The patello-femoral joint :

Fulkerson TTT & LR -  approx. 3mos post o - - Posted by kbluhm (kbluhm), 7 January 2005

Hey Everyone,

I am slowing approaching my 3 month mark on the 14th.  I've kinda hit a rough patch in my recovery.  I am able to get my knee ROM to 140% and I'm walking pretty well, but I still haven't been able to build up my muscles yet.  My OS had me completely NON-weight bearing for 7 weeks and I didn't start therapy until 7 weeks post op.  I think he is just a very conservative Dr. and didn't want me injuring my leg since I had the TTT.  I was doing great for a bit and felt like my recovery was really progressing but now I just feel like it's not progressing anymore.  The exercises hurt in PT and they have actually started to tape my knee cause my VMO isn't strong enough yet.  I wake up in the middle of the night EVERY night cause my knee is hurting and frequently feel discomfort (about 2 or 3) in my shin.  I know I haven't fully recovered, but I'm in a rut and need to know if this is all temporary or is the discomfort/pain I will be dealing with for the rest of my life.  Also, can you tell me how long it takes to build up atrophied muscles?

Thanks! Hearing others stories really act as a great "pick me up"!

Katie
Posted by sonofthedesert (sonofthedesert), 8 January 2005

Like yourself I am a little over 3 months post-op. I was only non-weight bearing for about 4 weeks then I was encouraged to walk as much as possible. I find that my knee still cracks and pops a little when I am sitting and straighten it out but it eventually gets into the groove. When I do some exercises to build up the muscles I also find that my knee continues to pop out a little. It doesn't ache as bad as before though and only really hurts when I walk up stairs. I have been told that it will take approx: 1 year for my leg to be the same size as the non-operated one and that the lack of muscle strength and continued imbalance is causing the patella to not track entirely the way it should. I have come to the conclusion that the purpose of the operation is to slightly change your anatomy enough so the vmo and quad strengthening exercises will actually work to improve your tracking. I was doing them before to no avail. Don't worry though as you are not alone. Keep working hard, be patient and see how it goes. I thought the operation was going to provide me with a quick fix. It doesn't! It is a big deal and it will take some time to see results.  
Posted by Leta_MT (Leta_MT), 9 January 2005

Unfortunately folks, with this type of surgery, the exercises that can be done by "normal" people to visually build the VMO muscle are not good for us. My OS said that as long as it is functional, don't worry about whether you can see it or not. What that really means is, the muscle will build only enough to work properly for whatever your activities are. That's why it takes so long.

TTT's are nasty little procedures! Their rehab is longer and more painful than TKR, from what I hear. (And from what I witnessed in PT!) I, too, hit a wall at about 3 months...then again at 5 months...from here, who knows I think that's the nature of the beast. As long as you don't feel like you are going backwards, I think you are normal. Most people have those progression patterns. Certainly if you feel like things are getting worse, not staying the same of improving, you should see your OS.

Good luck to you both!

Leta
Posted by Helena (Helena KTF), 10 January 2005

Why are most people so negative about a TTT ?? It won't make your knee excellent, your knee will keep cracking and crunching and clicking, it will stay painfull in a way and you'll never get muscle strenght back for 100%,... but i had a TTT 2.5 years ago and believe me I still have all these symptoms BUT this procedure really has been a lifesaver!!!! It is possible to run after this procedure, it's possible to lead an active life which includes sports, busy work etc. I am living proof (FT nurse, play badminton 3 hrs a week, I jog, did speleology post TTT, cycle etc...)! 100% sure I had a mod. Fulkerson/Maquet TTT!!!! Screws are still in the tibial tuberosity. Recovery hasn't been easy but I am alive and kicking (yes!).

Please be patient, keep doing exercises and keep the faith! Never give up! And make the best of it! I am sure you're knee will still improve! Took me 1 year to be normal again so have patience!

Helena
Posted by kbluhm (kbluhm), 12 January 2005

Thanks for everyone's help! I just went to my OS today and he says that everything looks great and I have got good bones because the Osteotomy looks healed.  I got a script for 6 more weeks of therapy (no surprise, I mean he told me 3-4 months of therapy)... and said I need to focus more on my quads... cause they are sooo weak.  I can't even straighten my leg forward when sitting on a chair, so I have some work to do I guess I knew this would all take a long time, I mean I knew he said that it would be up to a year of recovery....The OS and therapist have to keep reminding me that this was Major Surgery and that it'll take a while.  I know I won't ever be "normal" but heck, I wasn't before and the doctor said that I will be 98% better than I was...sooo, I just have to be patient and keep working hard! But with working full-time, night school, and now Physical Therapy, it's easy to get tired and to get frustrated...

I'll stop complaining now, everything is really going great, just which the journey was going a little faster...

Katie

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