Patellar Instability Archives - Dr. Beth E. Shubin Stein M.D.

Thomas Guardino

July 7, 2018 Beth Shubin Stein

When my experience with Hospital for Special Surgery first began, I was in a poor position mentally and physically, and my outlook on things weren’t the best. I had been competitively playing soccer in the Tri-State area since I was four-years-old. My soccer career included playing competitively in the highest division of the Monmouth and Ocean County (NJ) Soccer Association (MOSA) with the Brick Sharks. From there I played up a year on the Twin County Titans where we climbed to the top of the Mid-Atlantic Premier Soccer league from 2008- 2010. During this time, I was receiving training from elite coaches and trainers, using my older brother as the connection. Such training included private skills sessions with the head coach of Monmouth University. I often attended training sessions and tournaments under his supervision. This helped build my skills and confidence to try out and ultimately make a series of different select teams that drew from the top players in the Tri-State area.

My career continued to the Freehold Storm, returning back to my age on an elite team that was actively competing in premier soccer tournaments along the East Coast of the United States. On this team, I began to experience incredibly painful patellar dislocations to my right knee and eventually on my left as well. Between the spring of 2011 and the spring of 2014, I had experienced 11 patellar dislocations, 8 to my right and 3 to my left knee, each accompanied by a sometimes severe tear in the medial patellar-femoral ligament (MPFL). With this, my dreams of playing competitively in college were crushed as it was time to hang up the cleats for good. At the time, my career at my high school, Christian Brothers Academy, was bright, hopeful, and cut short. As a freshman, I was being seriously considered for the varsity team, an accomplishment only five players in school history have achieved. My chance and placement in school history as the sixth was taken away due to a dislocation during the tryouts. I missed most of that season and went on to play an important leadership role on the varsity team as the starting center midfielder. As only a sophomore, my ability caught the attention of reporters for elite high school sports and I was noticed by competing teams to watch out for. From my high school play, I began to look forward to playing for top division schools in the United States. I was most proud of interest from the University of Virginia, Princeton University, and Monmouth University. Due to further complications, my career was over, and my chances for Division I soccer were shattered.

My knees were in such bad shape that one of the dislocations happened while I was taking a step from grass to concrete, nowhere near a soccer field or the sport. I was told by a local physician that there was a talented surgeon in Manhattan that specializes in knee surgeries, including the operation I was to be receiving. Taking his advice, I had met with Dr. Beth Shubin Stein, someone who would ultimately change my life. When I first met with her, she was welcoming and allowed me to feel comfortable immediately. She knew I was scared and hurting and was quick to ease my nerves. At this time, I was looking for a medical operation to restore a normal lifestyle. I had given up on soccer because it was the reason I was in pain.

Due to a shallow femoral groove caused by improper growth and formation from birth, I had a high-riding patella, prone to dislocation due to my bone structure. The strong muscle contractions that are caused by kicking a soccer ball are enough to pull the knee cap from the socket towards the outside, exactly what happened 11 times. I no longer wanted to play soccer, I just want to be a kid again. I wanted to be able to ride my skateboard again. I wanted to be able to actually play street basketball or football instead of watching from the side, terrified that playing would lead to an excruciating dislocation. Without even thinking, Dr. Shubin Stein told me that I would be back on the soccer field playing without knee braces or worries in about a year. I couldn’t believe that. It was above and beyond any expectation I had.

In Dr. Shubin Stein’s office, she calmly inspected my knee and used X-rays and MRI screenings to determine an operation was necessary. She was the one who taught me about my obscure bone structure. She proposed a position in her case study, which would ultimately decide what type of surgery I would receive. She explained that so many people in my position were receiving a major operation revolving around the bone structure, like a tibial tubercle transfer operation, that were often unsuccessful and included incredibly painful recoveries. She suggested a study to investigate if patients eligible for the major operations could have more success with a ligament operation. As a result, I underwent two MPFL operations in the same year–my right knee in March of 2014, the left ifive months later.

