The patello-femoral joint :
Dr. never seen this before - - Posted by purple77 (purple77), 20 January 2005
Hello, I had a L.R on April 29,2004.Next I had a T.T.T on sept.28.2004 (same knee).My range of motion never got any better than 50.It has now gone down to 43.The Dr. says he's never seen this before, but my patellar tendon has gone from 2cm to 1cm.I can't walk very well and by the end of the day my leg swells up and turns much pinker than the other one.My Dr. want to do another T.T.T to move it up to compensate for the shrinkage.Has anyone had this happen before?Will my leg ever be good enough to walk normally.Help
Posted by bajalady (bajalady), 20 January 2005
Hi,
This is a better place for your post. The nurse I was telling you about on the other thread is HelenaKTF. She is on here often and has had the TTT. Hopefully she will respond. I just assume she might have heard of this happening post TTT and with her medical background might be able to help you or give some good advice.
Callie
Posted by RGrelsamer (RGrelsamer, MD), 21 January 2005
You may be suffering from arthrofibrosis, a biological condition that causes the tissues to contract.
You'll find a number of people with this on this web site.
This is a condition for which we're still trying to find a solution.
An alternative to moving the TT again is to lengthen the tendon. The risk is that the tendon could shorten again.
We'll eventually find an injectable medication for this, but I can appreciate that you don't want to wait!
Posted by bajalady (bajalady), 21 January 2005
Purple,
Glad our resident doc posted to you. I was hoping he would see your question. You can post on the soft-tissue site (the arthrofibrosis people are there) but most are not TTT failures and not in line for a repeat tendon transfer surgery (which I assume has already been set up for you?) and not at your very low flexion that I know of.
There is one cannot remember her name (somebody help me with this) who is in the same or similar situation with a tendon lengthening procedure in her future but she is on hold and pondering what to do I think. She is northeast.
I have the contracted tendon post TTT (thick and fibrotic) but I also have full ROM just trouble at full extension. You are in a different more critical situation with you inablilty to bend much which seems to be getting worse every day.
Still seek a second opinion if you can. There are scar specialists in several states that handle major fibrosis problems (read the soft tissue site--Steadman and Eakin are two) but if your tendon itself is contracted it makes you a much more difficult case. I've heard of the tendon getting stuck to the tubercle and it "acts" like it's short--as far as function. Maybe you'll get lucky and it will be just scarring "around" the tendon and not inside the actual tendon fibers. That is easier to take care of. The OS can also strip the tendon itself and separate the fibers one by one, but still the scarring just loves to come back.
Keep posting because you are not the only one with this complication post TTT I am sure. Many have tendon problems from scarring after this surgery but not very many with your 50 degree flexion is it? Very best to you.
Callie
Posted by sha22 (Sharon), 22 January 2005
Hi,
I think I might be the person that Callie was referring to in her post. I had a TTT on my left knee in July of 2002. That surgery never worked and although I had full ROM afterwards my OS suggested a revision TTT to further elevate my patella because it was still sitting too low and rubbing against the bone. I decided to go ahead with the surgery in June of 2003 and to be totally honest with you I really do regret it. That surgery is what caused me to have the severe patella baja that I have today. My ROM is pretty limited although not as limited as yours. I range anywhere from 80 to 100 degrees depending on what kind of day I'm having. I know that my tendon is pretty badly shortened by lots of scar tissue although I'm not sure how shortened it is.
I would definitely suggest that before you have the 2nd TTT surgery you get a second opinion if you can. In my mind the worst thing that I did was not get another opinion before I told my OS that I wanted to have the revision surgery. A few months ago, the OS who did both of my TTT's told me that he didn't know what to do for my knee anymore and he sent me to a colleague of his. Both of them operate out of the Hospital for Special Surgery in New York City which specializes in orthopedics.
So I saw the other OS and he recommended a surgery to completely replace my patellar tendon along with a piece of tibia and the very top surface of my patella. They do this with a donor allograft from a cadaver. He told me that he does several of these a year and all of his patients have seen significant improvement. Now I'm still not 100% sure that I want to go through with this because it's pretty huge and I'm just at a point where I'm scared of all of the what-if's that are in my mind. There's also the problem of finding me a tendon allograft. I am on the list to get one however they base the tendon that you get on your height and I'm really small. I'm 5'2 so I need a tiny tendon and they told me in a very straightforward way that it's going to be extremely difficult to find one as small as I need it. I'm also looking into getting another opinion about this but I'm just not sure of which OS to see yet-I'm still looking into it.
So I guess that's pretty much my story. Hope this helps. Let me know if you have any questions or need anymore info about anything. I'll be glad to help so feel free to post or private message me anytime!!
Sharon
Posted by bajalady (bajalady), 23 January 2005
Thank you Sharon. You are the one I was thinking of. I remembered the picture the second I saw it.
Callie
Updated Sat Nov 21 2009
