Posted 9/25/2016 5:37 PM (GMT -7)
Working with your pain mgm physician on a referral to a sports-medicine physical therapist seems like a strong idea to work towards in your upcoming visit.
The patella (aka "knee cap") is a small sesamoid bone that lies in the tendon of the quadriceps muscle. The patella provides mechanical leverage to the quadriceps muscle, enhancing the efficiency and strength of the quadriceps. That is, the patella places the quadriceps in an angle such that the physics of the quadriceps muscle is improved and enhanced.
People without a patella report similar symptoms and complaints that you have. Instability of the knee, pain, swelling/inflammation. The knee, as a hinge joint, relies solely on the muscles and ligaments that surround the joint. There is inherently no bony stability to the knee joint as there is bony stability to the hip joint, for example. The knee joint depends on muscular strength of the quadriceps (anteriorly) and hamstrings (posteriorly), as well as the anterior and posterior cruciate ligaments and medial and lateral collateral ligaments.
That you are hyperextending the knee is likely due to muscular weakness. Hyperextension of the knee, repeatedly, causes ligamentous laxity that then promotes continued hyperextension. The hyperextension problem increases - in both frequency and in the degree of displacement of the femur in relation to a fixed tibia.
It could well be that your knee pain (bone pain), swelling, and cases of hyperextension would ease given attention to a monitored and graded program with a sport-medicine minded physical therapist.
This is not to say that you should not pose the need for pain management support . . . you should be discussing your needs for pain control with your pain management physician.
But I am suggesting that surgical removal of the patella does dictate the need for a focused physical therapy program. The quadriceps muscles is at a mechanical disadvantage without a patella. Muscle re-education and strengthening is vital for the knee after resection of the patella. Little wonder that you knee is sore, hyperextending, and swollen.
While your pain management MD can ameliorate your pain in the short-term, the long-term management will entail a qualified physical therapist that will strongly work 1:1 in partnership with you.
I am a physical therapist by profession and would be happy to query any concerns/questions that you may have of any PT who works with you. As with any profession, there are good physical therapists and less than good physical therapists. Trust your instinct. If a PT is not a good fit for you or if the sessions and advice just feels "off," look elsewhere until you find a PT that you feel comfortable with and who is skilled in the skill set that you need.
- Karen -