FIXED my failed lateral release! (Exercises for medial patellar instability)

[DaniHigley]

Hello there everyone!

The last few months have brought a good amount of clarity to my situation (failed mpf ligament replacement). At the advice of Angela, my God send, I traveled to Sacramento to meet with Dr. Jamali. After multiple X-rays and an mri I am happy to say that we have a pretty solid surgical plan in place!

Apparently my new ligament that was replaced in June 2008 (omg almost 2 years!) was put in a bit more tightly than my body would really like. Dr. Jamali is going to lengthen it to allow for a bit more flexibility in the ligament. I am also down to 0% cartilage in some places making it extremely painful to exercise my knee the way it should be exercised. Atrophy of my thigh is still very evident. I will be getting a bone allograph in order to correct this issue. These procedures will be broken out into two separate surgeries.

The first of the two surgeries will take place sometime later this summer. I will be sure to update as soon as I get back! I hope to be back on here soon with a fantastic recovery story to tell! Angela you are fantastic! I will never be able to thank you for all your help and support! It’s amazing what has been set up here on KneeGeeks. Without this I have no idea if I would have ever found such a fantastic doctor like Dr. Jamali and such a fantastic friend like Angela!!!

All the best to everyone on here!!!
  Dani

[Silkncardcrafts]

Hi Dani,

I am pleased that you have found a doctor to help you that thinks he can help resolve your problems.

Do you suffer from medial instability from the MPFL reconstruction ? I am just really curious to know.

I actually had the operation you describe in loosening off the ligament as I had suffered medial instability from a lateral release. Unfortunately the operation did not work, so ended up needing a trochleoplasty to fix my medial and lateral instability of my knee cap. I am pleased to say that it was a complete success. I tried conservative treatment for a long time but didn't fix my problems. My knee surgeon said that usually surgery is the only way to fix medial instability. I had a really bad case. So, had no option to have more surgery, which has now completely fixed the problems.

Must admit I am surprised you have not had a CT scan. It is probably one of the best types of scans for patella problems.

All the best with your surgeries and recoveries.

[acheek71]

Dani, I am with you on how amazing Angela is!!  I am a KG newbie and she and crankerchick (just as wonderful) have both taken me under their wing, and I cannot thank them enough!!  I am so excited to have found a website like this, I just wish I had found it 6 months ago before my lateral release.  But what has been done is done, and it is time to move forward!  I am having my lateral reconstruction in a few weeks, along with a tibial osteotomy, and boy am I nervous!!! I just wish I could strengthen my quad before hand, because I like you I have extreme atrophy!  But I know I am in great hands with the surgeon I have chosen, I am just worried about the 20% fail rate, and having to go through the same process you are going through.  Please keep us updated after your surgery, I really want to know how it goes.  I am now addicted to this site, I could sit here all day and read everyone's stories.  I wish you the best!! 

Silkncardcrafts, when did you have your surgery, and what went wrong?  Just wondering!!!

Thank you!!

[Silkncardcrafts]

Hi Acheek71,

About 9 years after my lateral releases I got medial instability. It was really tough to fix. I had a trochleoplasty on both knees and has fixed my lateral and medial instability totally. So, I am one very happy customer. Still got a fair way to go in my recovery for my right knee, but getting there. Trying to increase my exercise program but have been experiencing a few problems with swelling. So, going back to see my knee surgeon on Friday.

I had the trochleoplasty on my left knee in May 2008 and the right knee done in February this year. So glad that I have such a good OS and never had to go to anyone else to get my knees fixed.

Good luck with your surgery.

[crankerchick]

Having a good OS is so important, as we have all learned. But it's only part of the battle. It also takes a patient willing to do the work and help themselves. It's great that there's a site like this so we can all help and support each other and pay it forward.

Acheek71, you are so welcome, but I can't thank YOU enough for reading all my babble! A lot of people come and go on this site, many who don't really consider the advice they receive (which is surprising, since they asked for it). I think I speak for A too when I say, thank YOU for being open to our help. I'm definitely stoked that you found this site.

Of course, I never need an excuse to go on about that kickass doc of yours. And you know right, you are in great, capable hands.

As far as the failure rate goes, well, in everything there is always a chance it won't work. The key is to have an understanding of the problem and make an informed and educated decision on how to fix it (and who to let help you fix it). That's all you can do. In the end, regardless of what happens, I think as long as you can feel good that you gave it your best effort to make the most logical choice, you will be able to deal with whatever the outcome is, and with no regrets.

For me, I'll be waiting to read your success story

[Carrie Lynn]

Hi, I was wondering if anyone could give me some more detail about med. Patella Subluxation.  I think this is what is wrong with me but, I'm not sure.  I began reading this thread tonight, and although a very great thread, I just can not get through it all tonight!  I will in the days ahead, though.