The experience I had at at the Hospital for Special Surgery, with Dr. Shubin Stein, was absolutely incredible. In my office visits, she was always professional and friendly. She made me feel like I wasn’t just another case for her. She built a personal connection with both myself and my father, and it is always a pleasure to see her. Office visits were more fun and beneficial trips to the city rather than dreaded doctor’s office visits. She was always informative and helpful with any questions, and encouraged me to contact them at any time throughout the recovery. Her team, including Amy, the Physician Assistant, and everyone on the nursing and operating staff were flawless. They helped me feel safe and comfortable and as pain-free as possible before, during, and after the operation. They were always there to help and constantly checked in on me.

The overall experience had an overwhelming effect on me. Two years later, I feel great. I am an active individual who loves to skateboard and play basketball with friends. I exercise and stay active as often as I can because it is what I love. This experience changed my life. It gave me back the opportunity to be active and happy. It made me an even better version of myself than I ever was. This experience gave me direction and purpose. Due to the overwhelming effect Dr. Shubin Stein had on my life, it inspired me to pursue a career in orthopedic surgery. I long to be able to give back the feeling of having your life back to someone just like me. I want to be able to help athletes return to their sport, because I know personally how it feels to have what you love ripped away. I long to be in the position to help someone, just like Dr. Shubin Stein and everyone at the Hospital for Special Surgery.

Ava Harrison

February 25, 2018 Beth Shubin Stein

When I was in 7th grade I dislocated my knee cap for the very first time. It wasn’t until I was in 8th grade when it dislocated again and my parents and I knew something was wrong with my knees. I didn’t go to HSS right away because we didn’t know if it would be that serious. We just went to a regular doctor in my town. He did a soft tissue procedure on my leg. A couple months later the other leg dislocated and I got the same surgery I had before on this leg. A full year went by after the surgeries without and dislocations and I was stronger then before. The summer of 2014 going into my sophomore year in high school I dislocated my knee cap falling down a huge hill. That’s when my parents and I decided it was time to see a specialist about this because my knee were not supposed to dislocate after the surgery. When I saw Dr. Subin Stein for the first time she wanted me to get an MRI on both legs to see what the issue was. She concluded that I had patella femoral deformation in both knees and my knee cap didn’t have a groove for the shin bone to sit in the correct place where is should be causing my legs to constantly dislocate. She decided the best thing to do was have a surgery called a Tibial Tubercle Transfer with an mpfl replacement. She had to carve a groove in my knee cap and break my shin bone in half to move it in the correct place. I got that surgery on my right leg in September of my sophomore year. I healed very well after the surgery, but I had to get it done on the other leg as well so I wouldn’t have the same problem again. I had that surgery done this July of 2015 going into my junior year. It was a very hard time for me because of all the physical therapy and having to get strong again but I did it. Its not an easy thing for a 17-year-old girl to have to go through 4 knee surgeries, but I got through it with the help of the doctors at HSS.5

Sarah Perry

February 25, 2018 Beth Shubin Stein

I have dealt with knee pain for eight years and finally decided to take the necessary measures to live a pain-free life. I came to HSS with hopes of being able to run, Irish-dance, take yoga, and have zero pain in daily activities. I have been active in various team sports throughout the years, but the pain increased when I began running three years ago.

My knee pain was unbearable and the subluxations were becoming more common. I made an appointment to see Dr. Beth Shubin Stein to see what could be done with my knee. After a few appointments, X-rays, and MRIs, we decided to schedule surgery for August 21, 2014. Dr. Shubin Stein performed a TTT and MPFL. A TTT, also known as a tibial tubercle transfer or osteotomy, is a bone-cutting procedure. The top portion of the tibia bone is cut, repositioned, and put in place with two screws. An MPFL, or medial patellofemoral ligament repair, strengthens the medial ligament of the patella to better stabilize it. This was my first surgery and by far, one of the most terrifying experiences I have had.

