Here is a look back at the article I wrote for Fall-line Ski Magazine check them out at www.fall-line.com
This month the case study is a little different. It’s not about some tragedy or horrible injury on the ski slopes (or even in trying to get your oversized bags at Chambery airport!) This is a bit of a feel good story of someone who had always wanted to go skiing and just couldn’t because of the issues with their knees, but we got them there (after a lot of work!)
Let’s call this person Lottie (not their real name). Lottie had since about the age of 10 had issue with her knees. It started at school at PE and she had dislocating knee caps. This is not as uncommon as you think and can be linked to lots of different problems. Sometimes this happens after an injury where the knee cap is physically forced out of the groove it runs in and stretches all the structures holding it in. As these structures no longer function in helping to guide the knee cap, it can keep dislocating. For example, I have many patients who have been hit in a tackle playing rugby that dislocates their patella. The majority with some rest and physio get back to normal and have no further problems. A small proportion go on to recurrently dislocate. This traumatic type tend to be older.
Lottie however just happened without a specific injury. This is much more commonly found in young girls who are hypermobile (very stretchy, elastic ligaments and tendons), who have a family history of knee cap problems, have knock knees (valgus) and in toeing (internal rotation of the feet). All of these things Lottie had and worse. When we scanned her knees she had no groove at all for her knee cap to run in. Because of this even normal activities like running quickly for a train or getting to quickly up out of bed meant her knee caps dislocated, let alone skiing. She was desperate to live her life and jealous of her friends at university enjoying a ski holiday and having fun.
We set off on a year long course of multiple surgeries. First we had to do what’s called an de-rotation osteotomy to correct the amount her femurs (thigh bone) were turned in. This needed us to make a controlled break in the bone above her knee and turn her leg nearly 30 degrees. This was held with a special carbon fibre reinforced plate and screws in the bone. After another 2-3 months we went back in to complete the surgery. We had to make a new groove for her knee cap to be able to run in. This is complex surgery called a trochleoplasty. We had to open the knee to see the joint and create a whole new knee shape. This is done by removing bone under the smooth shiny cartilage and then pushing the surface above in to this to new shape and holding it there to heal. We also had to do a ligament reconstruction to re-create the structure stretched when the knee cap had dislocated in the past (medial patella-femoral ligaments). Finally, we had to take the attachment of her patellar (knee cap) tendon where it attaches on to the shin bone and move this to allow the knee cap in its new groove to run in a straight line. This is held down with 2 screws.
Although a 2-hour complex surgery, Lottie brushed this off with surprising ease. On returning to clinic in 2 months after, she was doing amazingly well. Her wounds had all healed and her knee bending well and her knee cap nice and stable and moving normally. No more dislocations, no more thinking about how to move. Although a long process, the results have been amazing and make doing my job worthwhile to see such amazingly motivated and resilient people make such incredible recoveries.
After a year from our first surgery and after lots of hard work and physio, Lottie finally went on her first ski holiday. Sending me pictures of her snow plowing down her first blue. Something she though would never be possible. Well done Lottie.
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