Patella Dislocation, fracture, femur microfracture

[Keif_dawg]

Hi.

On May 31 I dislocated my right knee. It broke off a small piece of the patella and also of the femur. The Sports Physician I originally saw thought they would just remove the loose bodies and be done with it... a few weeks recovery... but not quite. The surgeon wanted to re-attach the pieces that he could. He used disolvable nails in the patella and performed microfracture on the femur as well as a repair to the FMCL with disolvable stiches.( Mid-June)

Because of the combo of surgeries i was immobilized AND no weight bearing for 8 weeks. So i didnt start PT until mid to late August. I started around 30* ROM and got to 80 in about 8 weeks, but since then (about 6 more weeks) I have only progressed to 90*.

The surgeon wants to go back in and try removing scar tissue but I am not really feeling it. I am functioning pretty well and he told me to wait till the end of the year to think about it. I have good strength and stability and all that good stuff. I just need more ROM and feel like I have plateaud for a good month.

Anyone else in  a similar boat or care to chime in?

[Suejs14]

You might want to check posts re: a MUA.  That's manipulation under anesthesia.  The OS forces the knee to bend, essentially breaking/tearing the scar tissue (vs surgically removing or cutting it).  Rollerblader had it done recently and shoecrazy is about to.  Their posts are in bone breaks around the knee.

Sue JS

[floridanightingale]

KDawg, I agree with Sue that you should check out the posts about MUA and conisder it with your surgeon.  You seem to be healing well, but after 6 months, your ROM isn't where your doc feels it should be.  MUA doesn't seem to be so bad, and it appears to allow the OS to break up the scar tissue and move you along in your recovery.  Good luck!!

[Rollerblader]

Hi Kdawg,

I had a MUA , but mine was 9 weeks post op, very early by all accounts.  There are several posters who've had one or going to have one in the coming weeks.  Elewis had one a week ago (she posted under  the General Questions section). Sintu was supposed to have one on thurs or Fri this week, but hasn't updated yet.  Timrand (sp?), her name is Tina, she's having one Monday.  All of us have had them around 9-14 weeks post op.  My OS wanted to do it right away because he said it would be easier to do it early than waiting after 4 wks of PT.  it's my understanding that the scar gets harder to break up the longer you wait.  That might be why the OS is talking about surgically removing the scar tissue.  I could be wrong, but I thought they go in arthroscopically and just cut the tissues to losen it up.  From what I've read, when some people have this done, if your body produces an abundance of scar tissue, then cutting it could create more scar tissue and it seems to work well on others.  I am no expert at all.  I would discuss all of the options pros/cons with your OS.  He may encourage you towards the one he has had the most success. 

There are people who've posted under the heading arthofibrosis.  I don't think that eveyone who gets scar tissue has it, but I i think there might be some good information under that section and you might want to post a question there.

I hope I haven't scared you.  Mine has worked out well, but the week + after my mua was really a setback. I ended up gaining from around 35 ROM to 133+ ROM in about 8 weeks.

Good Luck!  Hopefully you'll have a break through!

Take Care,
RB

[Keif_dawg]

Thanks for the replies.

RB: What was the therapy like after the MUA?  What type of things and how long each day? Were you walking after?

Part of my problem is that I have exhausted all of my time off work I can take ( I am working now ). I have read two to three weeks after is really bad but not too much detail of what bad is. My work is very accomodating but missing more time will cripple me financially. If it was only a week real bad I think I could make it through at work but worry how much time therapy will require as well.

The first dr. I saw thought they would just remove the loose bodies arthro and I would be ok in a few weeks, then the surgeon said 6-8 weeks immobile and 4-6 of therapy, now here I am 20 weeks in and talking more surgery.... He is saying out of work for 3 weeks but is that going to turn into 6-8-12...

ugh.

[Rollerblader]

KDawg,

My experience was different in that I couldn't drive to get to work...  My ROM was only about 35 or so when I had my MUA and it was my driving leg.  Elewis just had MUA and I think she was around 80 or 90 when she had hers and she could get to 110 or 120 right after, so you may want to watch her progress. 

