My Patellar Realignment Surgery Nov 4, 2010

[Countess]

Monday turned out to be amazing. I went to PT as usual. When Kim came over to measure my flexion she looked at me and said. "You are just taking all the fun out of this for me." "Why? Where am I at?" I replied. She paused then said, "133." "133??? WHAT YOU'RE KIDDING!!!" I exclaimed with surprise. "Nope I'm not kidding. 133." We both looked at each other in complete disbelief. Then tears welled up in our eyes. She then said, "See...this is what therapy is supposed to be about. Celebrating milestones. Congratulations." I then told her it was because I had such an awesome team behind me and thanked both her and Rich, her assistant, for helping me to get where I am.

Kim tells me I can start living a normal life. She took away all of my at home stuff except for the recumbent bike. One 20 minute workout in the morning before work and one 30 minute workout after work. In between just concentrate on improving my gait...and that's it! She said some flexion loss is expected because I am not in the CPM machine anymore. I still need to regain my strength in the quad as well. I have therapy tonight. I have a feeling I will be discharged. She told me on Monday that I didn't need her and that I can do it on my own now.

I have mixed emotions. On the one hand I am elated. This has been a long time coming and I have fought so hard for this. I bounced back fairly quickly from the MUA and my knee just took off. On the other hand I am apprehensive that my knee will somehow return to it's pre-MUA state and get stuck again. I guess I am just not convinced that it really IS better. The numbers don't lie but it's still hot...it still swells...it still cramps up and it still hurts. Granted the pain is intermittant now instead of constant but it's still there.

I left my OS's MA yet another message about needing a letter for my insurance company to approve more PT visits for me...I have heard nothing. I know that my OS is now on vacation in Europe and won't be back for 2 weeks. This has become very annoying.  

[Countess]

This past Thursday I got to 134 flexion in PT. I also went out Friday night and the knee held up while I was walking around the club. Saturday I paid for it though...it was really sore and painful. Sunday wasn't much better. Today back at work it seems to be doing ok but every time I get up it's really stiff and my back hurts for some odd reason. Maybe I just notice the pain more because I have cut back on percocet. I only have enough pain meds to last me through the rest of this week then that's it and I haven't taken any yet today because I have therapy later on. Tomorrow and Weds I will try Naproxen and see how that works. I'd rather save my percocets for when I really need them.

I got my medical records and it is really interesting what my OS had to do. Turns out I had a grade III lesion on the medial side and a defect on the lateral side gutter measuring about 1cm. He had to clean out all the loose bits of cartilage on both the medial and lateral sides. There were fissures on my patella as well which he smoothed out. So...I did have chondroplasty along with everything else. The medial reefing was sutured with pants-over-vest technique. The synthetic plug he used to generate cartilage was called an OBI Plug.

The second time I went into the OR for my MUA the official diagnosis was Arthrofibrosis...I KNEW IT!!! I told him early on that I thought I had developed secondary AF due to being in the immobilizer for so long. He suspected it as well but didn't confirm nor deny it when I brought it up.

I finally got everything I need and submitted my letters of appeal from my OS and from Kim for more PT visits to the insurance company on Friday. I will call them tomorrow and see where they are with review.

As I am reading more and more I hope the scar tissue never comes back. I hope I continue to improve. We shall see what I get tonight. I am fully expecting to have lost a little bit of flexion due to the heavy workload I placed on my knee over the weekend.

Until then... 

[Countess]

PT Update -

So this past Monday night I was fully expecting to lose a bit of flexion but it didn't happen. I measured out at 136. Kim's eyes lit up and she kept saying how awesome it was to watch me get better. Rich, her assistant, told me he never thought I would get this far. I told him I didn't either but it's partly due to them and I couldn't have done it without their help.

Last night I measured at 140 flexion! YAY ME!! The quad is still giving me issues. Kim pulled out this metal tool with a rounded tip and went to town because she said she didn't like how my quad felt. It was so knotted up that she couldn't get deep enough with her hands to try to work the knots out. I even took a muscle relaxer a full half hour before therapy. That's how bad the knots are....they don't even react to muscle relaxers. My hammie is still giving me fits off and on. She took the metal tool to that as well.

The pain has calmed down. It's only on the medial side where the reefing was done. After reading the surgery report I can see why it would still hurt as bad as it does. I walked around the grocery store this morning before work and the knee seemed to do ok...but it was only for about 15 minutes. I am sure if I were to have walked around much more it would have started to protest.

