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Author Topic: Failed LR..what next?  (Read 926 times)

Offline mags21

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Failed LR..what next?
« on: September 01, 2012, 03:04:48 PM »
Hi everyone,
This is my first post to the site, and I don't know what I'm doing, or if I'm doing it in the right place(:
I'm hoping to get some advice or opinions...

Here's my history.
I'm 18 and have had knee problems since I was 13ish?
Volleyball was my life, and I started feeling a general pain in my right knee when I was playing.  Only about a year later is when my knee started "popping out".
I put that in quotations because my dr. said it doesn't actually dislocate... but to be honest, "popping out" is the best way to describe how it felt - although one time I did have to sort of nudge it back to where it belonged..?
It started off not happening so much, but eventually I couldn't make it through a practice without it happening.  The aftermath never really included swelling, just pain..lots of pain.  After seeing my OS multiple times, he still couldn't put his finger on what exactly was going on, he didn't see any obvious tracking problems or much else irregular in just the evaluation, so I was sent for MRIs and such - I had 2 MRIs - neither showing anything worrisome or abnormal.  At one appointment, he suggested maybe a LR... I really didn't want to because of its bad rep.  After about a year of contemplating it, I finally decided to go through with it.  It was the only option at that point - I had already tried 6+ braces, 2 different, very long, rounds of PT and other conservative approaches, and all I really wanted to do was be able to play through a practice or game without it "popping out".
Last summer I went in for the arthroscopic LR, and I'm pretty sure that's all they did...they may have removed some plica as well, but I wasn't feeling pain prior to the surgery from where they removed the plica, so that was really just a "just in case" sort of thing.
The rehab for that was only supposed to be a couple of months, nothing huge, said I'd be back playing in 3-4 months.  Well, at about 3-4 months, my PTs still didn't have me jumping or anything.  Therapy was not going well and I was still in a considerable amount of pain.  Another MRI about 6 months later revealed quite a bit of scar tissue that they said could be contributing to my pain.  I went through more therapy and intense workout sessions that targeted the scar tissue, and still nothing.  I did everything I should have in my postop PT and more, and the scar tissue still formed.  My dr. tried a cortisone shot with absolutely no results.
Now I'm about 14 months from my surgery, and I am in so much more pain than before.  My knee still "pops", so the surgery didn't help THAT - and on top of that I just have pain everywhere. 
Its at the point where I'm in pain sitting, standing, laying down, almost anything.  I also feel pain in places completely unrelated to the surgery or any treatments, so I don't know if it truly has a connection to the procedure, or if its just some new random addition?  :-\  Sometimes I feel it all up and down the outside of my leg, sometimes right on (above or below, I can't really tell to be honest) my kneecap, sometimes around the lateral release, but more so in my quad ...etc.
I can't even take my dog for a walk around the block without being in pain/doing a really cute limp-walk thing ;) :-\
SO.  I haven't been to see my OS for months now, because he didn't think there was anything else to try.  But because of all the developments in pain since I last saw him, I have an appointment this Thursday to reevaluate.  We know he's going to say he wants to go back in to remove the scar tissue, but is that worth it?  My parents are considering taking me to get a second opinion, because so far everyone I've met with is really confused and doesn't understand the "popping problem". 
Again, I'm only 18.  I can't run without it "popping".  I'm still in school, so gym classes are weird, because I really can't do much.  I had to give up volleyball because I just knew I couldn't make it through 3 hour a day practices, 6 days a week, for 3-4 months.
Has anyone else had similar problems?  If so, what sort of options were you presented with?  Any recommendations for my next step?  I've tried so many things, and I probably left some things out in my hurry to type this all out(:   As I'm sure just like anyone who has posted to this, I'm always hoping for the simplest solution.  I've tried to do my research on what happens after a failed LR, and I have a general idea, but I don't know how much it all applies to my case.  Everyone's different, but anyone with ANY info, suggestions, opinions or advice- I'd REALLY appreciate your input!

THANK YOU<3

Offline crankerchick

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Re: Failed LR..what next?
« Reply #1 on: September 01, 2012, 03:27:21 PM »
You really need a second opinion from a more informed surgeon. MRI is not very useful for assessing tracking problems and lateral release is never indicated in cases of patellar instability.

I'm sorry you are in such pain and have had to give up volleyball. What you need now is a doctor who will do a full set of x-rays including standing lateral, standing full leg length, and sunrise views as well as probably a rotational CT study. MRI just doesn't reveal the type of information crucial for assessing leg alignment, which is usually the culprit in cases of instability.

