My TTT, MPFL Reconstruction, and Lateral Release

[Runner1993]

2 Weeks and a Day Post-Op

30 may seem like a lot to people who have never been through surgery...but it goes so quick going even twice a week. I never make it even close to the sports part of rehab. I'm going to have to do that all alone and it scares me. I don't think my body has a clue how to run, sprint, cut, jump, or anything :/ Maybe my surgeon can help me figure it out; he's fellowship trained in sports med and is a fellow of the American college of sports medicine. On his page, it details the awards he has won for his research in both family practice (kind of weird to do that and ortho surgery) and sports medicine.

I am doing the exercises my pt told me I could do at home which aren't all the ones I do there. Usually, every time I go I do something different at pt, but he has me doing the same ones at home that I got my first day at pt. They include all the ankle movement ones (alphabet, pumps, circles) which get more difficult as the day goes on and swelling increases, these ones where I lay on a surface (do them on my bed) and I push my ankle down into the mattress (it works your hamstrings and I can feel them too if I place my hand behind my leg), quad sets, and just some other tightening the quads one. Soon, he says he will give me more bands so I can do hip resistance ones, but he said hold off on the band ones. Since I was able to do straight leg raises at my last pt appt, he told me to add them to the ones I do at home. However, even though I was able to do them there, they are extremely difficult at home and very painful. It pulls on the area where my screws are, must be the muscles. I'm also scared that my leg will get tired halfway through and fall. I'm going to wait until I get better at them and do them more at pt.

Yes, weekends are my time to rest from a tiring school week! Hope you have a good weekend kasia_ny. If you don't mind explaining, what was the other procedure you had with your TTT? I have never heard of it.

Friday, I was plopped on the couch as soon as I got home with tired arms and shoulders, sore hands, a huge ankle (someone commented it looked like I broke it), a hurting knee, and heavy eyelids. TGIF!!

My knee, moreover my shin, has been bothering me more lately probably because I am increasing my weight-bearing with crutches due to my doctor's and pt's requests.

I did have to take some more pain medicine today...trying to wean off. I was off all pain meds within 5 days of my last knee surgery. I tend to handle pain well. However, today my leg is hurting a lot and I figure why try and tough it out when I have the pain meds to help.

I am able to stand on both legs without my brace or crutches; I did at pt with my pt standing by. However, I most definitely put more weight on my right. I'm going to hate walking again because of the giving out I know is coming due to just the quad shut down from the trauma of surgery, inevitable. I'll probably use my crutches, at least at school, if that keeps feeling like it will happen. I expect to use them at least 6 weeks. My pt says I have a long time before I get out of brace. He almost unlocked it to 30 so I could walk with a bent knee with crutches so my leg doesn't get stuck in a straight position like last time, but then he decided it was too early :/

I have no lunch period at school anymore due to my load of classes. I try and eat some during my classes, but can never eat much. The surgery still has affected my appetite though, don't eat as much as I use to. But I know how important being healthy is for my healing! I'm drinking my milk so the excess calcium levels in my blood will stimulate my thyroid gland to secrete calcitonin which in turn lower my Ca blood level by stimulating my osteoblasts to build more bone Thank you anatomy class!

Here's the pic of my xray. The quality is kind of poor due to the fact that it's a picture of a paper copy. The shot was taking while standing up with my knee slightly bent. I also have the straight on shot of both my knees standing, might upload that one some other time. The plastic screw in my patella doesn't show up on x-rays. I also wonder if it's the kind that absorbs/dissolves over time.

To further explain how my orthopedic surgeon did the MPFL reconstruction since it was something new I learned, he drilled the hole in my kneecap, placed the screw which also had sutures connected to it (referred to as a screw once in my op note and a suture anchor at another point), he takes that through the MPFL and tightens it to the right tension, and ties it in.

