mpfl recon and vmo

[aaa]

Hi

How would one respond to a surgeon who claims MPFL recon is dangerous as it can damage the VMO ...

From what I understand MPFL would be pretty isolated repair, but I'm not a Doctor, and curious what evidence could refute this notion

[TOMMAX]

Hi

How would one respond to a surgeon who claims MPFL recon is dangerous as it can damage the VMO ...

From what I understand MPFL would be pretty isolated repair, but I'm not a Doctor, and curious what evidence could refute this notion

Hi yb,

I would think that the surgeon has a good point since the MPFL and vmo are very close to each other so things could get damaged. They would be drilling into your patella and femoral epicondyle with screws so that in itself would be very risky and Id imagine there could be potential for nerve damage so that could possibly shut down the vmo? Just taking a stab in the dark here. I personally would also be worried of patella fracture with the drilling of screws into the kneecap.

Ligament reconstructions are complex and risky, lots of potential for problems I would think. Never came across any specific evidence of the vmo complication happening but maybe someone else will chime in with some data.

There is a poster on here who had an mpfl recon in the past couple months, "hckyguy". Worth checking out his thread, its been quite the battle for him to recover so it just goes to show that the ligament recons are no joke.

How is your rehab coming along otherwise? Do you have any laxity/ weakness in the quadricep tendon and quadricep muscles or is it just the medial and lateral patella femoral ligamanets that are still lax/ weak? Has your patella popped out of the groove medially or laterally at all since your surgery?

Take care,

-Tom

[aaa]

Thanks, looks like it can be a tough recovery from the ligament reconstructions.  Also given the age of my injury, I have to wonder about the screws into the kneecap, maybe a fracture is a higher probability.

Further I had a lateral release making my knee somewhat more unstable and now may need an LPFL recon too , I've heard LPFL recon is even more risky than MPFL? .. the release was very agressive as well, an extended release across i think the entire lateral retinaculum until the patella could be everted 90 degrees .  So now there is medial and lateral instability

Don't know if its in my head, but I feel extra strain above and below the kneecap, I guess without ligaments on either side of the kneecap the patella tendon and quads tendon would work harder?

My kneecap hasn't dislocated again, I have good trochlear grove depth, at least with a 'sunrise' view x-ray of patella, i still need to get CT scans

The main problem I have is the last 20 degrees extension, there is tons of instability.  I've worked very hard with the physio so the muscles are there, to untrained eye just looking at the knee flexed it looks to be a normal knee, in fact it looks very strong.

I've tried to work on endurance and proprioception as well, lots of hip strengthening and mobility work, ... I can do biking without too much difficulty, 10 minutes with good resistance isn't too bad.  Further, I can do a wall sit for above 3 minutes which I think even in a normal knee is pretty tough to do.

I've tried to get control in the last 20 degrees but its just not happening.  The instability makes walking very difficult, and it seems to be getting worse for me, i have to limit it how much i'm moving around.  If I walk too much, the quads just start shutting down, and I'm pretty sure it isn't an endurance issue, it is a structural issue.

I really don't like the idea of hardware in my leg and its quite a bit of surgery, but at this point its either live this way and sit around most of the time, or I go with the reconstructions with the hope I could move around and do day-to-day activities without extreme difficulties ..

I think you've raised some good points, i'll still have to think this through and really understand as much as I can about the recovery and risks.

[TOMMAX]

Hey, ya I remember you were saying you had the "extended lateral release" so he cut your lateral patella femoral ligament as well as the lateral patella tibial ligament. That will cause added instability. Even though the part he cut fills in with scar tissue, it heals "loose" so the feeling of instability/ strain is there and the ligaments dont pull the way they should. No, its not in your head, there is definetly instability and straining. I have the same feeling after my lateral release. I can also relate to the lack of control in the final degrees of extension which is frustrating while walking, standing, and everything.

I understand that you want to get back to a reasonable quality of life so it will be a tough decision of when and what will be done. On one hand, you could try and tough it out for another 6-12 months with rehab and see if things tighten up and stabalize more and become at least bareable for day to day life. On the other hand, it has been almost 1 yr. since your surgery and you have a family as well as other obligations so you would be more anxious to get things fixed and over with so you can enjoy your life and put this knee thing behind you.


Those basically seem to be the 2 choices and it is a very tough decision to make. I wish you luck in what ever path you choose and hope that things improve to a satisfactory (or beyond) level for you in the future.

-Tom