon (according to my daughter and my results).

Be your own advocate --get as much information as you can --and be the squeaky wheel.

If they totally replaced your knee --you might be pain free --I am.

Foxglove

[Arzny]

Horsegal301
Thanks for your advice! I think part of it is that I feel as if i cannot advocate for myself, as I am technically still a minor (18), and have to depend on my parents. (My mother believes that the doctors know what they are talking about, but is slowing coming around to realize the mismanagement this injury has had.)
I had a list of what/when was causing pain, and the PA and ortho both did not care to look at it.

I guess I will be looking into another doctor then.

Foxglove, the seem very reluctant to cut into my knee due to my age, but they are not offering any other options. He said if PT doesn’t help anything then he said they will look into surgical options.

[Arzny]

Horsegal301
Thanks for your advice! I think part of it is that I feel as if i cannot advocate for myself, as I am technically still a minor (18), and have to depend on my parents. (My mother believes that the doctors know what they are talking about, but is slowing coming around to realize the mismanagement this injury has had.)
I had a list of what/when was causing pain, and the PA and ortho both did not care to look at it.

I guess I will be looking into another doctor then.

Foxglove, the seem very reluctant to cut into my knee due to my age, but they are not offering any other options. He said if PT doesn’t help anything then he said they will look into surgical options.

[horsegal301]

[QUOTE=Arzny;8480724]
Horsegal301
Thanks for your advice! I think part of it is that I feel as if i cannot advocate for myself, as I am technically still a minor (18), and have to depend on my parents. (My mother believes that the doctors know what they are talking about, but is slowing coming around to realize the mismanagement this injury has had.)
I had a list of what/when was causing pain, and the PA and ortho both did not care to look at it.

I guess I will be looking into another doctor then.

Foxglove, the seem very reluctant to cut into my knee due to my age, but they are not offering any other options. He said if PT doesn’t help anything then he said they will look into surgical options.[/QUOTE]

PT absolutely won’t help if part of your patella is broken. I went through the same thing. My PT gave up on me, told me it wasn’t worth fighting insurance anymore because my knee wasn’t getting any stronger. She believed something was wrong and more PT wasn’t going to help. Turns out, it was never fully fixed in the first place! It will provide you minimum relief, but if there’s still something majorly wrong there, you’re never going to be 100%.

Doctors will absolutely try to not go back into your knee, especially at your age. The more they screw around with it, the better the opportunity for arthritis, which will just get worse as you get older. You also have to think about how serious surgery is, especially at a joint. Surgery always comes with complications, and doctors will be vary, vary wary about going back into a knee someone has already been in.

I hope that maybe showing your mom this thread would help - I made two other posts about my “epic knee saga” here in my quest for a doctor that I’m satisfied with (still not quite there yet…). Being in pain isn’t something you should live with, especially at your age, because you’re about 10 years younger than me, and I wouldn’t wish this kind of pain on anyone. If you’re in pain now, imagine wanting to do things like run, ride, do jumping jacks, or even skiing in your mid thirties to forties. Does it seem possible? Does it seem like your doctor is thinking of your future? If not, find a doctor who will.

I would absolutely recommend joining the “We are Knee Geeks” group on facebook if you use it, and also looking into the Knee Guru forums. They have all gone through similar issues and will be able to offer you valuable feedback as far as what you should be doing next.

[Arzny]

@horsegal301;8480786

Doctors will absolutely try to not go back into your knee, especially at your age. The more they screw around with it, the better the opportunity for arthritis, which will just get worse as you get older. You also have to think about how serious surgery is, especially at a joint. Surgery always comes with complications, and doctors will be vary, vary wary about going back into a knee someone has already been in.

If you’re in pain now, imagine wanting to do things like run, ride, do jumping jacks, or even skiing in your mid thirties to forties. Does it seem possible? Does it seem like your doctor is thinking of your future? If not, find a doctor who will.

My injury was never operated on, sorry I was not clear about that. The stitches were from a huge pressure cut from being kicked.

I have already quit running (I was going to play college lacrosse), and riding is a horrible experience, especially the flatter the horse moves. Fox hunting is also pretty much out of the question, unless I wish to live on NSAIDs, but I am too young to be on daily ib-proufen, or something similar. However, my job (basically a working student) is to ride right now, so I just suck it up and get going. This seems to be the major problem for me, my ability to deal with it. It seems that the doctors are unwilling to provide help because I can deal with it. I imagine that in my 30s or even earlier I will be unable to do any of these, will it potentially getting worse. Even sitting in class right now my knee is hurting, but standing doesn’t offer much relief either.

I just requested to join the group, thanks!