Now, Kate, you once told me there wasn't a difference between MPFL repair and Medial Reefing. However, I'm thinking maybe there is? But I could be wrong; no OS here lol. My surgeon told me to do the MPFL, he made a cut through the skin and tissue below (subcutaneous), then inline with that cut, he cut through the next layer which is the medial retinaculum, and then the MPFL is located below that. He freed the ligament from the surrounding tissues and did his work. Then, when closing the incision, he had to put the medial retinaculum back together in a pants-over-vest fashion or something weird like that lol.

I think when they do medial reefing, they do the retinaculum too, just by, as my current OS says who doesn't really believe in medial reefing, "they go in and grab as much tissue as they can and suture it tighter."

He says it's quite possible that my medial reefing to just get stretched out since the real factors of the lateralization were not addressed.

In the op note, it talks about the sutures of the medial reefing and says they ripped from the medial border of the patella. I'm confused though because they were never in my patella if that what he means!

Tomorrow, my family wants to go to the mall. I want to go too, but know I'll be tired and sore! I think I might just get a wheelchair since it's a fairly large mall and I should be resting up for the week ahead.

Have a good weekend everybody!

[oohheykate]

The PT thing is tough. Some how, when my knee first started hurting me, my OS got my insurance to approve PT twice after my inital 60 day limit. So maybe your OS could talk them into letting you do more PT. I know it might be difficult because insurance companies really don't care, but would be really beneficial to you. Even if you go in once a week.

When you mentioned before about not having a lunch period, I couldn't believe it and I still can't. I can't imagine having school without lunch. Even if I don't eat, I love talking and just relaxing with my friends. Kudos to you for taking that course load.

Are you sure you're not an OS?! The way you just described that sounds EXACTLY like what my old OS had said to me and what my op report says. I always remember the "pants over vest" part because I thought it didn't sound very medical at all. There might be a difference between a repair and MR. I assumed there wasn't because my old OS used the terms interchangeably. My new OS calls it an imbrication.

I went to the mall two weeks after my surgery and was too embarrassed to get in the wheelchair. My mom pushed out bags around. Haha

Do you, by any chance, know your TG-TT offset from before surgery?

[kasia_ny]

As for doing the SLRs at home I was attempting them even when I could not fully do them.  I had my husband put his hand under my heel and make sure that my leg does not bend or fall.  At the beginning he did most of the work for me  but every day it was less and less... You can ask your mom or dad for help.  My goal was 100 a day, no matter what!

Denovo NT is a relatively new method in cartliage transplantation.  It involves juvenile donor cartliage material (it is the weird part - I have not fully processed that I have someone else's tissue in my body).  The cartliage is harvested from donor's joints. In this procedure, rejection is not a concern. The tissue (it is in a form of little minced pieces) is glued on the defect.  I had a large grade 4 cartliage defect in the lower half of my patella and the doctor also used a dissolvable patch to keep the transplant in place.   

[Runner1993]

2.5 Weeks Post-Op

Although it gives us snow days, I am currently hating the snow! My area has way too much and we are getting even more tomorrow. Yay upstate NY. While other schools were closed or leaving early at noon, my school had school all day! All of the cars were buried by the end of the day and the roads were crap. My friend took my home, but she couldn't make it up my driveway with her car. I didn't want her to keep trying and be a bother so, I got out of at the bottom and walked up my long driveway with a ton of snow The snow kind of helped in a way of taking some of the pressure, and I'm glad I'm not NWB or else I couldn't have done it, but now my leg is throbbing and I'm going to take some pain meds, ice, and settle in on the couch. It was the only way to get up my driveway though since my dad won't be home from work for a while. :/ So, I would suffer the pain just to make it up. I'm pretty sure it wouldn't be possible to damage my knee doing what I did since I didn't fall, used my crutches, and had my brace on.

Yea, maybe later, I could try and get more approved, but the appeal process is pretty much not existent when it comes to my insurance. We tried before with physical therapist and even doctor notes.

I like lunch for the same reasons; I miss it!

