Continued Pain After Maquet Procedure

Question

Dear TAI Experts:

I had a maquet procedure done in 2006 for chondromalacia, how do I know when it is no longer functioning? I am having a great deal of pain in my quadricep muscle, like a twisting tension… is it a sign of failure?

Answer

According to the articles I have read concerning the maquet procedure it sounds like you met 2 of the 3 standards for increasing the likelihood for having a good outcome with the surgery: 1) age under 31.5 years 2) at least grade I med/lateral chondromalacia and 3) 2 dislocations prior to surgery. From what I have gathered, it appears they keep the lateral structures of the knee intact and preserved. However, they suture the inner quad muscle to the patella (if needed). They also state the average elevation of the tibial tubercle for the procedure is 2 cm to decrease the force by the quads through the patellar tendon, and therefore decreasing the forces of the patella on the femur during movement. Did you have good response to physical therapy following the procedure in decreasing your pain and attaining normal range through the knee? I would also question whether you have continued an active lifestyle and are continuing to strengthen/stabilize and stretch the knee structures following surgery (even multiple years following surgery). You may consider visiting a local physical therapist in the area to take a quick look at you to point out any obvious things that could be normalized (if something has changed since you were last in physical therapy). Your pain could be caused by many things at this point, including, but not limited to, decreased flexibility, decreased strength, decreased patellar mobility, tibiofemoral joint mobility, and/or functional strength/mechanics with activity. At this point I would suggest a good home program focused on good flexibility and strength of the hamstrings and quads, and avoid certain repetitive activities and/or strenuous activities that create/increase your pain. For example, performing multiple deep squats into painful range will move the patella over the tibiofemoral joint and likely cause pain. Again, I am not sure what activities cause you pain specifically. The twisting tension you describe may be as simple as quad flexibility limitations. I would recommend you visit a physical therapist who could distinguish why you are having this continued pain, and they will be able to start a program specific to your needs/impairments.

Krista Vigeland PT, DPT