Today the knee is warm to the touch but not hot. I have noticed my gait is improving ever so slowly. I think in a few months I should be up to speed with the rest of the world walking wise. At least I hope so. I have learned that my knee does things on its own time not on mine. I am just happy to be finally getting better. It has been a long, hard recovery.

Kim tells me that even though my strength is coming back there is a risk of re-dislocation because my quad is not strong enough to hold the patella in place. To me...that is terrifying. I have been really careful and haven't made any sudden movements to the left. I told her about my bathroom incident. She felt around and said everything is where it should be and it's probably just a mental thing. I told her she was right...

I see my OS this next Weds so we shall see what he says. Maybe I will be discharged. Now wouldn't that be wonderful.

Until then...

[Countess]

OS Update-

I went to see my OS this morning. He is beyond excited about my progress. My knee is working exactly as it should. I measured 143 flexion unassisted this past Monday in PT. I have full range of motion now...Kim says it's even better than most "normal" people. He tested my extension and flexion then had me hold my leg out straight and for the first time it stayed right where it should and didn't buckle!! My OS was all smiles...I was all smiles...he said "Well look at that." It was awesome. My next appointment is in 8 weeks and if I keep progressing like this it will be our last visit....our last visit. 

Kim also told me Monday evening that she is revamping my protocol. She is not worried about flexion anymore and is going to take away all my flexion stuff. We will now work on strength from here forward. In a month I should be sucessfully discharged from PT. My insurance company has also FINALLY approved 20 more visits of PT.

I never thought I would get to this place. So many times before I had hope...that this nightmare will be over and so many times those hopes turned to despair. But now...now it's real. Now I can believe I will get on with my life. Now I can feel it. It's been such a long time since I have felt like this. 

Every day I notice new things that I couldn't do before. Last night I was putting on my PJ's and usually I have to hold onto something while standing on my left leg. I didn't have to do that. My leg held me. Today I noticed my stride is much improved. I went from baby steps...to bigger steps. My knee is getting better.

The pain has also subsided. It still hurts sometimes where the reefing was done but not nearly what it did. Over the counter Tylenol actually works for the pain now.

I do not regret my decision to go ahead with the MUA. In fact, it was the best decision I ever made. There are horror stories on this board about AF and MUA's but for me...IT WORKED. This just goes to show everyone that even though some folks have had problems there are more successes than failures....and I am a success story. Don't be afraid to listen to your knee and listen to your OS. There are always risks with every procedure...but only the person who risks is truly free.

I will be free from this burden...and I will beat this...it will never beat me. I feel like I have already won.

That is all...for now.

[kasia_ny]

Wow, look at you!  You come such a long way.  I am very happy for you   I was so hoping it would work out for you too and here we are!

I am doing pretty well too as far as bending is concerned.  I had some serious troubles with my IT band - it got inflamed and very tight and pulling my knee cap off track - it is a very unpleasant feeling as if something is shifting in the knee.  It also hurts a lot, the whole knee burns on the outside.  So I have been struggling with this problem for a few weeks now and it is slowly getting better as my quads are getting stronger - and they are, because I have been working them like crazy .  I exercise by myself at least 2h daily + PT two times a week - I really need to get better before my summer trip to Europe (mid-July).

Do you do the stairs normally yet?  I can do only upstairs...

 
 

[Countess]

Hi Everyone-

Sorry for the delay but I wanted to concentrate a bit on getting better and not what is wrong with my knee. My therapist has cut me down to one day a week now. She did a strength test last night and everywhere it is strong except for the Patellar Tendon area. I am having extreme difficulty with step downs and my quad is still an issue although not as bad as it was. My hammie is doing great! She has me on a competely new protocol and when I am there it is usually for over 2 hours. I would like to start walking my dog, Jake, soon but I am afraid he will pull me down. He is a big...100lb chocolate lab who is very sweet but strong as an ox. I am still limping. Kim noticed it last night and said "Your knee isn't broken anymore. Quit limping." When I told her it hurt she said "I don't care. Quit limping." LOL.