Anyway, here's a somewhat brief version of my story.  9 months ago I tore my ACL, Lateral meniscus and had a tibial plateau fracture.  This was fixed by an OS I wish I had never gone to.  I ended up with severe arthrofibrosis.  I ended up traveling out of state (to stay with my mom to help with my young kids while recovering) and found a new OS and PT who I really liked.  After lots of PT and no improvement I had a MUA and LOA and I'm pretty sure a lateral release.  Unfortunately insurance only allowed 4 more PT's and then I headed home to rehab on my own until the new OS would see me 3 months post surgery.  Things were going well while I was on my own.  My ROM was improving fast and then I started having issues with my patella.  I would go to the gym and practice going up and down stairs.  Going down I had to hold on to the rails since my quad strength was terrible.  Eventually this is when my patella would feel like it was building up pressure and then POP very painfully.  I stopped the stairs of course but, as time went on it began doing this with any movement that involved bending the knee, usually from a locked knee, while my quads were engauged.  In 9 months there were only a handfull of times that I ever walked without a limp due to the AF and this patella problem.  The doctor I started going to at home never would do anything about it.  He finally said he would do a scope for some other issues I was having.  I decided to go back out of state to my old OS and PT for the surgery.  continued...

[Carrie Lynn]

So, here I am - 1 week post op.  I had more scar tissue removed in the fat pad and around the patella, medial plica removed, repaired med. meniscus, scraped (?) under the patella for grade 3 chondomalacia and manipulation.  Monday was the best day post op as I could walk with a bent knee gait! Then by the afternoon the patella started the mal-tracking again.  Today I went to therapy and it was acting up so she played around with it for a while and realized what I had been trying to tell her and the OS.   After the stitches come out she will tape it and maybe get me into a brace.  Before this she had commented on how much my patella was tilting in.  I looked down as I was standing there and couldn't believe it myself.  It was much more pronounced than the other knee.  Later she did mention how all my "new" problems were medial.

Sorry so long! Could this be from my second surgery or from all the other stuff my knee has been through? Is this medial patellar subluxation?  I only have 2 more weeks here before I go back home and I'm on my own again for rehab.  If anyone has any suggestions for me or anything I should ask my therapist I would greatly appreciate it!  Thanks.

[Silkncardcrafts]

Hi there,

Just because your knee cap is tilting in doesn't mean you have medial instability.

Medial instability is very rare and can sometimes occur after a lateral release or a trauma injury. It can happen though.

If you had medial instability you would definitely know about it. The knee cap goes out of the groove inwards, not outwards like it normally would. It is very painful and is very difficult to fix.

The popping you describe could be meniscus problems, not knee cap issues. It would be best to discuss this further with your surgeon.

[Carrie Lynn]

One important thing I forgot to mention is that in order to bend my knee such as when I sit, I have to literally push the knee cap toward the outside of the knee.  As far as the popping, this is definitely from the patella as it is popping back into the groove and is very painful!  So, yes this is definitelly a medial problem.  The tilted knee cap is just something that was noticed yesterday in therapy - it just looked very odd.  This patella mal-tracking has been my biggest issue since gaining most of my ROM after stuggling with Arthrofibrosis.  Before then I always walked with a very bent knee since I didn't have very good extension. When I had this last surgery I was hoping that removing the scar tissue around the patella and fat pad would have fixed the problem but, it hasn't.  I'm just looking for answers since I haven't always been able to get anything out of doctors.  This time atleast the therapist has seen and felt this problem first hand by holding the patella while I bend my knee!  If she held the patella in place I was able to take my knee from a locked straight leg through a full bend without mal-tracking.  If she didn't hold it, as I bent my knee the patella would go medially until it hurt too much for me to bend anymore - feeling "stuck".  I hope this information helps a little more.  Thanks for the reply.

Carrie

[acheek71]

Hey Carrie!  Sounds like you have bigger problems on your hands!!  You have come to a great place to help you find some answers though!  I cannot speak highly enough of the folks on this forum!  I, too have medial instablity, mine due to a failed lateral release 5 months ago.  I also have some underlying issues that are aiding in the instability.  Sounds like you need to get some more answers.  Is your doctor a patellofemoral specialists?  If not, that is the first thing that needs to change!  I was lucky enough to find a doctor that is wonderful, but I have to drive 4.5 hours to see him....well worth the drive!  I am having surgery in three weeks to reconstruct my lateral ligament and also have a tibial osteotomy.  Where are you from if you don't mind me asking?

Amanda 

[crankerchick]

If she held the patella in place I was able to take my knee from a locked straight leg through a full bend without mal-tracking.  If she didn't hold it, as I bent my knee the patella would go medially until it hurt too much for me to bend anymore - feeling "stuck".  I hope this information helps a little more.

Yikes, that definitely sounds like some bad tracking and definitely possible medial instability.

There are details in this thread somewhere about braces that seem to help and possibly even a method of taping, as well as exercises (see the first post) to assist in regaining some strength to help hold the kneecap in place. But ultimately you need a knowledgeable doctor to help accurately diagnose and treat this. I've seen your posts over in the arthrofibrosis section as well. It seems your problem has been going on for a quite a while. Have you read the AF tutorial on this site? Have you considered a trip to see one of the top AF guys like Noyes? It sounds like you have a lot going on and I just wonder if your problems have gone beyond the scope of the OSes you have seen now.