[horsegal301]

[QUOTE=Arzny;8480986]
My injury was never operated on, sorry I was not clear about that. The stitches were from a huge pressure cut from being kicked.

I have already quit running (I was going to play college lacrosse), and riding is a horrible experience, especially the flatter the horse moves. Fox hunting is also pretty much out of the question, unless I wish to live on NSAIDs, but I am too young to be on daily ib-proufen, or something similar. However, my job (basically a working student) is to ride right now, so I just suck it up and get going. This seems to be the major problem for me, my ability to deal with it. It seems that the doctors are unwilling to provide help because I can deal with it. I imagine that in my 30s or even earlier I will be unable to do any of these, will it potentially getting worse. Even sitting in class right now my knee is hurting, but standing doesn’t offer much relief either.

I just requested to join the group, thanks![/QUOTE]

My bad, I definitely read that as you had surgery before! I’d say a life on NSAIDs is a horrible idea, only because I know someone who was very near and dear to me who took them all of her life for pain and now has extreme liver damage.

Hopefully you can get approved quickly - I wish I could approve memberships to get you in quicker, but you should be in within a few days, if not hours.

[pony-girl]

Where are you located? Maybe some of us knee survivors could recommend doctors in your area? Looking at this on my phone so I’m not sure if it’s in your profile. As someone in her late 30s now who had patella dislocations as a teen I can tell you that once a knee is injured it causes trauma that may re-emerge later on. I can tell you I wasn’t happy with how my Mass General Hospital surgery went. I’m looking at Brigham and Women’s Hospital orthopedics now for a repair of that surgery. PT won’t help if your bone is still broken. You may need pins to stabilize the pieces and wear an immobilizer to keep pressure off while it heals.As a rule of thumb bones take 6 weeks to heal but the leg takes a little longer because it takes all the weight bearing of your body. Absolutely DO NOT just live with it. That will only cause more damage to the joint. Pain is the body’s way of telling you somethings not right.

[Arzny]

Pony-girl,
I am in North Alabama. However, the kneecap is a non-weight bearing bone, and it was kept immobilized for 6 weeks, and still did not heal fully.

I have started PT for the knee, although some appointments were cancelled due to the snow, they seem to be focusing on building up muscle around the knee, and just pushing through the pain, which I feel is very wrong, but any time I attempt to speak up about it, I am just told that it is “normal” and “okay”.

[Calamber]

I think you need some better physical therapy as in the use of cold laser therapy at the very least. See if you can find a doctor who knows something about that. you need to get that kneecap healed and then you can better tolerate and benefit from the other part of the physical therapy for strengthening muscles and ligaments.

[pony-girl]

[QUOTE=Arzny;8499054]
Pony-girl,
I am in North Alabama. However, the kneecap is a non-weight bearing bone, and it was kept immobilized for 6 weeks, and still did not heal fully.

I have started PT for the knee, although some appointments were cancelled due to the snow, they seem to be focusing on building up muscle around the knee, and just pushing through the pain, which I feel is very wrong, but any time I attempt to speak up about it, I am just told that it is “normal” and “okay”.[/QUOTE]

There is some pain that needs to be worked through, like range of motion exercises and even some muscle atrophy that needs to be built up, but if it feels like the pain isn’t in the muscle or from swelling (which rom helps reduce) then I would insist on further imaging. I had to insist on an MRI because I knew that the pain I felt was not “normal”. That’s when all the damaged cartilage showed up. I think the doctor was resistant to me getting an MRI because that proved the first surgery not only failed but caused more damage because of bad alignment/tracking of my patella. The pain you are having might not even be from the fracture itself but from soft tissue damage. You won’t know until you get further imaging. Then google the hell out of the results. Keep us updated and good luck!

[hoopoe]

were either of the orthopods someone who specializes in athletes?

That is where I would go for a third opinion

[Equisis]

^^ find someone who specializes in athletes, and don’t give up on it. I am 26, a horse professional, and living with several chronic injuries due to a lack of management when I was younger. Some was my fault (young and didn’t allow myself the proper healing time) but some is due to lack of proper treatment as a kid and doctors ignoring/writing off the issue. I also have a high pain tolerance and this can make it harder to get taken seriously as well (sounds like this might be part of your issue). Finding a doctor who specialized in athletes and understood the demands of my lifestyle made a big difference, but it would have made a much bigger difference if I did it ten years ago.

[bonstet]

I broke my patella in a fall about 12 years ago. It healed fine, but I do have occasional pain which I think is due to cracked cartilage behind the bone. I did not have any ligaments involved in the injury.
I agree with the others who say you need a second opinion. Pushing through the pain is for when your patella is healed and any tears to the surrounding ligaments have been ruled out. Good luck and I hope you feel better soon.