Clinical case: patient with patellofemoral pain syndrome and wrong operations. 10

Clinical case: patient with patellofemoral pain syndrome and wrong operations. 10

Clinical case: patient with patellofemoral pain syndrome and wrong operations. 10

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Is there a patient story you could discuss? A story that illustrates knee injury topics that we discussed today. Perhaps a composite of clinical cases that you often encounter in your practice. Well, I would like to just recall this story from yesterday. There is an online platform here in Spain. People leave comments about different doctors here in Spain. And I was very emotional because there was a patient I operated on a few months ago. He is 29 years old. He had several surgery operations. He had been looking for help in different countries in Europe. He was not able to walk more than 50 meters without the help of crutches. And he was really in pain. He was using morphine-based painkillers. He had, I think, four or five different surgeries before he came to see me. We provided him fresh osteochondral allograft transplantation. It was very large cartilage transplantation because it was triple cartilage transplantation. This patient wrote yesterday a comment saying that he is now back mostly to a normal life. This treatment could bring him to be functional again. We helped him not only from a functional point of view but also from a psychological point of view. So, that is also very important to consider. When we provide nice treatment solutions, we are not only providing treatment specifically for the knee joint. We are talking about young patients, the young population. This kind of knee problem treatment can provide them with a normal style of life. You are putting them back not only to their physical activity. But you also help from a psychological point of view. They return to normal relationships with their friends and with life. That is the story that I would like to share because sometimes we forget about that now. We focus too much on the meniscus, on the ligament, on the cartilage. But that is just a way to obtain good physical and mental improvement in the patient at the end. Patients don’t come to the office because their meniscus is torn or the ACL is torn. They come because they cannot do a normal life. And you read this kind of positive reviews or commentaries. You just remind yourself that you are doing something good, not just for the meniscus. Again, repairing the meniscus is only a way to get that life back for the patient. And when you read that comment, you feel, you know that you are doing something good. That is true! It is so inspirational to treat holistically. We have to treat the whole patient rather than focusing on an organ or system of the organs. We have to see the forest behind the trees, as you mentioned in our conversation. What was this patient’s initial underlying problem? What prompted him to have several surgeries before he reached out to your office? He had a patellofemoral disease condition. And unfortunately, patellofemoral problems are not sometimes well addressed. He had three different knee surgeries that I didn’t consider good. Those knee surgeries could not provide an improvement in that case. The fourth surgery was done because of an infection. At the fourth surgical operation, surgeons had to clean and to wash the knee. Then the patient’s disease affected not only the patellofemoral joint but also both femoral condyles. Something started with mild patellofemoral pain. But it ended up with a full degenerative condition in the patellofemoral joint and also in both condyles. So in the beginning, when he looked for medical advice, he was only unable to run and to use his bike. And when all that disease process ended, he was not even able to walk and to work. He had been off his work for 18 months at the time when we operated on him. He is still off work because we operated on him 2.5 months ago. But he says he’s willing to go back to work. And we expect him to be back to work after New Year. So in January 2021, I hope. We transplanted the patella and also both condyles. As I said, he is now walking without crutches. We expect his knee function not to be fully restored because he had a very severe knee problem. But at least at some point, he could do some normal life and work. All that underscores the importance of choosing the treatment wisely. It underscores how difficult it is for patients to choose the correct treatment with the correct physician or surgeon, or physician and surgeon. It’s a very complicated process.

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