Lisa's Fulkerson TTT, Lateral Release & Medial Plication LK- 1/25/11 RK- 4/26/11

[lisa424]

(FYI my Dr. was Donald Rose in NYC.- read my other posts)

Hey guys,
I've been reading this forum for the past month, and I thought I'd share my story.
I had my first subluxation at 12 years old. I'm 25 now and get monthly subluxations in both knees. I saw several orthopedic surgeons over the years and went through years of physical therapy - which didn't help at all. Some doctors said I'd outgrow it and other recommended a lateral release but warned me that the chances of it fixing my problem weren't good. So, I decided to limit my physical activity for years...no running, no sports, etc. At the end of 2010, I decided I was sick of being so limited. I started looking for some better doctors. I saw specialists at both NYU's Hospital for Joint Diseases, and the Hospital for Special Surgery. Both doctors recommended the same procedures for me. I needed a Fulkerson TTT, lateral release, and medial plication on both knees. I ended up going with an OS at NYU. I decided to do the left knee first, since it was worse.

I had the surgeries on my left knee on Jan 25. I went with general anesthesia with a nerve block. I woke up in pretty bad pain and got some morphine shots. The nerve block didn’t seem to be helping much, but who knows how much worse it would have been. I was pretty surprised at the size of the immobilizer. I'm 5'5" and it goes from my thigh to ankle. I was thinking how am I going to move in this thing?! I got home a few hours later and started on percocet for the pain. I only got up to use the bathroom..quite difficult because I hadn't really practiced on crutches beforehand. I also ended up having hiccups continuously for almost 2 days...a side effect of the general anesthesia.

The first week was pretty bad pain-wise. I spent most of my time sleeping.  The cryo cuff I bought ended up being a great investment. It helped a lot with the pain.  But, every time I got up, the blood rushes were pretty bad. The swelling got real bad around day 5, and I was screaming in pain when I tried to get up. One day, I had to get in a rolling chair and be pushed to the bathroom! I hated having to get up at all because it was annoying to have to move my leg.

One week post-op, I saw my doctor to get the bandages removed. I was actually shocked at how small my scars were. Two small incisions for the lateral release, a 1” scar at the medial plication site, and most surprisingly, my Fulkerson scar is only 1.5”.  I only have one screw. I got to see the xrays and arthroscopy pictures.  My knee was still somewhat swollen and my entire leg was badly bruised.  My doctor says I’ll be in the immobilizer for 6 weeks.  I’m NWB for the first 4 weeks. After 4 weeks I can be PWB. Crutches for 6 weeks, unfortunately. I really hate them, as I have very little upper body strength.  Physical therapy starts 6 weeks post op. Screw removal after 4 months.

Right now, my ROM is 30. It’s still kind of scary to do that even, because I’m afraid I’ll break something. I’m not used to my knee in its new position.  Now at 12 days post-op, I still have pain around the TTT site. Luckily, my parents have been helping me every day, bringing me food, etc.

I scheduled the surgery on my right knee for April 12, if all goes well with this recovery. I just want to get it over with.  I figure I might as well do this now, while I’m unemployed and can devote my full attention to rehab.

[Rknees4]

Hi Lisa
Welcome to the board. Glad to hear things are going quietly, hopefully you don't get any surprises.  Those blood rushes are a real treat aren't they?   Every surgeon does it different, thus the variation in scars, rehab and other post op protocols.  Hang in there it does get better and easier, but it is a long recovery so don't expect to be up and running to soon. Well take Care Lisa,
Rknees4

[Clav]

Hi Lisa

I had my TTT, medial tightning and lateral lengthning a week before you and i can relate a lot to you.

I never had any such subluxations like you - ive only subluxed/dislocated my knee 3 times in my life and after a failed lateral release i finally found my problem - am very hypermobile and lax in my joints.

Like you, I also only have 1 screw in and i was completely in bed 12 hours a day for the first 10 days because i dreaded the blood rushes - it was the worst - infact i went to hodpital because i thought theres a blood clot.. it is the worst

today is 3 weeks - i was 100% weight bearing since day 1 .. but i have to use crutches when i walk because my leg is very weak and i cant really walk at all..

I do excersizes but it is really difficult because my quad is very very weak.

My doctor did not do a lateral release but rather a lateral extension - he made it longer and on the medial side he made it shorter.. he believes it works much better.

Well I hope your recovery goes well because at 3 weeks i am still very upset at how long this road still feels.

all the best

Clav

[lisa424]

Rknees4, yes, it's important to remind myself that every doctor does it different. I was reading about everyone elses scars and multiple screws and thinking maybe there's something wrong!

Clav, I'm also hypermobile to some degree. I don't think my knees are though.  I also thought I had a blood clot last week, but it was just bad swelling. I wish I was weightbearing now. The only time I am, is when i accidently slip and have to put weight on it to keep from falling!

I love reading this forum because I've never met anyone with my same problems, and sometimes doctors didn't even know how to fix it! But here, there's so many like me.

[Rknees4]

Lisa,
I am glad to hear you are a little happier knowing there are others like you.  I go for round 2 on Thursday. Ouch is all I can think of.
Just try and remember everyone is different, everyones pain levels, rehab, and procedure have differences. But as a whole can shed a lot of light of what to expect and watch for. Hang in there.
Rk4

[JessicaO]

Hi Lisa!