I had knee surgery again in February 2015 by Dr. Shubin Stein. Recovery was long and hard, but with much determination, I finally began running again! I’m slowly getting back to what I love to do and it feels great. I never thought I would be able to run again. I want to thank Dr. Shubin Stein, her staff, all the nurses, and Theresa from the HSS Physical Therapy staff! They truly do amazing things here.

Katherine Trumble

February 25, 2018 Beth Shubin Stein

I first injured myself playing basketball when I had just turned eleven years old. I was side shuffling to block a shot when my right knee locked and I fell down, dislocating my patella. I did not know what happened and when I was told I would be out of sports for some time, I was devastated. Physical therapy and leg exercises helped to strengthen my leg, and I was back to playing sports in three months. It was my first practice back at soccer, when I was dribbling the ball and attempted to cut across another player. I fell again only to see my knee had dislocated a second time.

My parents and I visited a couple of doctors before coming to the Hospital for Special Surgery. That is when I met Dr. Shubin Stein. She told me that I required medial patellofemoral ligament reconstruction; I was nervous being that I was only eleven years old. On the day of my surgery, February 20, 2015, I was worried and scared. Dr. Shubin Stein was great at calming me down and reassuring me that the surgery would be successful. I then was brought to the operating room to begin the surgery. I will always remember her autographing my leg! The first couple of weeks post surgery was difficult. I visited Dr. Shubin Stein every couple of months and each time I was stronger than the last. Her awesome ability to make me feel comfortable and optimistic was a positive.

Now I am almost thirteen, and am back on the soccer field doing what I love. I always knew not to give up, even if some times were more challenging than others. HSS and Dr. Shubin Stein taught me that life can be hard, but you have to get right back up when you fall down. The journey through surgery and physical therapy was long and testing, but in the end all of the hard work paid off. I cannot express enough gratitude to Dr. Shubin Stein and all of the employees at HSS. All of you helped me overcome one of the hardest obstacles in my life I have ever faced. Now I know to never give up, and to get right “Back in the Game”!

Paulette Gangemi

February 25, 2018 Beth Shubin Stein

I just wanted to take a moment and share my story and wonderful experience with The Women’s Sports Medicine Center and Doctor Sabrina Strickland at Hospital for Special Surgery.

As you can see, I am not “local” to NYC. It is an effort to come to Manhattan, but the effort it well worth it.

I have had a lifetime of knee problems starting with a patella dislocation at age 14. In spite of repeated dislocations and unsuccessful surgeries I still managed to ski race in college in Vermont, Rock Climb, Backpack and competitive cycle and mountain bike. Recently in the past 5 years, as I approached 40 years old, I noticed I was unable to do basic life activities and athletics. It was a slow progression to inactivity and very upsetting. Other orthopedic surgeons told me to “stop all activity to preserve the joint” and I was truly at a low point. I was planning on training to become a volunteer ski patroller at a local mountain in PA and after seeing non-HSS physicians this goal seemed so far past my capabilities I had almost given up hope. I decided I was going to do everything possible to remain as active as I could, so I started researching HSS. (Best reputation in the world for Orthopedics, so I thought why not, I have nothing to lose)

I made a list of qualities I wanted in a doctor. I preferred a female surgeon, because I felt they may understand my situation better, I wanted a doctor who skied and understood the “skiing culture” and a doctor who went to a top university and specialized in knee instability. Honestly, I had low hopes of finding anyone who fit that description, until I read Sabrina Strickland’s profile.

My first appointment with Dr. Strickland was totally different then the lifetime of appointments I have had with other surgeons. She took the time to get to know me, my history and what I wanted to do, she understood skiing, that I was an educated patient and motivated. Dr. Strickland made me feel like it was possible to train hard, patrol and prepare for an MPFL reconstruction after ski season.

She ordered custom knee braces which were immediately helpful, ordered PT and monitored my situation closely. I was able to train, get very strong and become a Volunteer Ski Patroller that next season. I had a very successful first season patrolling and recently had the MPFL reconstruction.