Oh, hm, except for this board, I have never heard the terms medial imbrication or MPFL repair used by any orthopedic surgeons I have seen, but there's a ton of OS out there and they all use their own terminology!

I stayed home I didn't feel up to the mall with my leg the day of and decided to save my energy for the week.

I never asked for those numbers, but my OS said he was going to try and get them off my old MRI. I'm very trusting when it comes to doctors I guess just because they have so much more education than me, etc. However, I do ask the necessary questions, etc. When I brought up the list of all the factors that could cause the instability, my surgeon could name all of them without me even saying them. So, then I felt silly for even bringing the list since he already knew them. Plus, from the way he showed the lines on my knee and the pull, and what he told me, I was confident the TTT was needed. Sorry I never asked. However, I do know that he moved my tibia tubercle by 1 cm. When he does TTTs though, he probably corrects it to the lower end of the spectrum. My Q-angle, according to surgeon #1, was 17-18 degrees. However, surgeon #2 never measured that; he was more interested in TT-TG since your tubercle can be out of line and not your tibia if you know what I mean.

Thanks for the advice for the SLRs! I'm still attempting them everyday even if they suck and are painful; I can only get better with practice!

Grade 4? That's the worse of the worst! That procedure sounds pretty advanced in terms of what doctors can do now today to fix knees; I hope it works!

My back kind of hurts lately, too, just a lower back ache. Sometimes, when I don't have a friend in my class going to the same class next, I carry my bookbag, which can be heavy at times, due to my lack of free periods to go to my locker...as of now, that is what I'm contributing it to.

Hopefully, my brace gets unlocked some when I go to pt this week! Fingers crossed!

[Runner1993]

Nearly 3 Weeks Post-Op

I had physical therapy today. I worked on a lot of strengthening, had Russian stim, bent to 37 degrees with my physical therapist, and officially got my brace unlocked to 30 degrees. It feels a lot different to walk with an unlocked brace! Surgeon's protocol calls for it to be opened 15 more degrees each week, however, physical therapist says it's all based on progress; some weeks we may not unlock it if I'm not ready. I have a problem right now with being able to actively straighten/lock my knee out. So, when I walk with the unlocked brace and crutches, my knee doesn't really straighten with my gait so I practiced walking with my physical therapist. I have to learn to walk all over again! lol.

Also, I'm a little nervous about my TTT incision. My physical therapist let me take off the steri-strips today because they were peeling and getting gross anyways. However, I also have this red blister thing and it looks a little filled with pus and fluid (tmi I know, but it's all in the joys of knee surgery). There is redness surrounding it which my physical therapist outlined in pen and told me to watch for spreading. He's not too worried right now. My MPFL incision has healed very nicely. The TTT one is just gross with that thing.

I still shower with a chair; how long before you guys started them standing up?

Not completely off the prescript. pain meds yet, have to take one now and then, but am very close to being off of them!

Next physical therapy on Wed, but I got the o.k. to start adding hip band exercises and terminal knee extensions while standing at home so that will keep me busy.

[mermaids]

Don't you just love that Russian stim?    The blister thing seems not uncommon, but definitely watch it.  It should be getting better, not worse.  Some people are sensitive the steri strip glue. 

It was quite some time before I removed the shower stool.  Even once I could stand easily on the bad leg, I still used the shower stool.  Showers are slippery places.  I liked the extra security.  Besides, it was kinda nice to sit and relax in the shower for a bit. 

Walking *is* weird at first.  My team explained to me that the knee joint is now moving in a different way so it will feel odd, but it is important to try to regain a normal gait. The muscles around the knee will need to learn to accommodate the new mechanics of the knee.

[Runner1993]

I'm definitely keeping an eye on it as today when I was walking with my crutches to my next class I felt wetness on my knee and looked down to see the jeans over my incision covered in a bloody liquid. I went to the nurse to take off my brace, move my pants leg away, and clean it. It's very gross looking, oozy, a little pussy, not really though, just a lot of blood/clear fluid. It is red around it, but hasn't spread really. It's sore.

