My TTT, MPFL Reconstruction, and Lateral Release

[oohheykate]

Don't worry Runner! I'm here. I read everything that's posted. I just don't have anything to add because I don't really know what you're through right now. But I'm glad you're progressing well and hope you continue that way. It's still a bummer about the PT limit though 

[JessicaO]

hey runner ive been keeping up with your thread too. it has actually just helped me in a way too. I am currently 3 weeks post op from a TTO and MPFL. My PT pushed me to 85 degrees tonight. Im not exactly sure how far i can get it myself. but i read what you wrote about damaging the MPFL. i didnt know anything about that. my brace is locked at 45 degrees but my physician assistant said i dont need  to wear it when im sitting around or sleeping. so im hoping im not bending it further than im supposed to. i just figured the further i can get it the better ya know? well apparently not and im hoping i didnt ruin anything. i emailed my physician assistant after i read your post.

we are reading even if we dont write anything. i wonder that about my diary too, i feel like no one reads it! ha oh well.

[Runner1993]

Thanks guys! I try and stay updated with your post-op diary, too!

Jessica, I wouldn't freak out just yet. Each surgeon has a very specific protocol based on how they do the procedure, what they feel works/doesn't, and each individual patient.

That is just what my doctor told me. However, a friend of mine had a MPFL reconstruction and I'm pretty sure she didn't have the same ROM limits. Also, if you just google MPFL reconstruction protocols, I'm sure you would find numerous ones, some even allowing unlimited ROM from the start.

I would ask though if you are unsure what range of motion you are allowed though.

I am a little fearful that these limits will cause my knee to become stiff and unable to bend later, but doctor knows best! I just have to convince myself that this time is different from last time and will be better!

[JessicaO]

i dont think your knee will become stiff. when i was 14 years old i got knee surgery and i was put into a cast for at least 6 weeks. full leg cast up to the top of my thigh and even my foot. i achieved full range of motion on one of my knees and not the other one but not because of the cast. so i thought it was cool that this time around i didnt have a cast and i was in PT so soon (2 weeks post op). I think things were alot different back then though. that was 11 years ago. i remember they would have me lay on my stomach and they would crank my knee and i would be screaming. do they do that anymore i wonder?? god i hope not.

[Runner1993]

5.5 WEEKS POST-OP

Well, after my last surgery, I was placed in a knee immobilizer for 5ish weeks. Then, once I got out of that, I started physical therapy. I had 30 degrees and my knee barely gained any range of motion by the 2 month mark to the point where my doctor debated manipulation and my physical therapist asked my doctor for recommendations because he didn't know what to do. They then decided to drain it and inject cortisone and I started pool therapy. With that, I was able to get up to about 110 by 6 months.

I think after my last surgery, they did have my lay on my stomach, haven't done it this time though. What knee surgery did you have then?

I had physical therapy today. Stupid lack of dorsiflexion!!!! When I walk, my toes drag and don't pull up. It's frustrating that my ankle is not working right when it's my knee that is the main problem! My physical therapist, always being the creative one, took a resistance bad and looped it around one of the buckles of my brace then put the loop under my toe keeping them pulled up. He says if my dorsiflexion isn't working  by next week, I'll have to wear it to school like that. Talk about the looks I'll get lol.

So, I had to sit on the edge of the table today and let my knee drop over and then he would push it back. That was so painful and not very successful. I have to say the most painful thing I do is the can under the knee exercise. My whole "extensor-mechanism" (the kneecap, the patella tendon, and my shin) hurt soooooooooooo much with that one Reminds me of the old days.

My physical therapist told me to use one crutch, but I don't think I'm ready for that at school yet (I'm off this week) or in public. I walk poorly with it due to my lack of dorsiflexion and thus lack of locking the knee out straight with my gait. Plus, I don't feel stable enough to have that and a book bag in a hallway with hundreds of other kids. I will ask my pt about this later this week before I return to school next week.

I'm also taking showers standing up now. I don't really move once I get there as I try to not slip.

I'm still sleeping in a brace, when did you guys ditch it? Pt told me maybe 6 weeks. I'll be nervous the first time though since even with my brace, I walk up in pain sometimes due to the way I moved.