Even at 2 weeks post op I could see the difference in where my patella is and how it tracks in my knee. I am now 3 1/2 years out of surgery, passed my Ski Patrol toboggan test (transport) 2 years ago and am more functional than I ever thought possible.

The entire experience at HSS was positive and singularly focused on getting me back to sports. I cannot thank HSS and Dr. Sabrina Strickland enough for giving me my life back and continuing with follow-up care so that I may realize my full potential.

Maureen Suhr

February 25, 2018 Beth Shubin Stein

Since adolescence, I have had knee pain and subluxation and many knee surgeries. Knee pain was a part of my life for over twenty years, but it became increasingly worse to the point where I had episodes of significant swelling every other week. It began interfering with my work, my commute, and limited my activities with my family. I was directed to Dr. Shubin Stein who recommended surgery to improve the alignment and stability of my patella while decreasing the stresses placed on it. When we first met, Dr. Shubin Stein told me that she couldn’t make me pain-free but she would make me feel better. I reluctantly agreed to surgery. I underwent a tibial tubercle osteotomy, medial patellofemoral ligament reconstruction, and De Novo cartilage graft.

It was a long road to recovery. I spent many hours working on my range of motion and strength in physical therapy. My therapists, Glen Rowell, PT of BiCounty Physical Therapy (an HSS Rehabilitation Network Member) and Theresa Chiaia, PT at HSS were an invaluable support system.

Dr. Shubin Stein told me that she would make me feel better but I never anticipated the end result. I feel AMAZING! My knee is better than it was twenty years ago! The experience has been life changing for me. I climbed Mt Crested Butte, elevation 12,162′ and I had no pain. I am a fun mom now! Over the winter I was able to run through the snow and sled and snowmobile with my two young boys. This summer we went to the ocean and jumped over the waves for hours. There is nothing better than hearing my children squeal with laughter as we play tag and chase each other across the yard! I wake up in the morning and I have no pain. I wish I could put that feeling into words but I can’t describe it. Finally, I am IN the game!

Laura Carhart

February 25, 2018 Beth Shubin Stein

I am 27 years old. A few years ago my knee cap was on the left side of my knee and half of my cartilage was gone on the right side of my knee. So my doctor down here told me he could not do it and he sent me up to HSS see Dr. Shubin Stein. She looked at my knee and told me I would need surgery. On April 24th, I had the surgery. Now I feel great walking without crutches, just the brace. She is the best doctor for knee surgery. I thought I would not be walking around without the crutches this soon. It’s been two months and I see her a few times a month. Down the road, she wants to my right knee. I am happy with the surgery and recovery. Thank you so much, Dr. Beth Shubin Stein. You are the best doctor I could ask for.

Seyward Darby

January 16, 2018 Beth Shubin Stein

My left kneecap started dislocating and subluxating in early adolescence, when I was playing soccer and basketball regularly and also growing tall rather quickly (I wound up close to 5’8). Over the next 15 years, the condition was a constant in my life–I lived with the pain when my kneecap popped out of place a couple of times each year. It didn’t hold me back from anything, exactly… I ran 35 miles a week, hiked in the Himalayas and the Andes, and did all sorts of other intense activities. I saw several doctors, but all of them said, “If you can walk, you’re fine.” Some people, they insisted, just had weird knees.

Then, when I was 28, I was walking across my apartment one morning when my knee sublaxated terribly–so badly, in fact, that I could feel pieces of something (cartilage, it turned out) floating around the joint for weeks after the fact, as I struggled to walk even short distances without pain and instability. I had to give up running and wear a brace almost constantly; my left leg became noticeably small as I favored my right. I tried physical therapy, but I couldn’t lift my leg while in a seated position without the kneecap popping out of place; same went for doing leg presses.