Unfortunately, it was one of my favorite pair of jeans now stained!

I called my physical therapist before I attempted to get a hold of the doctor (today is his surgery day). He said yesterday by the way it looked, he's not worried about infection and that it's just fluid leaking out. It looks like a hole, not wide though. It's so gross though :/ Ugh.

I'm going to keep changing the dressing regularly and keep on eye on it. It seems so late, if it was infection, for it to start.

[agresknee]

Hi You sound like your making good progress, the messy part of your incision and the hole reminded me of my daughters TTT and she had to have that screw removed because it wasnt letting the skin heal over it for some reason so they removed that screw re stitched and all was fine.  Our doctor never ever had this happen before in all his years doing TTT and he had done a ton  but it was another Knee guru person who had me tell the doctor. My daughters hole was directly above a screw. We even spent weeks on antibotics and packing the hole and watching the size.  This  may not be your issue because it is extremly rare, but thanks to the knee guru person pictures she sent me we were able to fix my daughter.  She still has two screws and they dont bother her so we will probably leave them.

Keep up the good work My daughter had TTT, MPFL and Lateral Release it will be two years in June She is a Senior now and had it done the Summer of before her Junior year.  Be very careful in School the kids are in a hurry and thoughtless and we had few scary almost falls. She is back on the Basketball Court for her team and having a great year so I hope you are all mended and ready to go for your freshmen year in college

[bball123]

Hey Runner!

How is the blister thing looking today? I hope it's looking better. How is PT going? Are you finding walking with the crutches any easier as you have healed more?

[Runner1993]

4 Weeks Post-Op

Hey long time no talk bball123, how are things going with you? Crutches are getting easier as I am able to put more weight on my leg.

The blister thing that popped I was talking about has healed again for the most part. You can still tell where it was as it's still a little raised and red. Unfortunately, I developed another one on another spot down my TTT incision and I have been watching it carefully. Due to my careful protection, it hasn't popped.

Agresknee, thanks for chiming in. I am going to ask my doctor about it. I'm so happy to hear your daughter is doing so well. Going back to playing basketball after a surgery like this is a big accomplishment.

I had physical therapy this week and after seeing that a second raised blister/red bump developed, he was more concerned. One, he said, wasn't much to worry about, but the fact that there's another one is more worrisome. He told me to call my doctor. I did and left a message yesterday. Usually, they get back to you within the hour so I'm thinking maybe he wasn't there today or yesterday. I'm taking pretty good care of the incision myself plus I see him for a follow-up from surgery next week.

Physical therapy this weekend concentrated a lot on gait. I got on the treadmill and my physical therapist put it on really slow. Now, without a brace or crutches, I walked while he moved my leg into a normal gait pattern for me so pretty much he was doing the walking for my leg. Unfortunately, he decided to turn it up a little, but it was too fast for me. My feet couldn't keep up and I was falling. I screamed for him to stop it and he, in a panic, hit a bunch of buttons and turned it off. I looked around to see everyone staring at me. It was embarrassing and I was really scared for a minute. My physical therapist caught me though before I had a really bad fall and apologized. He said he didn't expect for that to happen and thought I was ready for that speed. I then returned to a 1 mile/hr speed. Back in my healthy days, I don't think I couldn't even walk that slow if I wanted to.

We also worked on bending, strengthening quads and hips, did stim, did ice, unlocked my brace a little more, and a few other things.

So, right now, my physical therapist says I lack dorsiflexion (the pulling up of toes) in my gait pattern thus my knee does not achieve full extension if you guys can picture that. However, it's difficult to bend my knee too while walking so it's just kind of stays in a semi-flexed position working hard on normalizing my gait. For the first time since I hurt my knee, I want to not limp!

I am in no way a back sleeper. I miss sleeping on my sides and stomach. I find that sometimes I will turn over onto my side, but I wake up during the night in a lot of pain and go back on my back.

