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Q. Due to wrong twist, my knee got locked in hyperextension. Please help.

Answered by
Dr. Manav Gupta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 28, 2020

Hello doctor,

My knee is locked in hyperextension. I had an injury on my knee had lateral damage that was fixed by knee scope. This was successful, however, about two months ago, I twisted the wrong way and my knee got caught in hyperextension. I saw my Orthopedic surgeon and he told me I had a high rise patella and Chondromalacia. We did Synvisc and cortisone and physiotherapy. But my knee is still caught in hyperextension and cannot fix it. I am only 32 years old so I need my mobility but now I am in pain and can barely move any thoughts? Right now I am on Naproxen, and Tylenol.

#

Hello,

Welcome to icliniq.com.

From what I can read and understand by the brief history you have given is that there can be damage to ligaments and meniscus in your knee. Can you please elaborate on the range of motion of your knee? If it is barely movable it means that probably some tissue (either meniscus or soft tissue) is stuck causing block to the range of motion.

Also are you having hyperlaxity? Generally people who have hypermobile joints tend to go for hyperextension. Also, kindly update the details of your surgery. Was there ACL reconstruction as well? As you pointed high rising patella, patella alta is more responsible for patellar dislocation/subluxation rather than knee hyperextension.

Do attach a copy of the MRI you have.

Thank you doctor,

Everything is intact, that is the issue. It does not make any sense. I have no motion it is like it is stuck there in hyperextension. There is some scar tissue on my PCL in my older surgery they removed the lateral plica in my knee.

My MRI said my meniscus and all ligaments are intact. But I have a high rise patella. The doctor seems to think that my patella might be getting caught on my femur?

#

Hello,

Welcome back to icliniq.com.

Yes, it does not make any sense. There has to be some sort of arthrofibrosis (scar tissue) in the knee joint and contracted capsule responsible for your condition. If you were immobilized for quite some time after your injury/surgery, it could possibly lead to this.

In this scenario, you need to go for arthroscopic adhesiolysis (release of scar tissue). Another possibility could be tight quadriceps along with the stiff knee.

MRI (magnetic resonance imaging) is not always 100% accurate, it is just an aid to clinical diagnosis (more of confirmation). Even if you have a high rise patella, it should not be causing locked knee. There is a definite solution for high rise patella which depends on tt/tg ratio and various indices. It could be distalisation of the tibial tuberosity with or without antero medialization (surgery).

In basic terms high rise patella means patella is above the groove which means it can slip laterally and dislocate but should not be causing a locked knee. There is no compulsion to go for this surgery unless you have recurrent dislocation of the patella (not in your case). My sincere advice would be to see an ortho surgeon and possibly go for repeat surgery followed by aggressive rehabilitation.

Until then you can go for TENS, IFT (electrotherapy to reduce pain), muscle relaxant like Thiocholchicoside.


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