Fulkerson Proceduere

[NLJ723]

Hello everyone I am new here and am looking for some advice.

I am a 32 year old female.  My RT kneecap has been dislocating since I can remember and my left is subluxing all the time (everytime I take a step it sublux).  Both my kneecaps maltrack.  I went to see an orthopedic doctor who recommended the fulkerson procedure (distal tibial osteotomy).  I am not in extreme pain except when my Rt knee dislocates,  that is extremely painful and my LT knee has a dull ache all the time.  I were knee braces to work everyday and have so for the last 4 years.  Without them my knees feel very unstable.  My RT knee has been dislocating more often and seems to be doing it a lot easier recently (did it in the ocean, a wave hit my leg and down i went,  was getting up off the floor).  And my LEFT knee just feel very uncomfortable, it feels like it is twisted all all the time and not bending correctly. 

I guess I just really want to know from people who had this surgery...Would you do it again.  I don't like living like I am now but I don't want to make myself worse ( I had three foot surgeries and wish I never had).   Please give me any feedback you can think of,  I am so confused and frustrated about what I should do.  It is all I can think about anymore, it is consumiing my life.    Also if anyone knows of any knee/patella specialist in PA/MD area please let me know.  I am looking for a great doctor also.   And if anyone knows of any other treatment options please let me know.

Thank you so much in advance.

[am7800]

I had a Fulkerson on my left knee in June.  It is definitely something I would do on the right if I need to. I've never actually dislocated but have horrible tracking and frequent subluxation. The relief I got from the surgery is unbelievable. It's a long recovery and was not always easy, but totally worth it in the end. 

[NLJ723]

Thank you so much for your response.  My left knee is the one that bothers me the most but that one does not completly dislocate, just sublux all the time. 
Does you knee feel more stable since having the procedure done?   Where did you have this done?  I am still trying to find a doctor that specializes in patella disorders and not just a sports medicine orthopedic surgeon. 

Can you walk normal now?   Do you have any pain?  Are there any limitations you have now?

Thank you so much again.

[allyd]

you can absolutely have a successful surgery, as long as you find the cause and get the right surgery/procedure for it. (not to say a Fulkerson isn't the answer) Just do a lot of research and read around to learn the various causes to instability, and in turn the 'fix' for them. Alignment, bony anatomy, hypermobility, rotational issues, etc... Just ask a lot of questions to make sure these things have been considered.

THere is a short list of patella femoral 'specialists' on the info hub>knee surgeons>who's who:
http://www.kneeguru.co.uk/KNEEnotes/node/1725

[am7800]

I had it done in Virginia.  My knee definitely feels more stable now.  I can walk normally and only have pain from the screws. My knee does not hurt at all, the screw pain can get pretty bad at times but it is getting better.  The only thing that I have difficulty doing is kneeling. From what I've read on here a lot of people can't kneel after this surgery. I can, but it just gets really uncomfortable after a couple minutes.

Like allyd said, ask a lot of questions and research. A lot of people on this board are very helpful!

[NLJ723]

Thank you all for your responses.  I am so torn on what to do as far as surgery.  I feel like I am very limited in my life right now, I don't any sports, I am always scared someone is gonna bump into me and knock my knees out.  I am always on edge about my knees.  I just don't know what to do.  I had three bad foot surgeries (all on one foot) due to bunions,  and that was supposse to be an easy surgery and turned out miserable.  So I know my foot is not correct and I am not walking correctly there but there is nothing else that can be done with that.  So i am terrified to have another surgery fail and I end up even worse again.  This is just so damn scary and nobody will give you any gaurentees. 

Any other info would be great and if anyone knows of any other surgeries or exercises or anything that might help.....PLEASE let me know. 

Thank you all again.

[NLJ723]

Another question I have is...Would you recommend this surgery for someone who is not in a lot of pain,  I don't have much pain, just lots of instability.  My left knee feels twisted and does not track properly.  Everytime I bend my knee my kneecap glides the outside cause a subluxation.  My right knee also does not track properly but feels ok.  The right knee dislocates a lot.   

thanks again.

[RLE]

Thank you all for your responses.  I am so torn on what to do as far as surgery.  I feel like I am very limited in my life right now, I don't any sports, I am always scared someone is gonna bump into me and knock my knees out.  I am always on edge about my knees.  I just don't know what to do.  I had three bad foot surgeries (all on one foot) due to bunions,  and that was supposse to be an easy surgery and turned out miserable.  So I know my foot is not correct and I am not walking correctly there but there is nothing else that can be done with that.  So i am terrified to have another surgery fail and I end up even worse again.  This is just so damn scary and nobody will give you any gaurentees. 