I'm able to do straight leg raises with 1-2 lb ankle weights (depending on the day lol). They are really painful esp on the shin, but working the quad is worth it.

When is it appropriate to take the no pain no gain outlook and when isn't it?

I also do treadmill walking a lot at pt: did 10 minutes forwards, 5 minutes backward. This is with no brace, but with the aid of my pt with my gait. For some reason, it's so much easier to walk on a treadmill than across the room.

[JessicaO]

Hi!
I have HORRIBLE dorsiflexion also! you are not alone girl! I am not full weight bearing though so i do not do treadmill what so ever. When i have been trying to walk now with my brace and crutches because i am now 50 percent weight bearing my foot like doesnt do the heel toe movement. i like cant get my heal to hit the floor. it sucks. PT has been trying to stretch my ankle alot though. im hoping that gets better. Im still having the terrible foot pain where my foot always feels like it is falling asleep or pressure or something. its so hard to describe the feeling i am experiencing. i feel like no one out there has this feeling i am having.

I stopped wearing my brace at night at seriously before my 3 week mark. i dont even sleep with it elevated anymore.and  i sleep on my side. im not experiencing this pain that you are getting when i wake up. i cant sleep through the night though because i am soooooooo uncomfortable even though i dont have a brace and i sleep on my side. its mainly because my foot bothers me so much i am constantly moving it because it feels like its falling asleep.

when i put a towel under my knee is push down to flex my quads it doesnt really hurt it just feels weird. maybe  u can try doing it with a rolled up towel? it will be softer.

today was my 4 weeks! woohoo.

[Runner1993]

Thanks to having school vacation this week I am on these boards all the time! When school starts again, I'll probably only be on every few days.

I wonder what causes the dosiflexion to disappear. I hate how my foot drags. If I could actually walk, I would be tripping all over my toes. I was WBAT from the start so my physical therapist takes the opportunity and since it's "allowed" to put me on the treadmill I can't do the bike yet so treadmill it is.

I don't have any foot pain, maybe some slight ankle ache and tenderness now and then.

The exercise I was actually talking about is the one where you put the can under knee and so it's bent over it. Then, you lift the lower leg up to straighten the leg in the air. Talk about pain!

I'm closing in on 6 weeks soon!

[purplechick13]

Runner1993,
I just finished reading your diary, your story is so similar to my daughter's it's crazy. Her injury started in October 2007 while playing soccer. She was goalie for the 3rd year in a row. The coach decided this game would be the perfect game to practice a new goalie kick he had taught her. She got that ball tossed high in the air and as she pivoted I saw that left knee cap move and she hit the ground in pain. Her dad is an EMT and immediately ran to her pulled her by the ankle and popped the knee cap back in to place. The next morning we took her to her primary doctor who put her in the wonderful immobilizer. She return to soccer 6 weeks later, her team won the playoffs and headed to the championship games in Jan 2008. During warm ups we saw the terrible event unfold in front of our eyes once again. She jumped to keep a kicked ball from entering the goalie net. As the ball flew out of the net she came down and this time the right knee dislocated. Again my husband was able to pop it back in place and she watched the rest of the championship games from the sidelines. From that point on her knee caps would dislocate constantly, it got to where the ligament was so laxed she could place one foot under the dislocated knee and pop it back in herself. Her OS decided her knee caps were dislocating because of the angle of her knees (knock kneed) she decided the only chance Miranda would have was to staple the growth plates and hope the knees straighten out. So she proceeded to her first knee surgery which was suppose to be orthoscopic however the OS ended up giving her 2 3 inch incisions on each knee. Both knees were done at the same time since there wasn't much growth plate left to close. It was terrible, she was completely bed ridden for about 3 months, couldn't even use the bathroom, had to use a bed pan. We thought it had worked though. Attended PT 3 days a week and went back to playing softball this time. About half way through the season, at one of her practices she rounded 2nd base and ended up on the ground with knee cap dislocation again. It started all over again, many braces and PT sessions later the knees were so bad all she had to do was sit in a chair and they would dislocate. Finally we got sent to her present OS who said her only hope would be this fulkerson/MPFL reconstruction with LR. This is where we are now. She had the left one done on Feb. 3 and is doing great. She was able to weight bare as tolerated immediately after surgery but as you said there was no way. She is getting around pretty well with the crutches, her only problem right now is she has developed pain in her left shoulder. She can't move it forward. SHe is 2 weeks and 4 days post op and can bend to 60 degrees. She is so ready to ditch the crutches however the brace is like a security blanket for her. Her steri stips came off yesterday as wee, I was so pleased with how nicely the OS did stitching the incision. It is much more becoming than the last surgery. She had those big blood blister looking things also, they appeared around where the drain tubes were. Hers have since gotten a lot smaller however still big red circles. I have been on her to try and scrub that iodine off her leg and she keeps telling me it's tender, now from reading your post I realize it too could be bruising, I'l back off her. She is ready to go back to school, she is so bored here at home. I expect her to also only make it 1/2 days but it's better than none.
Thanks so much for allowing me to read your diary, it has calmed a lot of my fears to know there are other young girls out there going through the same things.

