What can I do for knee lock due to hyperextension?

Question

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.

Answer 1

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.

Answer 2

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 sometime 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 a 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 a 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 the 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), or muscle relaxants like Thiocholchicoside.

Answer 3

Hello,

Welcome back to iclniq.com

Did they tell you anything about the intraoperative range of motion when you were under Anesthesia? (We do tell the intraoperative range achieved here, for eg 0 to 120 degrees). Also, did they do a tracheoplasty ( for fitting in the patella or knee cap)?

I understand that you must be in pain. But, you need to be very aggressive on the knee range of motion. The more range you achieve in a couple of weeks, the better it is. You can request your doctor to give you a patch of Buprenorphine (which helps to control the pain) so that you can bend your knee pain-free.

Take care, and recover fast and well.

Thank you.