People still ask me what is wrong with my leg. It is still apparent that I am not quite normal yet and won't be for some time. I have noticed clicking in my kneecap area while riding the recumbent bike and my patellar tendon is tight sometimes. Last Friday night I went out and wore some heavy boots. They were flat of course (I won't be wearing heels anytime soon) but I noticed as I went to step out my kneecap acted like it wanted to dislocate again. I stopped the movement immediately. Kim also noticed I am bruised on the lateral side of my patella...she asked me what happend and why I am so bruised. Honestly I don't have an answer.

This past Saturday I helped my boss paint the ceiling in the new office. We are moving July 1st so everything has been rush rush. I just handed him things that he needed so he didn't have to go up and down the ladder all day. I could only stay for a few hours. My knee started protesting and I had to go home to take a muscle relaxer because I was standing a lot...kneeling a lot. My knee just wasn't having it.

Then Sunday was spent cleaning the house and going grocery shopping. By the time I got to the frozen foods aisle my knee had enough and let me know by collapsing from fatigue. It didn't dislocate...my quad just gave way. 

It reminded me I have a long way to go still. I hope in a few months it will be much better and much stronger. I need to work it out more than I do. I have been so busy lately with everything that I haven't been as diligent.

The billing department at my therapist's office is stupid. My insurance was paying my claims and all of a sudden they stopped. I looked online to find out the problem and my insurance kicked it back because of coding issues. So now I have 6 bills which total $168 each. I had to print off all this crap and take it to them so they can re-bill. They said they couldn't figure out why all of a sudden they weren't getting paid. DUH!!! I told them I better not be getting a bill for anything because I refuse to pay it as it is their mistake not mine and I don't have $1008.00!! 

New protocol is:

Treamill - side step for 5 minutes each way
Step Downs - 4" riser 15 x 2
Step Ups - 8" riser 15 x 2
Side Steps - 8" riser 15 x 2
Standing Hip Matrix - 20 sec each hip pump, hip fast pump, short quad arc, hip flex (this one kills me)
Wall Sits - 4 x 30 sec
Gait Improvement - (It looks like a version of the drunk test. Step out, quad in the air, hip flex then down for next step. 4 Reps)
Balance Board - 2 minutes each side to side and front to back
Bosu Balance - Stand on Bosu Ball and balance for 2 minutes
Leg Press - 3 times, 15 reps 85lb weight
Walk outs - (5 x each...right side, left side, front and back with 30lb weights around your mid section. I also call this a draft horse pull.)
Side Line Shuffle - (6 cones spaced evenly apart on the floor. Look straight ahead and step over the cones laterally. 2 reps)
Twist Lunges - (Like a step down..left knee bent, right leg goes out to 1, 2, 3 ,4, 5 & 6 o'clock. 3 Reps)
Green Therapy Band - (Put this right behind my knee and pull straight back. 30 Reps)
Hamstring Stretch - (3 x 1 minute)
Quad Stretch - (3 x 1 minute)
Hip Matrix - Lying down on right side...this also workes my glutes. 10 leg extensions, 10 kick outs with quad at 45 degree angle then hold straight out for 30 seconds.
Wall Slides - (5 minutes)
Prone Quad Stretch - (5 minutes)

I think that's everything. Whew! I am consitently at about 146...but last night I measured 2 degrees off straight. I was able to dance for the first time since my surgery this past Friday night but I stayed in one spot and didn't move much laterally. My knee is still weak and won't support that type of movement quite yet.

Kasia - I hope you are doing MUCH better girl! I read your blog...just keep going. I can now go up stairs one at a time but I am still two stepping them going down. It is scary!!

I think I need to get out and just walk more...hopefully that will help.

That's all for now...
   

[Countess]

What they say on this board is true...when you start feeling better you spend less and less time on here. I am feeling better. 

Well ok so I am not healed 100% but every day I notice little things I couldn't do before. Now I am taking off pants while standing on 1 leg at a time. I can bend down to the ground which makes gardening a hell of a lot easier. I am walking faster although still not as fast as everyone else. My step son noticed it this past weekend when I took him to Dave N Busters. He told me I am walking a lot better. I am able to go out more and enjoy it...rather than being in pain. I have stopped taking Tylenol and Aleve alltogether and only use it when I go to PT. Granted I am not completely pain free. My knee still stiffens up when I have been walking too much or when I sit for a prolonged period of time. I still get up in the morning stiff as well but as soon as I am on the bike that seems to help.