[Carrie Lynn]

Thanks, Amanda and Crankerchick for the replies!  It's true I have a lot of problems so, I think that's where all the confussion comes in to play.  I found KneeGeeks after my second surgery when I had to return home and rehab on my own.  I have learned so much more from this site than I have from the 3 OS's and 3 PT's I've been to!  It has definitely helped me with AF.  It's these other issues that just seem so confusing because I don't know if they are the result of AF or something else.  The OS who just did my surgery last week is not a patellarfemoral specialist but, one who I really trust and has done the most good for me (and the PT!).  When I went back home to Indiana after my second surgery I eventually got into one of the AF specialists.  I was absolutely dissatisfied with him and the therapist. 3 weeks after I started seeing them everything went bad!  Pain, swelling, clunking, etc. and all they kept saying is that they didn't know why its happening but, that they would do an exploratory scope.  I wasn't comfortable so, I had my records sent to the OS and PT in Florida.  When my PT read my MRI report everything starting making sense.  I had 2 possible meniscus tears (1 moderate), lax ACL, more scar tissue.  Why didn't the well know AF specialist tell me about this stuff and all the times I complained about my patella tracking improperly they never did anything or gave me any explanation. I even asked about taping on the advice of a KG'er and the PT said it doesn't work and he wouldn't try it.  The patella problem was the only reason I couldn't walk without a limp as my ROM was so much better at this point. So, I made the decision to come back to Florida and stick with an OS I could trust.  To make matters worse this year our health insurance changed and everything is costing us way more $$.  I have 4 kids and a husband who travels for work so traveling for medical care is hard except for coming to Florida to stay with my mom.  I do really like my PT, probably more than the OS.  She really know her stuff so while I'm here I'd really like to work on this issue with her.  I'm really glad she wants to do the taping but stitches don't come out until next Wednesday.  She said she will do it then.  Is there any specialists for this condition near Indiana? Is there anything I should mention to her?  Thanks so much.

Carrie

[Carrie Lynn]

I'm stilll reading the thread - very interesting!  ClippedWings mentions how her knee hurt when she used her quads.  The same thing happens to me.  At times it is so bad I can't do quad sets or SLR's.  Also, I had cartlege damage (grade 3 chondromalacia) that I didn't have before surgery #2.  I've noticed that this has been mentioned by others.  I assumed the damage had been done by limping with a bent knee for 9 months.  Or could it also be from the instability I've had since surgery #2?  My PT said she would see about me getting a brace.  They use Don Joy for their braces which sounds like that's a good thing.  Tomorrow at PT I'm going to ask if I had a lateral release during surgery #2, if that could have failed (not really sure what that means yet, though), and if she would recommend the Don Joy Trull Pull Lite.

[Silkncardcrafts]

Hi Carrie,

So sorry to hear what you've been going through.

I really think you need to find a patellofemoral specialist to look at your latest problem. It seems like the AF could be part of this problem. Doesn't sound like the typical medial instability. It may also be that your muscles are just not strong enough yet.

Getting a brace may help but it certainly won't fix the problem.

You probably need to see a really experienced OS that knows how to deal with your issues as they seem to be very complex.

Glad you've got a great PT.

All the best with your recovery.

[WorkinWings]

Seems like in the past 1.5 - 2 years I always start out with an apology for taking so long to reply...Not gonna drag it on, this time, so here goes:

Sorry! 

I am zippin' through not only to say THANKS to all who have recently enriched this thread with your posts, and for your extremely kind words, but today especially to wish Amanda ALL THE BEST tomorrow with her surgery.

Amanda,
You are in fantastically capable, wonderfully caring hands. And you got yourself one very cool (and very funny) dude for a doc, on top of all that! Congratulations on your choice!!
I am very much looking forward to your reports once you come out the other side.
Please let us know here how you are doing, once you are up for it? Also, let me know if there is anything I can do for you. You will be in my thoughts.

My best wishes,
A.




PS - Oh, and Amanda........ we are still scratching our heads over how you were able to ID me!! 
Quite the sleuth you are, girl! I'll never figure it out! LOL! 

PPS - Dani! Haven't heard from you...Did you have your surgery with that mythical creature of a hybrid doc of yours (the one who is half patellofemoral specialist / half patellofemoral patient -- what a marvel!) Pleeeease let us know how you've been? Hoping very well.

PPPS - Carrie Lynn! Were you able to figure things out?? Please feel free to email me: workinwings@gmail.com and I will do whatever I can to help. Hope you are doing better.

PPPPS - Latise and Kirsty! I appreciate your friendship and support very very much, as well as your wisdom. Thank you for gracing this thread with your presence.


Oy! So much for "zippin' through"!! Late late late now....Still, hope I didn't leave anyone out of my telegraphic thanks and good wishes...........