My experience was that I could bend my leg quite a bit at the hospital.  The procedure was a day surgery.  It only took 30 min and I walked out with my walker.  I've been full weight bearing since my patella break surgery.  I think, i felt ok the first day and then my thigh got really sore for the next two weeks.  The first week after was pretty awful.  My thigh was swollen maybe 3 inches larger than my good leg until I got on anti-inflamatories.  I should have been in those from the first day after mua, but OS didn't prescribe or mention them for some reason.  If I could have driven and been on anti-infamatories I might have been able to sit and work a week after.  It's hard to say...  I didn't feel ok, till I got off the pain/narcotics.  I thought I needed to be on them during the day, but I found that it didn't help with the pain in PT...  Just made me feel awful and teary.

I went to PT 3 x a week for an hour, so it wasn't bad.  Some people are on CPM machines all day afterwards and some people have PT for 10 weekdays after.  It seems like every OS is different.  I rode a recumbant bike everyday 3-5 x a day.  I went around until I couldn't go around any more and held it, then I went around backwards and did the same for about 8 mins.

The pain from the MUA is mostly in the quad.  It hasn't been used to bend since your injury and the OS forces it to bend while breaking up the scar tissue.  It basically shocks your quads and hamstring and your muscles are in knots and that is what is the worst part.  In my case, in PT, the limiting factor in gaining ROM was the tightness of the quad.  After about 2 weeks the knee was the limiting factor. 

The one thing that drove me crazy was the caffiene/hyper leg.  That happened when I got to about 90 ROM.  Have you had this?  It seems like alot of people have it.  My leg was restless unless I was excercising.  It was bad when I had to sit or sleep.  It lasted for a me for 2 or 3 weeks. 

I don't know how long the recovery for cutting up the scar tissue with surgery would take to recover.  I think FannyFatigue had this done.  You might search her threads. 

Let me know if you have any questions.  Hopefully, the ones having the upcoming muas will post their progress so we can all compare recoveries.  Elewis seems to be having similar experience as me, except for the CPM.

Wishing you well!  Take Care,

RB

[Keif_dawg]

I have scheduled it for the 20th so I will update...

[Keif_dawg]

Well, I had it yesterday.

Arthroscopy, scar tissue removal and MUA. The surgeon said the scar tissue was a real mess inside but he got 140 degrees during the manip (heel touched butt). He said he thinks this will be it.

This was WAY less than the first surgery. I used crutches for a couple hours and then ditched them in favor of a limpy walk. My knee and upper leg are REALLY swollen and there was a lot of blood when I changed the original dressing. The knee itself is humongous and deformed but I think that is mostly saline. Some bruising on the upper leg. Surprisingly my calf feels fine which alot of people said would hurt. The upper leg muscles seem to be the most painful part of the whole deal. And that is quite painful, especially to the touch. The hamstring isn't bad yet either, lets hope it stays this way.

The first night I laid on my stomach and used a pilates band to pull the leg towards my butt and I am already getting more than I was before with minimal pain. It took a couple times to get there but it is not the hard stop I was dealing with before.  I waited about 4-5 hrs after surgery first and then tried this a few times before bed.

Pretty much what Rollerblader described, seems to be  close to the same for me so far but I haven't gone to PT yet. We'll test those waters today.  It definitly seems like the right choice so far though. No CPM either. I feel like I could tough it out at work right now (sitting or desk duty) and am feeling much better mentally about having it.  Thanks to everyone for the insight.

[Suejs14]

Great news KD -- I've heard that the quads were hurting for most of the MUA folks, so you're pretty much normal in that regard.  Ice, elevation and continuing to work on your ROM -- so glad you've had such an outstanding result!  140 degrees - awesome!

Hope your Holidays are wonderful as well --

Sue JS

[Rollerblader]

Kdawg-

Great news!!!  So glad to hear you are feeling posative about the mua.  If you tighten up a little, it's normal, so don't worry.  Make sure your taking anti-inflamitories if your OS will let you.  It helps with swelling.  I took 2 aleve at night and 2 in the a.m.  That was higher than the regular dose.  I'm down to one in morning and one at night.  My PT did not want me limping around, i actually used my walker more after my MUA than before.  It was a pain carting it around, but I wasn't limping.

Also, if you are on perscription meds for pain, try to wean yourself off as soon as possible.  I think I was miserable the first week until I got off the percoset.  I then took Norco for a couple of PT sessions and at night.  The PT hurt, so I didn't really feel like the Norco did anything for me in the PT sessions.  I was able to manage fine without it.  Everone is different though.

