Fulkerson TTT with MPFL reconstruction booked with Dr. Fulkerson!

[2cutekiddos]

I posted earlier about needing a reference for a patellofemoral specialist in Va. Well, I thought I would call Dr. Fulkerson to see if his office gave out referrals for people in other states...guess what! They do!!! Donna who runs Dr. Fulkerson's office is an absolute angel! She was so friendly! She told me she would ask Dr. Fulkerson if he knew anyone in my area. Within two hours she called me back with names!!! WOW!

I started talking with her about if Dr. Fulkerson takes out of state patients and how it would work to have surgery with him! Well, you arrive the day before for your initial consultation with all your scans and paperwork and the next day is the surgery! I decided to go with the pro!

I know the Fulkerson and MPFL is the correct surgery for me (I have been searching my area for specialists with no luck). I love my home town Dr. but he had only done the Fulkerson once and never the MPFL. I am so happy I called Dr. Fulkerson's office!!! He had an opening so I am scheduled for June 14! ...which is perfect since I am a Teacher and I will have the rest of summer to recuperate! My wonderful mom from Ca. is flying in to drive me back to Va from Ct. and will take care of me for 6 weeks!

I can't believe how excited I am to finally have something booked...I know as June gets closer that I will get more nervous. Oh well...I am going to bask in my happiness right now! WHOO-HOO!

[kneepaincure]

Hi 2cutekiddos (lol),

Before you go getting a TTT done, you should find out if you have rotated bones. If it's only a shallow groove, then that's ok, but if you have twisted bones, the TTT will not be useful and can fail soon. There are plenty of people on this board who have been treated using the TTT when their real problem was bone rotation.

So if a doctor hasn't done full length leg x-rays, etc to check rotation angles, it would be best for you to get that done.

Take care and good luck!

[2cutekiddos]

Thanks for the response. I definitely hope my hometown ortho will order a CT study when I see him on April 13th. I have been told by another ortho (by eyes only, no scans) that I do have slight femoral antervsion but that it isn't the main contributing factor to my 30+ years of instability. However, I want peace of mind the next time I lay down on the operating table, so I am really hoping for the CT study so I can rule out rotational deformitiies.

My main contributors to instability are:
1. Non existent MPFL (no tears, just really loose)
2. Ligament Laxity (not to the point of hyper but pretty close)
3. tilted patellas
4. TT:TG offset greater than 20 (eye balled by Dr. He said it was obvious on my knees but I would like the data)
5. Trochlear Dysplasia (very shallow groove) This is why my patellas easily dislocate laterally and they reduce on their own.
6. Slight knocked knee (valgus)
7. Slight patella alta
8. Prominent J-tracking
9. Increased Q angle

I would love anyones opinions. Thanks!

[kneepaincure]

Well don't just hope for it, but ask directly.. You don't want someone doing a surgery that won't fix the root cause of your troubles.. A point to be noted is that if the doctor you're seeing does not routinely treat cases of bone rotation, then he/she may not check for it.. So insist on a study before going under the knife.. Your knock knees may be a big factor in the instability..

This may be helpful: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958271/

[allyd]

Definitely ask if you have any concerns about measurements. I think the TT-TG measurement can be taken from your MRI scans easily. It sounds like youa re doing due diligence in seeking out a doc with experience, rather than  just going with your local doc, who may very well have an understanding of the problems, but just not a lot of experience fixing them.

I'd trust that Dr Fulkerson will do his own work up on your initial consult. I'd suspect he will make his own recommendation based on this, and not just go with what you want, or what another doctor has recommended. If he feels more tests/info is needed... I'm sure he'd request them.

Overall, you know your knee better than anyone, and it seems like you have a good handle on the options, and what will work for you. Rotationally studies are not a must have. Plenty of people have had successful surgery for PF instability without them (myself included).

Good Luck!

[2cutekiddos]

Thanks again for the replies and encouragement! I definitely want all the data before I go in! I am trying to add pics of my knee and KneeGuru is telling me my files are too big. I wish I knew how to make things smaller. So I will add one at a time. When they come up I should let you know that the MRI is from Nov. 2011. The X-ray (yes I know it is a little dated but I don't have any current ones) are from 1993 before LR & Medial reefing surgery. As you can see my patella is still in the SAME place!
 
For those of you who have had rotational abnormalities, was it obvious when looking at your legs? ...or was it only visible upon CT scan?

Sorry if no pic comes up...and if so, if anyone can instruct me on how resize my pics, I would greatly appreciate it! I have a Mac.

[2cutekiddos]

Whoo-hoo I figured out how to resize my images! Now, I need to figure out how to do it within one post...sorry for the numerous posts to come of just my "beautiful" knee! HA!

[2cutekiddos]

A pic with some skin!

[2cutekiddos]

Standing

[2cutekiddos]

So here are both of my knees (which both are bad). So can you tell if you have rotational abnormalities from just looking? What was anyone's experience?

[Zilldancer]

I am no expert so I won't judge the pictures, but yes, you do need a CT scan to learn your measurements for femoral anteversion and tibial rotation as well as TT-TG offset. Make sure you get that done.

I think you only need X-rays to see patella alta and flat trochlear grooves, but I'm not sure. I have both of those problems as well and they definitely contribute to patellar instability. Whether it spontaneously reduce or not, dislocation is a nasty thing to live with.

Crankerchick on these boards has posted a great deal about rotational deformities. Her diary is here: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=49136