Finally, my PT recommended that I go to Dr. Sabrina Strickland at HSS. Within two weeks, I had an appointment. Dr. Strickland came in, took one look at my MRI, and said she could help me. She recommended surgery–specifically, a tibial tubercle transfer with an MPFL replacement and Denovo cartilage implants. I wouldn’t be able to walk for about six weeks while my leg was in a locked brace, and then I would be in physical therapy for several months. It would be a very involved process. But Dr. Strickland said she operated on young women like myself all the time, and that I would be able to resume the activities I so enjoyed. (I should say that at this moment, I burst into tears imagining major surgery; a nurse practitioner kindly came into the room to comfort me and offer tissues.)

A little over a month later, Dr. Strickland and Dr. Beth Shubin Stein performed my surgery. It was bizarre to walk into an operating theater and then, when I woke up, not be able to walk at all. But my care at HSS for the first two days was fantastic; nurses came by my room regularly, not just to check my pain but also offer a smile. A PT taught me how to hop up stairs (I live in a third floor walk up apartment), another showed me how to use an RPM machine, and I was given clear instructions for followup with my doctors.

The next six weeks were very hard–I’d never had major surgery and certainly had never been unable to walk. My fiance was my full-time caretaker, and he was incredibly attentive, even renting a wheelchair so he could push me around Brooklyn a bit each day (I hated being trapped inside). I would hobble on crutches to the local YMCA to do arm and abdominal exercises, trying to keep my fitness up. Dr. Strickland’s office was always available if I needed advice from a nurse.

At six weeks, I saw the doctor and was told I could start putting my left foot back on the ground–and that I was ready to start PT full time. Here, things got great because I met Theresa Chiaia, the best PT at HSS–or, I’d wager, maybe even the world. For the next 14 or so months, I saw “T” twice a week at HSS (an hour commute for me, but well worth it). Bit by bit, she helped me get better; if ever I felt discouraged with my range of motion or muscle strength, she assured me it would improve. She kept in constant touch with my doctors, to keep them abreast of my progress. The day that I was told I could ride a bike at the Y, on my own, felt like my birthday: I’ve never been so excited to work up a sweat! The big goal, though, was for me to be fully on my feet and able to dance at my wedding, which happened to be scheduled for about six months after my surgery. T and I worked hard to make sure I was ready; she even helped me pick out shoes that would make me comfortable and stable.

Things took a turn when, in May 2015, three weeks before my wedding, I was in the Amtrak 188 crash outside Philadelphia. I was in a front car, which flipped over when it derailed; my seatmate was killed. Purely by luck, I emerged with a hurt lower back and ribs; my “new knee,” as I called it, was bruised but structurally sound. Within a day of the accident, Dr. Strickland called me in Philadelphia to check on me and said she could see me immediately. I went in for an appointment and she checked not only my knee but my whole body, offering to recommend a back specialist if I needed one. (Thankfully, that wasn’t the case.) I was extremely anxious that my injuries would set back my PT progress. But the staff at HSS rehab were amazing, and I kept getting better. I danced at my wedding. I hiked (lightly) in Utah a few weeks later. I started riding hills on the bike at the Y, and using an elliptical trainer. One day, for the first time in my adult life, I realized I could do a leg raise without my kneecap popping out. The cherry on top came when I saw MRI pictures: The juvenile cartilage that Dr. Strickland had implanted looked good, and seemed to be growing.

I went for my first run in almost two years in March 2016, when my husband and I took a belated honeymoon to Hawaii. I jogged slowly along the Kauai coastline, thinking there was no better place to celebrate being healthy again. When we hiked the Na Pali Coast, my husband took pictures of me and I texted them to T, thanking her for getting me back on my feet. These days, I work out 5 days a week: biking, using the elliptical, and doing light jogging, in addition to PT exercises that help my strength and flexibility. I feel the best I’ve ever felt: confident, fit, and unafraid that my kneecap might suddenly slip out of place, tearing cartilage as it goes.

To say that I’m thankful for HSS is an understatement. The doctors and PTs changed my life. There’s a reason it’s the best orthopedics hospital in the country. The staff does procedures routinely that other doctors (including ones I saw) do rarely. I’m so glad I got my surgery and rehabilitation at HSS, and I will be singing its praises forever.