[chrystyna]

JessicaO: You are definitely not alone with the foot pain.  I had a very similar surgery 7 weeks ago (fulkerson osteotomy, Lateral release, and work done on my ligaments-not really sure what it's called)  I currently am in college and went back to school 4 weeks ago and find that my foot is constantly falling asleep in class and I just feels numb.  Most of the time I have it up on a chair which I thought would help, but no!  I am also having ankle issues and at PT they are constantly on me about it, but no one is worse than my surgeon.  He is more concerned about my ankle issues than he is about my knee and gets frustrated and yells are me for turning my ankle in.  He said he has never dealt with an issue like mine, but says it's more of a bad habit than anything because of my last surgery in August.  My OS gets so mad, but I don't know what else to say or do.  So I saw him Monday and he wants me to try this new ankle brace to see if it will help.  I just gave him a look like are you serious.  He then said it is much less complicated than my knee brace I am in, but I don't get how I am suppose to wear both.  I guess I will find out tomorrow... 

My PT is guessing that my ankle, foot, and shin bone are hurting because of how my ankle is always turned it.  He is guessing that my ligaments or whatever are stretched out on the outside of my ankle and on the inner side they are shortened which is why it is turned in.  My physician's assistant also said the same thing.. he goes to grab my foot to move it over and gives me this look and was like, "while of course it hurts..if you would learn to stop turning your ankle in there wouldn't be such a problem!" 

Just know you are not alone!     

[Runner1993]

6 WEEKS POST-OP

Physical therapy was really tough today. The tears fell at therapy for the first time in a long time. Physical therapist told me he knows he's being a jerk, but he won't stop being one until I'm better. I think he feels bad about putting me in so much pain. He is also making me use only one crutch at school although I told him I don't feel ready. He said they are called "crutches" for a reason.

I will post later about what I did at therapy today. I'm just looking for some encouragement---some "keep going"s, some "it will get better"s, some "no pain, no gain"s and just some

[bball123]

I'm so sorry to hear about PT Runner That sounds tough, I can't even imagine the pain. Although I have no idea what you are going through, it will get better before you know it. Your PT just wants to get you better as soon as possible, and you will be thankful for how hard he is pushing you in the long run. Also, even though you don't feel as comfortable with only one crutch, I don't think your PT would be forcing you to ditch the other one unless he was positive that you could do it.

STAY STRONG! and enjoy the rest of your vacation!!

[Lana_O]

So sorry to hear about your tough day runner It is  so hard to find right words of encouragement when it happens, but the only thing I can tell you is keep thinking about near future, this all is going to seem like a distant memory, and your whole life, pain free I hope is ahead of you.
You are right, "no pain no gain" is true in this case, but unlike in most cases, pain is good here. I don't know what did they do to you today, but I assume some manipulation of the knee, and pain means, blood is entering there and healing the joint. Nothing heals us better than our own bodies. Maybe you can visualize blood getting into the painful area and healing it, kind of like braking down the barriers. It means every time you reach new pain threshold you body memorizes it and next time it gets easier. I know, it all sounds like a lots of "malarky" but hey why not try anything. I think you're doing amazing, pat yourself on the back, you are truly a trooper.