Any other info would be great and if anyone knows of any other surgeries or exercises or anything that might help.....PLEASE let me know. 

Thank you all again.

You didn't have bad surgeries, you had bad surgeons. I think you should have the surgery but I think you should find the best surgeon possible. Try this site to start, they have lists of surgeons and reading the forums you'll find out who's good and who's not. I had a TTT but I also had an MPFL and other stuff. I am happy with it but since I didn't have a TTT in isolation I'm not sure my experience is applicable. You don't have much quality of life at this point. Be very, very careful who you choose to do your surgery and I'm sure it'll go well and you'll have your life back. Good luck with everything.

[NLJ723]

RLE...even though you had more than just a TTT how are you doing?   When was your surgery and do you feel it helped you?

I was also wondering has anyone just had an MPFL reconstuction for patella instability?   Did you have success with it and would you do it again.  I am not in extreme pain just very unstable and feel like I could drop at any second. 

thanks again for any advice.

[RLE]

My surgery was mid-August. My progress is slow because I was on crutches for a year before surgery. I'm at 139 ROM (my good knee is 143) and -2 extension. I am still very stiff from the MPFL and I have to be careful what I do in PT and on my own in the pool because of the TTT-so that I don't undo the work. But I'm thrilled with the surgery. Before the surgery I was in extreme pain and couldn't bend my leg. My patella was permanently dislocated.
I don't know much about it but it seems like many people have the combo of TTT and MPFL for instability-though maybe others on here can correct me. My surgeon going in just told me he was going to do a cleanout and the MPFL, when I woke up he had done the TTT. I didn't ask him why (I will next appt) because I trust his skill.

[allyd]

MPFL vs TTT... I had just the MPFL. But truthfully, its not an either/or, pick one over the other fix. They fix different things. If the instability is caused by alignment or patella alta issues they are corrected by a TTT. WHere as MPFL is used to fix stretched out medial soft tissues caused by the dislocations... when mpfl is done alone, it's usually a case of trochlear dysplasia (shallow groove on the femur the patella rides in). 

THey will also sometimes do a TTT/Fulkerson to unload the Patella of a cartilage defect. But this isn't done to correct instability.

[RLE]

MPFL vs TTT... I had just the MPFL. But truthfully, its not an either/or, pick one over the other fix. They fix different things. If the instability is caused by alignment or patella alta issues they are corrected by a TTT. WHere as MPFL is used to fix stretched out medial soft tissues caused by the dislocations... when mpfl is done alone, it's usually a case of trochlear dysplasia (shallow groove on the femur the patella rides in). 

THey will also sometimes do a TTT/Fulkerson to unload the Patella of a cartilage defect. But this isn't done to correct instability.

This is way more than the surgeons I consulted seemed to know since none of them other than Dr. T and Dr. J (who was going to also add a partial knee replacement) offered to do more for me than a lateral release. Very concise explanation. I'm still not sure why I had both procedures except that my knee was basically destroyed and my surgeon told me going into it that he wasn't sure it would work and at my first post-op was told me again that he was surprised it turned out so well.  But in any case my kneecap is in the right place for the first time in years and bending again if still stiff.

[Adobec]

I had a TTT done on 11/6/2012.  I had suffered from maltracking since I tore my ACL in 2011.  Every step was painful, my quality of life was greatly diminished.  With a ttt, you need to make sure you are a proper candidate for the procedure... And that the surgeon does a lot of them.  If you care to travel to Houston, my doc was great.

I was a bit intimidated by the recovery, but it has been great.  Pain medicine for 3 days only, 50% weight bearing on that leg for 5 weeks.  I actually had my OTHER knee scoped (meniscus, clean out) on December 6-- also a piece of cake.  So...6 weeks out, I am biking, swimming, doing the elliptical and yoga.  I would do it again in a heartbeat!!!  I'm still not sure if my tracking is great, fingers crossed.  So, even with an uncertain outcome, I'm still glad i took a chance.  Good luck!!!

[Leentje]

Had my TTT 10 years ago and would do it again! I do EVERYTHING! NO restrictions! Surgery was to prevent dislocations after a failed LR. Will need it on R one in future and won't hesitate!

Good luck!