I had Kim check out a click that was present in the knee. I was pretty worried about it...especially with the ordeal Kasia has gone through. She tells me it's just the patella hitting the bone and she isn't worried about it. My quad still isn't strong enough to hold the patella in place but we are working to fix the problem. She also has me working on lateral movements now along with everything else. I am working hard to get the muscle back as I have my first vacation coming up since this all started. I will be headed to the beach in August and I am extremely excited about it. I still can't walk Jake yet but it's coming soon. I tried last week and he was so excited he pulled a bit too much so I had to let go of the leash a few times. Then I realized maybe in a few weeks that will be possible and had to take him back home. He was so upset and it broke my heart. 

When you have problems like I have had it is hard to be hopeful. Now I smile...A LOT. I have so much to be thankful for...even if I get annoyed when people ask "What happened to your leg?" Believe me...when you get asked the same stupid questions over and over again for 7 months it's hard not to want to poke people's eyes out. They really can be insensitive. Even peeps at PT who have had surgery. If I really wanna know what happened to someone I will ask them if they mind telling me their story. I don't jump to conclusions and ask them if they have had a TKR. (That's the worst IMHO!!) 

Anyway...I hope you all out there are progressing and doing well.

Cheers! 

[cdubb]

Sounds like you're doing great!  Glad to hear that!  I've been MIA for quite awhile now, so it was good to get on and see how you were getting along! Congrats!

[Countess]

Thanks cdubb! I guess I haven't been on here in quite some time as well. I kept meaning to get on here and well...life happened.

Shortly after my last post my therapist had me go independent. She said she could either discharge me or I could go independent...which basically means I can use all of the equipment, she and Rich still make sure I am doing my exercises correctly while adding new stuff from time to time but Kim can't treat me anymore. Kim also said she would still do my OS note. I can go to PT as much as I want and don't need an appointment.

Her decision was based on the fact that I have regained flexion and strength everywhere but the quad (DAMN THE QUAD!!) and she can't say when I will regain that strength back. It could be a month...could be a few months. 

I told her I had been meaning to join a gym anyway and asked her in her expert medical opinion...have I sucessfully completed therapy? If not then I still need to go to PT. If yes then I can go to the gym. She said no. Then I said "Well I still need to be here then."

Since this happened I have been going faithfully twice a week. This past weekend I was able to go to the mall for the first time since my surgery. I walked all the way around it before me knee started complaining.

In a few weeks I am going rafting and will be back on the river....and the one thing I wanted to get back...the one thing was walking my dog Jake. I am happy to report I can do that now!! Jake is soooo happy!!! Kim is completely excited for me and has called me a rock star!! She told me she fully expects me to recover 100%.

The pain is still there and I still get stiff. Working out the knee helps a lot but I still cannot go down stairs normally. Kim had me run for the first time last night. It was weird. My quad didn't know what to do at first and gave out a few times but Kim was right there to encourage me and tell me I won't fall...that it will be ok. I am happy I made the decision to stick it out and still go to PT despite Kim not being able to treat me anymore. It is still scary to do some things and without their help I don't know what I would have done.

I go see my OS this coming Weds. I don't know if he will discharge me or not. Guess we shall see.

I hope everyone else's recovery is going well!

Cheers!!

[Countess]

Well it has been almost a month since I have been on this site and a lot of things have happened.

I went to go see my OS July 27th for a regular follow up visit. Prior to that I was having pain in the knee for about two weeks on the lateral side and couldn't figure out what was causing the issue. I had Kim, my therapist, take a look at it while she was doing my progress note and turned out I had fluid in the knee. My OS said he was more concerned with the constant pain than the fluid as the fluid wasn't all that bad. So he ended up giving me a steriod shot to try to clam the pain down. Now...I don't know if any of you have experienced this but it hurt like hell and the needle looked like something a doctor in an insane asylum would use. Yes...it actually is THAT big!!    I was screaming "Therapy is worse!! Therapy is worse!!" during the whole ordeal and had a death grip on the chair while he was doing it. The steriods BURNED. After all that he told me he would see me in another 6 weeks and off I went back to work. It hurt all day and I was glad to finally go home!! I can still see the needle puncture and bandaid outline to this very day!!