So happy your making progress!  Hopefully this will be a distant memory before too long.  Hope you have a happy healthy holiday season!

Take Care!

RB

[Keif_dawg]

Thanks. I made it in to work on Thursday (2 days after) and was able to tough it out with a slight limp. Days 3 and 4 have started with some stiffness in the a.m. but I am able to work through it myself with my giant rubber band or by starting the bike on a higher seat position for a couple minutes and then gradually lowering. I have a lot of bruising on the inside upper leg now but most of it just appeared last night. I am not sure what from, last night I was using a portable massage thing on my leg through my jeans, that may have caused some of it. Before that I had one 4 inch bruise but now pretty much the whole inner thigh is black and blue. I am only getting 90-100 right now but all the pain is in the quad, it is a totally different kind of stop now. It really does feel like a stretchy stop in the muscle now. Before it was a hard stop and it was in or around the knee. I have a 4 day weekend now and then I have to work 3 days next week, so we'll see how that goes. Right now all the pain is in the quad and I am limping a little more than I was the first couple days but I am able to function well, about the same as before the MUA. I am on the same page with the pain meds where I feel they dont really help much if at all but I try to take them before PT. I didn't yesterday morning and I had a rough time on the legpress, hard to say if it was lack of pain meds or just soreness though. I have been taking motrin too. The swelling went dont 3.5mm between my first 2 PT's and then another 0.5mm between the next 2.

I am still glad I had the MUA and I think it is going to work based on the difference I am feeling now though. Thanks again for this site, being able to get a little insight before the surgery really helped me. Hopefully my experience can help someone else now.

[Rollerblader]

Kdawg,

Sounds like your experience to the mua is very similar to mine.  My bruising didn't actually show up until my 4th day after the mua.  My bruising was mostly green and yellow.  I was suprised I didn't have back bruises.  My PT said the bruises may be from where they strap you down.  I asked my OS and he said they didn't steap mw down, they just pushed my knee towards my chest from my foot or calf and held my leg, so I suppose the bruises could come from the Dr's and assistants gripping your thigh. 

That's great that you were able to go to work so quickly.  I didn't have enough ROM to be able to drive until 3 weeks after my mua and my work is in a different direction than my husbands, so no carpooling...

Thanks for updating!  Oh, yeah, I take Aleve instead of ibuprophen.  It lasts for 12 hours, which is nice!

Take Care and Happy New Year!

RB

[Keif_dawg]

Well, about 3 1/2 weeks since the MUA. It is still sore but seems to be lessening. I am at about 120* ROM although it does stiffen up at times and I have to stretch it to loosen it up. Just the last couple of days I have stopped limping for the most part but still catch myself at times. The bruising went away after about  a week. Most of my pain is in the muscles still but I am having some in the knee too. I still have a large pocket of fluid on the outside but the OS didn't want to drain it when I saw him last week. He was very happy with my progress though. The area around the fluid is the most painful part of knee pain but there is also an  area on the inside that feels sore. Other than that when I max out my ROM there is some pain that is hard to pinpoint. I am feeling pretty good though and am still making progress which is encouraging. If I try to sit on my heels I can touch my foot and butt with my pinky and thumb of my hand opened up. That is probably more than 120*.

I will keep working...

[smileyshaz]

Good to hear that you are improving!  The bruising that you experienced around your thigh would have been from the tourniquet that they apply to stop the bleeding whilst they are operating, so they can see what they are doing (it's a bit like a blood pressure cuff only it stays really tight until they take it off).

Keep working on bending that knee as often as possible! 

[Rollerblader]

Hi Kdawg,

It's good to hear your progress!!!  You've had a long road, but it sounds like the MUA really helped you break through.  I hope your swelling goes down where you have the fluid.  I'm sorry you're still sore.  It's amazing how long it takes our poor muscles to recover from the MUA.  I think I was sore for 3 or 4 weeks.  I remember the side of my quad seemed to take the longest for the soreness to go away.

I'm going to have my hardware out on Feb 6th.  I can't believe this will be my 3rd surgery in 6 months : ( I'm ready to get it over with.  Life is getting back to some normalcy.  I have noticed I have problems climbing the bleachers at my kids basketball games without a handrail... It's so much better than not being able to go and having to sit at home and miss everything!

Keep us posted!  120 is terrific!

Take Care,
RB