medial repair retorn!

[tbeck]

hello all, I got some bad news the other day on my medial repair.  I had a medial repair on my right knee january 2003 and it was very successful in preventing my dislocations from a partial tear of my medial quad tendon.  A few weeks ago while in a fight at work (sheriffs deputy) i twisted my knee and my knee popped right around my scar and my knee cap subluxed.  I had immediate swelling and intense pain medially as well as laterally where my knee cap ended up.  I then had my knee again sublux at the hospital while trying to show the Dr what happened.  I was placed in a immobilizer and referred back to my os.  I had a lot of swelling and the medial side of my knee was black and blue and i have a large, almost lump like thing on the edge of my kneecap about an inch away from the scar.  The os feels I probably retore my repair from the way my knee looked (swelling and bruising) and felt to him.  He is sending me for aggresive therapy to try to avoid surgery, but feels like i will need to have the tendon repaired again!  Has anyone had to have this procedure redone and if so, how did it go?  Is the second repair less likely to work and what else is there to expect?  This is incredibly frustrating because my knee had felt good and I was back to doing almost everything that I could before surgery and original injury.  Thanks in advance

[bdmrad]

Some feel that a repair of the Medial retinaculum is bound to fail if you don't address the factor that predisposes one to dislocate. The repaired tissue is weaker than the original tissue.  Also I think that people who are prone to sublux (patella alta, trochlear dysplasia) start out with a deficient medial patellofemoral ligament (MPFL.)

To address the predisposing factor means altering the configuration of your knee i.e., a TTT of some sort. The other option is to repair the injured medial structure with a graft that is srtonger than the original - i.e., reconstruction of the MPFL with allograft or autologous tissue( your own quad or whatever).

At my six week post-op check, I mentioned a story I had read here about a young man who was planning to have arthroscopic repair of the medial retinaculum by one of the real big names frequently mentioned here. He just shook his head and said " Tried that twenty years ago, didn't work then."  He is a proponent of MPFL reconstruction.

[anasta5ia]

Hey there-

I had a repair of the MPFL done last June in conjunction with a revision TTT on my right knee.  Then when leaving the movie theatre 2 weeks post-op, I slipped and landed on that leg....completely retearing the repair.  My knee began to dislocate again right away.  A couple of months later (Oct. 22) I had another revision TTT and also a complete reconstruction of the MPFL using a material called SIS.  With the exception of tearing out a few of my sutures, my knee is no longer dislocating.  It still subluxes when I do a lot of things, but at least it is stable enough now that I can be up on it as it is now my dominant leg since I am on crutches for my left knee.  

I also had a MPFL reconstruction on the left knee about 8 weeks ago with a TTT, but after partially tearing my patellar tendon and the graft, I am going to be having another one done on May 19th.

My OS feels that it is absolutely essential to address the reason for the lateral movement of the patella.  He feels that it is pointless to go with either a repair or a reconstruction if you are not dealing with the underlying reason for the dislocations.  He will not do one unless it is done along with a TTT to give the best results possible.

Feel free to IM me if you have any questions about my reconstructions.

Hugs-
Heather G.

[tbeck]

thank you all for your responses.  The problem is that I never had any issues with dislocation or instability in my knee until i tore my tendon in the knee previosly and then had the repair done.  They tried a LR first and that only made the problem worse until they addressed the injury.  What is involved with the MPFL reconstruction? Is this the ligament that was repaired previously or is it the Quad tendon?   Is the recovery period similar and with my type of work is this a better option?  When they do x-rays of my knee eveerything looks alligned and i have no problems untiul weight bearing it seems.  This has been a discouraging process and the thought of more surgery is upsetting. Thanks

[dm]

If they have not taken xrays with you weight bearing, you might ask them to. They might prove more informative than non weightbearing xrays, which are the usual ones.