Patellar realignment, proximal and distal

[Knee129]

I am a 22 yr old female who underwent surgery for a proximal and distal realignment of the patella.

My knee history...
I have unstable patellas on both knees, but it has always been much worse than my left. I started experiencing problems when I was 12 years old, when a middle school friend kicked the back of my knee as a joke and my left patella dislocated. It recurred a few more times afterwards. I underwent conservative treatment in 2009 (14 yrs old) by doing physical therapy to increase my quad strength to stabilize my knee. I did not play sports in high school due to knee issues. However, I was still dislocating my left knee more and more frequently.

During college, I started powerlifting and have never had bigger/stronger quads in my life. Despite the strength, my left knee continued to dislocate. During a one year period, my knee dislocated 3 times and I finally decided that if I want to have an active and normal life when I am older, I needed to get knee surgery.

The surgery (outpatient procedure)
On the day of surgery, I was given general anesthesia and knocked out for the ~90 min long procedure. I underwent a distal patella realignment (Elmslie-Trillat procedure) which included a tibial tuberosity osteotomy, transfer, and fixation with two steel screws. I also had a proximal realignment that included a lateral retinacular release and MPFL reefing. The surgery was performed through an 8cm long incision site along the left side of my patella. After the surgery, I woke up in immense pain in the recovery room with an immobilizer wrapped around my knee. I was given plenty of painkillers, but it only decreased my pain from a 10 to 7. I had to be moved from the bed to a reclining chair and then onto a wheelchair. Every time I was moved, I cried. If my operated knee bent at all (inevitable because of the weight of of my foot), I would feel an intense and terrible pain that could only be relieved by holding my leg in full extension by the ankle. I was discharged less than two hours from regaining consciousness and went home. I had crutches and was full weight bearing, and I was instructed to wear my immobilizer at all times if I were up and moving around for the next 5-6 weeks.

Weeks 1-2 post-op
The Novocaine in my leg wore off the evening of my surgery and I couldn't sleep for extended periods of time due to the discomfort and pain. The following morning I urinated myself because it was too painful to get from the bedroom to the bathroom quickly. For the next few days, I had to take very frequent bathroom breaks because I'd otherwise urinate myself from hobbling too slowly... I took my first shower 48 hrs after surgery and used a shower chair (this was a must for me). Day 2 post op was the worst day for me, and I very slowly started to feel better. The first week of this surgery was really tough, and I got my stitches out 10 days post-op. I was recovering at home and needed my parents to do absolutely everything for me. I didn't start any hardcore PT after stitch removal, but was given a list of ROM and quad strengthening tasks to do like heel slides, sitting knee flexion, and quad setting. My ROM was at 0 degrees flexion, so it was a long way to go.....

[Knee129]

Weeks 3-4 post op
These weeks went by a lot faster than the first two. I kept doing the ROM and quad tasks daily, and saw vast improvements as each week passed. I was no longer noticing differences in 24 hour timeframes. I switched from crutches to a cane to use for balance, not to bear any weight. At 3 wks post op I somehow had enough strength to do straight leg raises (with pain underneath my patella). I was really surprised and excited, because I literally had no control of my quad muscle 12 days prior. My ROM increased to 90 degrees by 4 weeks post op and I started walking around my house without my immobilizer (with my leg straight) because I was too lazy to velcro it on/off constantly. By that time, I started trying to sit for longer periods of time with my knee bent after doing my ROM stretches. At first it was only tolerable for 5-10 mins at a time before it got too sore, but my tolerance slowly increased with time. At 4 wks post op I was also taking walks with my immobilizer on, and walked over a mile a day without any problems that rest/ice/ibuprofen could not fix.

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I forgot to mention in my previous post that I am taking the entire summer off because I recently graduated from undergrad and will be starting grad school in Aug. I wanted to get a summer job, but I'm lucky that my parents are okay with having me at home and taking care of me.

[Knee129]

Week 5 post op
I saw my doctor for a second follow-up appointment today, one day shy of my 5 wk post op mark. He checked my ROM (~115 degrees) and saw that I could do straight leg raises. He said I could start walking around without my immobilizer anymore! I expected to spend 6 weeks in an immobilizer, but I am very glad that I got early clearance to start walking normally, but slowly. I still use my cane for balance, but I try not to depend on it too much. I am allowed to begin PT now, and will begin in two weeks since I will be traveling next week. Since I'll be traveling alone, I made arrangements for wheelchair assistance at the airport and requested bulkhead seating so I could have a little bit more room to extend my leg occasionally during the flight.

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I hope these posts are helpful for anyone who is considering patellar realignment or also recovering. Of course, each individual's recovery is unique, as I am 22 yrs old and have the opportunity to take extended time off this summer. Nonetheless, this recovery has been a lot tougher than I imagined. I spent the first two weeks of my recovery very sad about living a suddenly inactive life, where I would spend every day either in bed or on a couch. I'm only starting to mentally feel like myself again. I am humbled by all the other posts of the Kneetalk community, as they have offered me so much perspective and hope during my recovery. I'll remember to post again when I have more updates, but in the meantime I hope whoever that is reading my posts feels better, no matter what knee problem you are dealing with.