Now, sometimes, my kneecap feels like it's moving, not popping out, but shifting around in the groove and it's bothersome. I'm sure it's just because of the state my knee is in (tight, swollen, scar tissue, etc).

Next pt is Monday so he can do a progress note by the time I see my doctor again.

Progress is slow, but it's coming. Hope everyone else is doing well.

[agresknee]

Glad to hear your going to the doctor for sores, the women on knee guru had holes over all three screws, we only ever got them on one,
kates would heal over then reopen and then it got to the point it wouldnt heal over at all,  The lady is still on Knee guru and if you reached out to her I bet she would send you the picture so you could see if it looks like yours, Our Doctor was surprised how much kates looked like the lady since he had never had this happen before .

good luck and hope it is nothing Let me know if you need help finding her post I will find her post name and put it on your site

[agresknee]

Fraud Ninja is her  post name in she will be in the longest section

[Runner1993]

Thanks for the info Agresknee.

I had physical therapy yesterday, and I'm off to the orthopedic surgeon tomorrow. Hopefully, it goes well. I will post about it all later!

[agresknee]

Great news good luck thanks to reading your post got back in touch with her and you will be happy to know she is another success story doing AWESOME and running  4 or more times a week and 4 miles it is so wonderful to hear about success make sure you keep posting

Be patient listen to your doctors and PT and I am sure in a little while we will be reading about your total recovery as well.

GOOD LUCK!!!!!!!

[Runner1993]

5 WEEKS POST-OP

I have to say physical therapy this week was very painful. Whenever I do exercises or motions when the knee is bent, it kills to straighten after as it feels like everything is jammed. The lateral inferior part of my knee is very tender too; my physical therapist started massaging it and doing patella mobilizations. My body just stiffened from the pain. Another specific exercise that I hate, but do diligently, are the ones where you place a can under the knee, lifting up the lower leg to straighten the leg. Physical therapist and I carefully debated which way would make the best use of my limited therapy visits. I was in favor of doing 2 times a week now instead of later as now is when I need my physical therapist's help more in my opinion and if I get a limp or stiffness now, it would be harder to resolve later. Later, it would be exercises mostly that I do on my own---doable at home. Physical therapist was leaning towards using more later in recovery when we are allowed to do more with my knee and I can use it to its potential. He said progress is going to be slow now. However, we agreed to try doing 2 this week and seeing if progress comes faster.


Now, onto visit with surgeon. My blister things were what he called "stitch abscesses." Because he didn't want to leave me with railroad tracks up and down my leg, he did most of the suturing on the inside, closing with a weird stitch thing I mentioned earlier, glue, and strips. However, as a result of them, the pussy/bloody blisters formed over some. He put a needle in the one I had and blood and fluid drained out. He then squeeze out the puss and other stuff, tmi I know. He then placed what he called ABD pads on it and wrapped my leg all up and told me to use heat to make sure "nothing can survive in there." I felt like I robbed a medial supply store when we left with all the wrap and pads. He doesn't want me using gauze because it could get stuck in the incision. We have to watch like a hawk for redness, increase pain, fever, etc. as it would be bad if the infection spread to the screws beneath.

Other than that, it went well. My ROM is 50*. He said that isn't too bad since I was only allowed 30* weeks 1-3, 15 more each week so 45 in week 4, 60 week 5. He said the limitations on ROM are due to the MPFL. As the knee bends, more pressure is put on the area. If the ligament stretches out just a little and the kneecap happens to shift, he said it will not be a good situation.

I also got an updated outlined protocol starting from week 0 to 16 weeks< to give to my physical therapist. Maybe I'll post some of it later just to show how my OS outlines recovery.

So, I'm still in the hinged brace and on both crutches. I go back in 4 weeks so will not be ditching the brace before that, maybe the crutches, but I'm not sure.

OhheyKate, I haven't seen you around here, hope you still read I sometimes feel like I'm the only one talking here, but that's okay; it helps to write about my recovery.