[chrystyna]

Runner, just know you are not alone!  I seriously feel sick the mornings I have to go to therapy because I know what they are going to do.  I have come so close to crying numerous times at PT but before I start to cry I walk out on him, which is hard to do now since I am watched like a hawk by every single therapist at my place and they know I need to still be on both my crutches (even though i'm 7 weeks post-op).  Sometimes I feel that they don't understand, but all he keeps telling me is he knows it hurts, but it has to hurt before it gets better.  He also told me last week that it is all psychological with me and I need to turn my mind off and not think about it hurting...that is easier said than done!   So maybe that could help you, try turning your mind off and tell yourself it doesn't hurt! 

I was also warned before I had the surgery by my OS and his teacher who is head of orthopedics at the medical college that the surgery is the easiest part and the recovery is the worst and hardest thing you may ever go through in your life, but you just have to stick with it.  Like my therapist also said, I may greatly dislike him but he doesn't care as long as he helps me to get better.  I guess you can call it tough love!  

We can both make it through this, we just need to stay positive and know things will get better!

[oohheykate]

Awl, Runner! It'll get better  Just keep thinking about all the things you'll be able to do when you get better and this will all be worth it. Keep on keepin on 

[Runner1993]

Thanks everyone. Bbball, you are right...in the end, I will be grateful he pushed me so hard to get better. He told me I'm coming on to all his tricks though. I bet you guys encounter these with your physical therapists too. Having them say I'll keep count, then they all of a sudden "forget how to count" or "lose their place" so they say do 20 more and we'll call it done. Also, we'll do this exercise for 30 seconds, get set go.... pushes timer on his watch, then says "I'll be right back and walks away" forgetting to pay attention to the time. Also, when your physical therapist talks to you and tries to keep you in conversation while they are doing something really painful to you. I have obviously been in therapy too long!

You are right, Chrystyna. It's definitely easier said than done. I always tell people that who don't understand what's going on and don't understand why I just can't walk right or bend my knee.

My physical therapist always picks on me because in the op note at the end of the surgery it says "knee was taken through a full range of motion." He'll say "why can't you do that now...it is possible." He's joking though because well I was asleep then and blissfully unaware of the pain!

I hope things are going better for all of you, too. Thanks for all the support.

Anyways, I'm 6 weeks post-op, down to one crutch and still in the hinged brace which my physical therapist unlocked to 60. I can't see my kneecap yet. I made the decision to go back down to going to formal therapy 1 time a week.

At physical therapy yesterday, I started off on the treadmill with walking and gait training. My pt was bending my knee for me and flexing my ankle (my two worst gait parts) while I was walking. The PTA across the room, who is always watching me too, noticed I was lifting my hip up to avoid any real bending the pt was doing. She, of course, told him and then she decided to come over and hold my hip down. So, in the end, the whole staff there (just a PT and a PTA where I go) were helping me walk. The other patients got a kick out of it.

Then, I did sitting in a chair and bending. He would put his hand at a certain point and made me bend until I touched it or else he would "assist" me in getting there. Then, I did mini-squats, gripping the table for support. I then sat on the edge of a table and he wrapped a resistance band around the table and then put it around my leg so it pulled it back towards the table. Next, I believe I did hip strengthening (standing pulling leg backwards, forwards, out to the sides). Then, terminal knee extensions with a thing to hold of balance, but I had to close my eyes and try to stand on just the bad leg. He is trying to reestablish my proprioception. Then, I did ones where I lift my leg up (bending the knee) to place it on a step, but did not step up, just brought the leg up and down. Then, toe raises. Then, table exercises. SLR with 2.5 lb weight and side ones too. Then, he took what he called a "Tiger Tail" (type of roller) and rolled my calf and quad and my IT band. It was so tender and painful which he said meant it needed to be done more. He also had me stomach and bent my knee back. Ouch. I was nearly off the table by the time he was done.

It was a tough day. I'm nervous about going to school with one crutch, a book bag, and hundreds of kids roaming the halls. He also wants me to go slow in the halls so I can walk as right as I can. He said if it means I'm late to class, he'll personally write a note and get one from my doctor if any of the teachers have a problem with it.

Overall, my pt session lasted almost 2 hours and needless to say I'm sore.