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Author Topic: Revision of a revision + PLC procedure  (Read 1488 times)

Offline kpoppy

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Revision of a revision + PLC procedure
« on: July 08, 2010, 04:04:41 PM »
Hello-

I have frequently been on the KneeGuru site.  I, like so many others, have had trouble getting past physicians to fully understand symptoms and get answers, frequently feeling misunderstood.  And I, like so many others, have had bad luck with complications and physicians' technical error (2 different past surgeons, 2 misplaced ACL tunnels, infection, intra-operative patellar fx, post-op hemarthrosis, infrapatellar arthrofibrosis, missed PLC issue). 

I have only recently been compelled to register on this forum as my surgery date approaches.  Like, I've read frequently here, friends and family are great, but those that have been through knee problems, are understanding on a different level. 

Even though I have 100% confidence in my new surgeon (who is a true knee specialist and a total  class act), I feel the anxiety creeping up.  I've read so many bios/diaries on this site that seem to have a slippery slope of complications after certain surgeries.  And up until travelling to my new physician, my luck has not been too good.  I am scheduled for a 2nd ACL revision with a contralateral BPTB autograft, PLC (hyperextension block) procedure, and peroneal nerve decompression on July 21, 2010. 

Any words of wisdom would greatly be appreciated.

KP




R ACL,MCL,med/lat men tears- basketball 06.

ACLr w/ BPTB auto, w/intraop. patellar fx/ORIF 06

Med/lat part. meniscectomies 07, Post-op infection, I & D.

Revision ACL w/ ham auto 1/09.

Bone graft ACL tunnels, debridement AF Jan. 2010

ACL Revision #2/PLC procedure July 21, 2010

Offline roze87

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Re: Revision of a revision + PLC procedure
« Reply #1 on: July 10, 2010, 11:01:15 AM »
Hi Kpoppy. Um sorry i dont really have any words of wisdom as I am going through what sounds very similar situation to you. BUt I just wanted to say I do empathise with you and can relate to your anxiety etc. I have long history of knee crap (fractued femur, tibia, fibula, patella, failed acl due to infection) and have just found out my revision acl failed. I am left alot worse off and I am 99% sure I have PLC issues and PC has gone as well now. I am currently on an urgent referral to a specialist for 2nd opinion as my current surgeon has lost interest in my symptoms and has completely fobbed me off with 'Im sure with physio it will get better with time.' I am certain my 2nd opinion is going to tell me I need PLC/ revision ACL/PCL and so am trying to get my hamstring and quads strong enough so that he doesnt put it off too long. But at the same time i am really NOT looking forward to it.

Would just like to say the very best of luck. Sounds like you have now found the right man for the job so dont lose faith, give it your all and I am sure it will work for you this time. I'd be really interested to know how you get on as PLC is so rare I have never met anyone who has gone through it and come out the other side. However I am sure you will and would love to know about your experience as i know mine is coming up to the very near future.

Rose
06/04 Fell - Fractured tiibial plateau, femur, patella, torn acl
ORIF and bone graft of tibial plateau
09/08 failed acl recon due to wound infection
06/10 failed revision acl with pcl/lcl/plc damage
now facing multiligament surgery

Offline Kaputt_Knee

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Re: Revision of a revision + PLC procedure
« Reply #2 on: July 10, 2010, 04:00:59 PM »
Hi KP

I had a revision of a misplaced patella-tendon graft in Aug 2008. My surgeon also found a PLC injury that had gone undiagnosed for 18 months as well as an avulsed LCL. In a 6+-hour operation he revised the ACL using some of the semitendinosis and gracilias tendons, broke the incorrectly healed fibula head and reset it and did an LCL graft (I assume he also used some of the tendon harvested for the ACL for that).

I was NWB for 4 weeks and in a post operative brace set to zero. I began physio though straight away on the first day post op. The first days were passive mobilisation and proper manual lymph drainage massage to reduce the swelling. At 3 weeks he was so pleased with my progress I was allowed to partially weight-bear, then at 4 weeks I was given the go ahead to fully weight bear. Then the real physio began but I always received LD massage at the end of each session. At 6 weeks I was driving and back at work although still in a brace. The flex was limited for the first 6 weeks to a maximum of 90 but then released.

If your surgeon has recognised that you have a PLC injury you are already on the right track. I was seen by several ortho specialists who knew that the original ACL graft was incorrectly placed but they tried to tweak it in 3 operations after the first ACL reconstruction. None of them spotted the PLC injury nor that the LCL was completely avulsed from the tibia head! Even if the first ACL had been correctly placed I did not have a snowball in hells chance of having a stable knee while the PLC and LCL were ignored!

After my operation I rehabbed like a demon but always under the guidance of my therapists. I was cleared to return to my main winter sport of skiing at 5.5 months! So follow the rehab protocol you are givenvand be conscientious but do not over do it and you will be OK.

Last season (2009/2010) I skied over 50 days in total and this coming November I am hoping to represent myself for my ski instructor's license. Whether I get it or not is irrelevant. For nearly 4 years I thought I would never be able to reach the standard required ever again! My former ski school boss has invited me to the renewal tests as he has seen me skiing this season on several occasions and says I'm skiing better than ever with a much more precise style.