Lateral release isn't the only procedure out there, it just unfortunately was the only one presented to you, so you felt like it was your last option. I hope you all will seriously consider a second opinion and also look around this Site for the wealth of information available here on what might be wrong with your leg and what procedures address which conditions. The key is making sure your leg is in proper alignment and if not, determine what isn't aligned so the proper procedure can be embarked upon. It is essential to fix the root cause.  That begins with proper imaging.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline slmac

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Re: Failed LR..what next?
« Reply #2 on: September 02, 2012, 09:44:47 PM »
I second what crankerchick wrote. You'll feel a lot bettter about any decisions you end up making if you've got a second opinion.
Knee pain and issues during HS...played tennis
7/30/09 dislocations began
9/18/09 TTT (Fulkerson Osteotomy), MPFL Repair, and arthroscopic debridement
12/29/10 hardware removal
8/12 dislocations started
9/11/12 MPFL recon with allograft

Offline veganbee

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Re: Failed LR..what next?
« Reply #3 on: September 11, 2012, 08:22:04 AM »
I third what crankerchick said - it doesn't sound like your OS is much of an expert if he did a LR without really understanding what was going on inside your knee? Whereabouts are you located?

Offline RLE

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Re: Failed LR..what next?
« Reply #4 on: September 13, 2012, 02:42:56 PM »
If your lateral release failed then it can be repaired. There are people on this board who have had them fixed. I feel like a broken record telling people before serious surgery to please get a second or third opinion even if it means shelling out the consult fee.

My GP reamed me out for 45 minutes when she found out I had been to 10 doctors. She told me no doctor would treat me (totally untrue) once they found that out, that I had no business going from doctor to doctor, that I should find a local doctor and turn myself over to him trusting that he would know best.
I found a great surgeon in my state but 9 hours away, he didn't care how many people I'd seen. In the end I was lucky enough to make the waiting list and be called for one of the best surgeons in the world so I chose him. I also liked his honesty that he wasn't sure that the surgery would work. Thank God, I kept looking.
I was talking to my neighbor who had back surgery. He went to a bunch of local surgeons who scared him. He did finally find one (who has since moved to Scottsdale) who did a fantastic job and he's now pain free and can run and jump (he's an overweight man in his late 60's) On the other hand his cousin who's 56 went to one of our local back surgeons (who my neighbor rejected) and is now paralyzed.
You're lucky with the lateral release that it's not the end of the world, you can find a surgeon to fix it.
Accident 2011: permanent dislocation, hole under the patella, bone fragments/debris embedded, scar tissue, 3 torn ligaments, fracture, cartilage sheared off, contracture
2011 MUA
PT on-going
2012 MPFL reconstruction
        TTT
        Arthroscopy/clean out
God bless Dr. T.

Offline xbeentoolongx

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Re: Failed LR..what next?
« Reply #5 on: September 16, 2012, 03:43:00 AM »
i had also had a lateral release that failed and i tried cortisone shots and physical therapy, and nothing helped, was in pain everyday, so i opted for another surgery called a ttt ( elmslie trillat tibial tubercle transfer), i just had surgery on thursday.. i can try to help you out more if you would like..


Heather
*23 years old
* right scope aug 16-plica removal-sheet
* left scope dec 18-lateral release and plica removal,partial synovectomy,and debridement
 2 cortisone shots
*left scope sept 13-ttt,and lateral release,well see what else?

Offline Summer007

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Re: Failed LR..what next?
« Reply #6 on: September 16, 2012, 04:42:50 PM »
Hiya mags21,
I had a LR last October and like you, it failed. I did several courses of Physio and still I was in pain everyday and I couldn't lead a normal life. I went back to my surgeon and we decided on another surgery- like Heather it was a TTT (tibial tubercle transfer). However I didn't end up having this, I had an MPFL Reconstruction- I am now four weeks post-op from this surgery.
There are many more surgeries out there that would address your problem better than a LR has done.

I also agree that you should get another opinion. Try to find a surgeon that knows all about knees and how they work and that way they will be able to fully understand what is going on and fix it for you. Good luck!  :)

Summer
October 2011-L LR
August 2012-L MPFL Recon
January 2013- awaiting more surgery!

Offline drmark

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Re: Failed LR..what next?
« Reply #7 on: September 16, 2012, 05:05:26 PM »
There are dozens of things that can be done after a failed lateral release.  This might have all ready been said earlier in this thread, but they start with an opinion from a doctor who is experienced in PF problems, and has all the possible solutions in his/her tool box.  Unfortunately this excudes the majority of Orthopaedic surgeons.

The  tools start with a careful history and physical examination.  This can exclude medial and lateral subluxation (some folks have both), and rotational deformities.  A simple lateral X-ray can excude a shallow/absent trochlear groove, patella alta, and PF arthritis. A standing frontal view will excude arthritis of the remainder of the knee.  A CT scan can determine exact femoral and tibial rotation (or malrotation) and the tubial tubiericle/trochlear groove offset. 

When all this is done, the answer will be obvious.
drmark
Mark Sanders MD FACS
Certified by the American Board of Orthopaedic Surgery
Subspecialty Certificate in Orthopaedic Sports Medicine
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