We are surgery twins! I also got mine on 1/25/11 and I am 24 years old. (Right knee though but i do need my left done i just really do not want to go through this again )

I am also 5' 5'' too...anyways, i also have a post op diary if you want to follow mine. Right now my pain is ok, u have my first doctor appt tomorrow (well i did have one at 6 days post op because i had these horrible blisters that they had to look at) I am start PT on wednesday. Are you still on pain meds? I am trying to cut back on mine but it is hard.  I just dont want to become dependent on them, with the meds i feel ok. I am just so darn uncomfortable at night and pretty much all the time. I also am getting very bored! sleeping alot even if im not tired.

Anyways, you sound like u are doing great. Do you have any foot pain? My foot constantly feels like its falling asleep and tingly i hate it! its worst than the knee pain

Hang in there!

[Runner1993]

Hi Lisa. My recent surgery (a little over 3 weeks ago) was very similar to yours, but instead of a Fulkerson (anterior plus medial) I just had a medialization TTT and I had a MPFL reconstruction instead of medial plication. Like you, I also had the lateral release.

Your scars are smaller than mine, lucky duck! For my TTT, it's about 3 inches down my shin below my knee. Then, my MPFL reconstruction is located on the upper medial part of my knee and is about 1.5 inches. I have the scope holes through which the lateral release was done. I have 3 screws for my TTT. Then, my MPFL one is a plastic screw.

So, you are in a straight leg immobilizer? I was in one after my first knee surgery. I much prefer the hinged brace I have now. For the first 3 weeks, it was locked at 0*. Just recently, it got unlocked to 30* and depending on my progress, it will be unlocked 15 more degrees each week. I was WBAT right out of surgery and am encouraged to put weight on my leg. I'm still using both crutches currently however. I started physical therapy 2 days after my surgery. It's interesting to see how much protocols can vary!

Why does your surgeon plan to take the screw out? Usually, they stay in unless they give problems. However, my surgeon can predict now that I will probably need mine out due to the nature of my leg (bone right below the skin).

Good Luck!

[lisa424]

Rknees, good luck with your surgery!

Jessica,
I read your story. Showering, even with the chair really sucks and I'm also bored out of my mind in bed all day! I don't want to go back for part 2, but I also don't want only one good leg after all this!  I'm still on pain meds, one or two during the day, but mostly at night to help me sleep, since it's a pain to sleep with this brace on. My feet are ok, but my ankle's killing me for some reason. I'll have to ask my dr, next week. Hopefully, we both heal fast!

Runner, I think my doctor was more concerned with scars than I was!  I'm in a hinged brace, but I'm supposed to keep it locked at 0 most of the time. I can unlock it to 30 to bend it a bit.  I can't imagine putting any weight on it right now. My surgeon always takes the screws out asap for some reason. I'm not sure why.

[lisa424]

Day 16, and I've been having bad muscle spasms and twitching throughout my leg all day. I'm worried about damaging something since these quick contractions are quite painful. Has anyone experienced this before? I don't think its a hydration problem...
I feel a lot of hard spots around the knee. I hope I'm not gonna have a big problem with scar tissue.

[Clav]

Lisa,

They pretty normal as far as I am concerned - I had them aswell, I started having them on day 1 already and I still get them now but they not painfull at all anymore - I am almost 4 weeks and I have also got a lot of hard spots - physio works them everytime i go to break them up. my calf is also rock hard.

[mermaids]

Hi Lisa,
You are smart to have this done while you are unemployed.  Going back to work is tricky after this surgery... even for those with a desk job.  My OS wanted me to take 3 months off after my TTT.  I think he exaggerated a bit because he knew I would go back early.  "If I tell her three months, maybe she will take off two months..."  Yeah, well, I went back, part time, about 6-7 weeks.  I am teacher, so on my feet all day and have to move around campus. 

You are probably over the worst part.  Around 4 weeks, it seems to get better.... well, until PT kicks into high gear.    When they start pushing you to bend it more, PT can be rather unpleasant.  I encourage you to follow that PT protocol to the letter.  Do those home exercises diligently, even when it hurts.  You lose a lot of muscle tone with this surgery and it takes hard work to get it back.  Having your second surgery so soon after the first one means you don' t have time to play around.  That newly repaired leg is going to have to lots of work after the second surgery.  I'm not trying to scare you... just being honest. 

This board is great place for support and information! 

[lisa424]

Yea, its not ideal having the second leg done so soon. But I have time and insurance constraints. Hopefully my left leg heals in time to do the right. If not I'll have to push it back a bit. I just know if I dont get it done now I never will...can't be unemployed forever!

Now I'm worried that my screw is loose. It feels weird. Maybe I'm just imagining things. I have an appointment with my os monday so we'll see.

[KW]

I'm sure the screws are fine....Why do you think they are loose?  Did something happen to cause them to loosen?  It takes a pretty good trauma to pull one loose....Plus I will tell you from experience that the pain from a loose screw is like nothing you have ever felt before...the pain of the original surgery is nothing compared to walking around on a loose piece of hardware.

[Rknees4]

I am with KW it takes something tramatic to pull one loose.  You are yonger so the chances of being healed are good.. you will probably not be 100% but will be able to take it easy until you feel good. Hang in there.
Rk4

[lisa424]

3 weeks post-op now! I saw my doctor on monday. My knee looks pretty good...I can get it wet now and the stitches will dissolve. The screw is fine. The fracture healed a bit. My ROM is 60 right now. 2 weeks until I am PWB and 3 more weeks on crutches.

I really hope this fixes my instability. There is always a chance that it won't because I have shallow trochlear grooves. I really hope I don't need a trochleoplasty eventually. My doctor tells me not to worry and it should be fine, but I always consider worst case scenarios! I guess I'm always gonna be scared to run or play sports.

Also, now I'm feeling a little grinding & crackling when my knee is bent. Is this normal or should I be concerned about my cartilage?