Rafting was great. The launch site was down this steep hill so I had to have help getting down it but once I was in the raft I felt so free. The mountains were more beautiful than I had remembered and just being in nature did wonders for my soul. It was the first time since my surgeries I had been up there and the joy I felt...the fun I had...well I can't remember feeling like that in a very long time.

I also went on my annual Mother/Daughter trip a couple of weekends ago and went to Santa Barbara, CA. I was born and raised in Cali and miss the beach so much. I was nervous about the airport as it is absolutely HUGE but I navigated it just fine. I even managed to self park my vehicle and take the shuttle to the terminal....with my luggage!! The only problem I had was when I tried to go in the ocean. The constant back and forth pull on the knee was not good...my knee DID NOT like it AT ALL so I only waded in hip deep before I decided to come in. I told Kim about it and she said my quad (DAMN MY QUAD!!!  ) isn't strong enough yet to handle the rip tides. I was able to get in the hot tub at the hotel and that in itself was heaven!! I LOVE hot tubs and I put my quad right up to the jets which helped A LOT after a long day of sightseeing. Swelling was minimal and the steroids seemed to have helped with the pain and fluid issues. I wish I had a hot tub at home. Now that would be fabulous!!

I still have issues with going down stairs. I can do it now but still don't have the control and have to hold on all the time. Downhill is an issue too. That's the only thing I am still working on. My OS said that I will probably have to work on it the rest of my life but once I get the strength back it will be a matter of maintenance...and not a constant every day struggle. I hope he is right. I don't know when it will come back. I have been making the knee work though and am not so afraid of going down the stairs or falling. I went from the 4" step to the 6" step on my step downs recently and I can feel it getting stronger but it's so damn slow to recover. I have still been working out 2 days a week at PT and the days I don't I walk Jake for an hour. I was finally able to complete our old route which was great as I wasn't able to walk the whole thing before.

Which brings me up to date. Still struggling but doing MUCH better. I go see the OS Sept 7th. Hopefully by then this will all be a bad nightmare and I can put it behind me...and look forward to a "normal" life.

Hope all of your recoveries are going well.

Cheers!

[Countess]

Exactly a year ago today my life changed forever. I never expected I would have such a diffcult time nor did I expect recovery would be this long. In some ways, the surgeries changed me for the better.

I never knew how strong I was until strength was the only thing I had left. I had to dig down deep to find it. I almost gave up many times but I kept coming back to my motto. "I will beat this...it will not beat me." I can walk now. I can shovel snow for an hour and a half and my knee holds up just fine. Kim...my physical therapist...has just cleared me for wearing heels again. It has been over a year so this should be interesting. The things I took for granted I no longer do. I want to get out and live life again instead of just watching it pass me by. I want to experience new things....new places...new people. I want to start over and embrace a new beginning.

In some ways...the surgeries have also been a curse. My marriage is falling apart. We are seeking council but the surgeries have amplified what has been wrong with our relationship before my accident. I don't know if I want to continue to be unhappy as life is too short. In an instant it can all be taken away. I know that more than anyone. When your health fails or your limbs no longer function correctly its devistating. My quality of life has been severly hampered for the last year.

My OS visit this last September did not go so well. The scar tissue was still giving me problems. He told me if it did not get better he would have no chioce but to go back in for a 3rd surgery. I also had tendonitis in my patellar tendon which hurt like hell. Now I don't think a 3rd surgery will be necessary. I still don't have quite the control going down the stairs but its almost there. The strength is almost there as well. I would say 95% now. I go back to see him next week. Hopefully I will be discharged for good.

My OS did tell me he never thought I would walk again. Kim told me the same thing. I am here to say...don't give up. It has taken a lot of blood, sweat and tears to get where I am but it's worth it. The only one who pulled me out of this mess is me. No one did it for me...and no one can do it for you. Find your strength. It's there. Don't worry about anyone else in your recovery or how many times you cry. Who cares. Do you want to live the rest of your life as a cripple? It's your choice. I chose to be free of this burden and I am walking proof you will get there if you work hard enough.

My Dad says after a surgery nothing will ever be like it was before or work as well. My new rebuilt knee works better than what I had. Its stable...its stronger and I don't have to worry about it dislocating at whim every time I step the wrong way. I am more confident in the knee and am not afraid of falling like I was before.

My OS says my knee will be a lifelong journey of upkeep and exercise. I accept this challenge and move forward with a new knee...and a new lease on life.

Good luck out there.

~Until then...