completely lost quad muscles after patella realignmnet surgery

[jay22]

Hello-I’m new to this board and was not sure where to post. 7 weeks ago I had patella realignment surgery on my right knee because it would constantly dislocate. This procedure fractures the bone under my knee to move it over and I also had 2 lateral releases, and scraping of scar tissue. I was on crutches, in a brace, allowed to bend it to 30 degrees, and could put weight on it right after surgery. It took me a few weeks to put weight on it because the pain was so bad. I started physical therapy after 3 weeks and could bend it to 45 degrees but was difficult to do so. 7 weeks later I’m still in the brace so my knee doesn’t buckle and I’m using one crutch to walk because my quad muscle is too weak to hold me up. I’m allowed to bend it to 90 degrees but I’m only getting it to 75. I also can’t extend it straight all the way (when sitting on the floor with my legs out there is about a 3 inch gap between the floor and my knee). I’m constantly bending and straightening to get my range of motion back, but it just tightens right back up and is really painful to bend again. I do E-Stim (electrical stimulation) at therapy, and work everyday to bring the muscles back.  I lost so much muscle that my knee is way bigger than my thigh, and my right thigh looks twice as small as my left. I can take a few steps with no crutches but it gives out easily. I can’t do any leg raises because I can’t pick my leg up AT ALL. I can’t drive yet because I have no control over my leg and can’t switch from the gas to brake. When I make a quad set it moves a little but not much. I’m a 21 year old female,  a runner, very athletic and did PT for 4 months before surgery. Has anyone experienced this much muscle lost? Is it possible I have some kind of nerve damage where the muscle won’t come back or it just takes much longer? Am I doing too much exercise?

[lisa424]

1 year after my TTT and really bad atrophy my quads are still not what they used to be. At 2 months I could do a straight leg raise with a lot of pain.  The vmo especially takes forever to get back. It can take a really long time to get muscle back.
You say you just had 2 lateral releases? On the same knee?
Not to scare you, but I also had the same realignment surgery and a lateral release because my knees dislocated constantly. It turned out the lateral releases destroyed my knees. They're horrible for unstable patellas. They made my knees dislocate more than ever. It turned out I needed to get both lateral releases reversed with ligament reconstructions. It was part of the reason I couldn't seem to build muscle back.
Did you ask your doctor what the reasoning was for the lateral release?

[AlissonAus]

Hi Jay

I had a MACI procudure on my patella 6 weeks ago, and I'm currently still in my brace, locked at 0 degrees when walking, and allowed to bend to 70 degrees when I'm sitting down, and walking partial weight bearing on crutches. I have experienced LOT muscle loss too, at just 4 weeks I've already lost 12cm of quad circumference, and my operated leg is much skinnier that the good one. Im also a 21 year old female.
My doctor gave me some exercises that after just a week made my leg feel stronger. They are fairly simple, one is sitting on a bed with your legs in front of you, and tensing your quad, then when the muscle is tensed, to push your knee gently into the bed, hold for 3 seconds and relax. The second one is a leg raise, and I really suffered with them, but its going much better now. He told me to sit on a bed, and before you try to lift your leg, first of all tense your quad muscle. When your quad is tensed, press your "good leg" hard into the bed and then attempt to lift your "bad" leg. When I did the straight leg raises like that, it became easier after a couple of days.
MACI is different from what you had done though. I had a friend who had a realignment and a lateral release done 6 months ago and she also did these exercises.
These excercises helped me a lot, so maybe they would be able to help you too.

Good luck with the rest of your recovery!

Alisson 

[jay22]

Thank you for your replies. Lisa, I had the lateral release to help realign the knee cap. I had two on the same knee because my knee sat tilted when It came out of place. That does scare me and hopefully doesn’t happen to me . Alisson, I also was given similar exercise. For a month I have been doing the quad sets (so often im probably doing them in my sleep!) I haven’t tried leg raises like that but I will definitely give it a try. I also do toe raises, mini squats while holding on to a counter, and when standing switch my weight from my left to right leg. I haven’t seen much improvement. I do these exercises often during the day so im wondering if maybe im overworking the muscle. Thank you and good luck with your recovery too!

[allyd]

Hey Jay - I didn't have the same procedure as you... But the best I can say is, yup... it happens. Nothing worse than watching your leg waste away, and it seems to get worse before it gets better. Hang in there, keep working your PT program, do what they tell you, and it will all start to come back in time. That timeline is seemingly different for everyone, can have a lot to do with a Dr's protocol, how strong you were pre-surgery, if you have any problems along the way, and just flat out how your body responds to the trauma of surgery.

Good luck!

[LindaM]

Hi Jay,

Yes, it will come back.  I know it is discouraging to become deconditioned, but you will get better.  I had a PKR four weeks ago and my quad quit working for me too.  My PT said it was completely normal (I was worried because it didn't happen for the first PKR) and it did come back bit by bit over a period of 2 weeks.  He said it is common due to all the cranking around they do when they are working inside the knee.   In the time before I could fully control it or have the strength back, he had me use a towel under my arch to help lift the leg on straight leg lifts.  The quad still got as much workout as it could handle, but the assist for the first few inches was really important.  Maybe it will help you as well.

Part of the problem straightening is probably due to all the limping you did before surgery.  In protecting your knee you walked with it slightly bent and now it is staying that way.  I had that issue with the first knee after limping 9 months before surgery.  A gentle way to help stretch that out is to put a rolled towel under your heel for a few minutes at a time when you are seated with your leg outstretched. Your knee will gently stretch downward a bit more each time Also, try (just for a minute or so at a time) sitting with your leg outstretched, tighten the quad and VERY gently press down on the knee.  DO NOT FORCE IT.  Leave the rough stuff to you PT.

I know it is slow going now, but once the healing gets going your recovery will become more rapid each day.  Good luck.

Linda