Good luck

Sue ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline kpoppy

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Re: Revision of a revision + PLC procedure
« Reply #3 on: July 11, 2010, 11:34:16 PM »
Hi Rose and Sue-

Thanks for your kind responses. 

Rose, it does sound like you've had similar luck to mine. I understand your frustration and it angers me when I learn of other surgeons dismissing their patients as I have been.  Hopefully your 2nd opinion has the answers you need.  And hopefully you have the same overwhelming sense of relief I got when I 1st saw my current physician.  Even though I was bummed when I was told further surgeries were needed, I was relieved that I got the answers I was looking for.  And was reassured that the symptoms weren't all in my head.  For so long I just knew something was not right and my prior surgeons (3 different consultations) failed to figure it out.  Just like you stated, I don't know how many times I was told to "just get it stronger" and "you should be satisfied with this outcome", despite the ongiong instability.  I sure hope your appointment goes well- please let me know how it goes.

Sue, it sounds like you have been through a similar surgery with flying colors.  I have sponged inspiration and strength from many of the postings in this site.  It's great to see someone with such an extensive history of knee problems have such a wonderful outcome. 

Thanks, KP 
R ACL,MCL,med/lat men tears- basketball 06.

ACLr w/ BPTB auto, w/intraop. patellar fx/ORIF 06

Med/lat part. meniscectomies 07, Post-op infection, I & D.

Revision ACL w/ ham auto 1/09.

Bone graft ACL tunnels, debridement AF Jan. 2010

ACL Revision #2/PLC procedure July 21, 2010

Offline onthewave

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Re: Revision of a revision + PLC procedure
« Reply #4 on: July 20, 2010, 11:06:12 AM »
Hi everybody,

Im passing for all tht too, acl revision with bad insertion, now, a doctor propose me a lemaire procedure (extra-articular plasty) in order to help ACL work preventing external rotation sating it would prevent the lateral laxity caused by the PLC, NO NO and NO, It is just like it was.

KAPUTE_KNEE, can you please give me the contct of the doctor who solved your problem?
No matter where it is, I would love to hear his opinion about my situation.

Thankyou so much.

Good luck for everyone whos trying to have a normal knee and a normal life.

Best regards.


Offline Kaputt_Knee

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Re: Revision of a revision + PLC procedure
« Reply #5 on: July 20, 2010, 11:26:11 AM »
onthewave my surgeon is Dr Horst Mller-Kittnau and he works out of the OrthoZentrum Rosenheim (http://www.orthopraxis-rosenheim.de/cms/ I'm sorry but the site is only in German. I'm not sure how much English is spoken there as they only ever used German with me.

The Lemaire procedure looks pretty drastic according to the things I've found by simply googling it. Looking at the pictures in one of the articles it looks like I had a similar procedure on my other leg about 21 years ago!

http://www.genou.com/anglais/acl/lemaireprocedure.htm
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/lemaire_orthop/lemaire_us.shtml
http://www.springerlink.com/content/2006052513710413/

My surgeon just rebuilt the lateral collateral ligament by using part of my semitendinosis/gracilias tendons from the hamstring muscles on the same leg. I'm not sure if that is what your surgeon is proposing to do though.

Not sure if this helps you or scares the living daylights out of you!

Sue  ;)

1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline onthewave

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Re: Revision of a revision + PLC procedure
« Reply #6 on: July 20, 2010, 02:33:20 PM »
Thank you very much for your answer, guess im going to visit this doctor, Im very worried, and I dontt know if you can answer to me or not, I dont know if having made this lemaire procedure it is possible to rollback and do the right thing, Im very ansious because Im feeling like i found the solution too late you know? I feel that my problme is just like yours and wich I have not done this surgery.

If you know some case of a person making a second external plasty with sucess please let me know.

Many THanks again

Hug.

Offline blew_knee

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Re: Revision of a revision + PLC procedure
« Reply #7 on: September 03, 2010, 04:51:56 PM »
onthewave my surgeon is Dr Horst Mller-Kittnau and he works out of the OrthoZentrum Rosenheim (http://www.orthopraxis-rosenheim.de/cms/ I'm sorry but the site is only in German. I'm not sure how much English is spoken there as they only ever used German with me.

The Lemaire procedure looks pretty drastic according to the things I've found by simply googling it. Looking at the pictures in one of the articles it looks like I had a similar procedure on my other leg about 21 years ago!

http://www.genou.com/anglais/acl/lemaireprocedure.htm
http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/lemaire_orthop/lemaire_us.shtml
http://www.springerlink.com/content/2006052513710413/

My surgeon just rebuilt the lateral collateral ligament by using part of my semitendinosis/gracilias tendons from the hamstring muscles on the same leg. I'm not sure if that is what your surgeon is proposing to do though.

Not sure if this helps you or scares the living daylights out of you!

Sue ;)

this is a bit offtopic but reading sue's posts always give me strength and hope for better days, tks sue :*
- ACl + meniscus 03.2008 - ACLr 4 monts after.
-stretch ACL Graft 5.5 months after surgery.
doc's dont want to do surgery because i dont have pain and have a partial function ACL
-Rehab 6 months, pain starts cant find doc to help me... dam country
+ 5 months ACL revision- not so stable knee