The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: PAULSDAWN on November 23, 2009, 05:33:07 PM

Title: 15 yr old daughter having TTT & LR soon...need advice!
Post by: PAULSDAWN on November 23, 2009, 05:33:07 PM
My 15 year old daughter is having TTT & LR surgery in few weeks.  She is a competitive figure skater whose knees pop out at least once every time she skates... which is 5-6x a week.  Tried PT but it wasn't enough. . She  hasn't been able to skate normally in almost a year and has been off the ice completely for almost 4 months while waiting for school break to have the surgery.  It is killing her.   She already has early signs of arthritis & most of the cartlidge under her one kneecap is worn away.  The problem is in both knees but the one is more severe than the other so that's the one the surgery is being done on.  We'll see how it goes before addressing the other knee.  We've had 2 opionions with both OS telling us for this type of problem she has the worst case senario.  We know surgery is necessary and are confidant in our OS as he & his colleauges are OS's for many pro sports teams in the NYC area.  But it is still scary...I'd love to hear some real life experiences & what to really expect...she's determined to be back to skating by spring/summer.
Any info would be greatly appreciated!
Title: Re: 15 yr old daughter having TTT & LR soon...need advice!
Post by: SunshineBec on November 25, 2009, 11:37:19 AM
Hi, It sounds like your daughter and me are in the same boat, only i am 1 or 2 years younger. My surgery is tomorrow and will let you know how mine goes. After everything i have read it is good to ice your knee alot and take lots of pain meds. I am a gymnast and have been for 9 years which is when my knee started to go bad. They dislocate about twice every week so i am tired of that. I hope that i can get back to gymnastics and lots of PT will be required. I am pretty sure if your daughter keeps doing her exercises after her surgery, as set by her PT she will have a better chance of fully recovering.  I hope your daughters knee improves before her surgery date.

Good Luck,
Title: Re: 15 yr old daughter having TTT & LR soon...need advice!
Post by: fraud_ninja on November 25, 2009, 01:52:15 PM
Sorry to hear that your daughter is having so many troubles with her knees.  I can relate to her frustrations as my kneecaps were at one point so unstable that I could not even do basic activities without them popping out of place.

My biggest advice is to make sure you have the RIGHT surgeon doing the RIGHT surgery.  When it comes to Patella Femoral issues, there are a lot of factors that come into the picture that determine the stability of the patella.  Unfortunately only a select few Surgeons will even think to check for all of these issues.  It can often be difficult to locate a really good Patella Femoral Specialist, but in the end it will make all the difference.  There is a world of difference between a good surgeon and a patella specialist and just because a surgeon is recommending a particular surgery does not mean that its the right surgery to do.

One thing that catches my attention is that your daughter's surgeon is wanting to do an Lateral Release along with a TTT.  The Lateral Release seems to be one of the most over done procedures.  It tends to be in the old school way of thinking when it comes to patella issues.  Here are some of the factors that a surgeon should take into consideration:
1.) Rotational Issues of the femur and/or tibia: This is where the long bones in the body are "twisted".  A simple CT can check for that.  This is not as obvious as you would think.  I have quite twisted femurs and never knew they were twisted until I saw a patella specialist.
2.) Patella Alta: Does the patella sit to high on the femur?
3.) Size of the Trochlear groove: is the groove at the end of the femur deep enough to hold the patella in place
4.) Offset between the Trochlear Groove and the tibial tubercle
5.) Medial Structures: mostly is the MPFL damaged or not.  It typically will be if there are recurrant dislocations.

These are just a few of the things that a surgeon should check for before doing any surgery.  Sadly, most will not.  It is so important to rule out all possible issues before having any surgery done.  An incorrectly done surgery can often lead to the problem becoming worse and even to possible further surgery.

I do not mean to scare you with any of this.  I am only sharing what I learned through experience and I had to learn it the hard way.  I had a TTT and LR on both of my knees and I was left in such bad condition that I could not even walk around the block.  It was then that I went to a patella specialist and was able to get the proper diagnosis and treatment.  The outcome of my second round of surgeries was fabulous.  I was running up to 6 miles a day this past summer and doing anything I wanted to do activity wise. (Surfing, water skiing, cycling, swimming, hiking, dancing, yoga, pilates, you name it)  I am not doing those things now only because I tore a tendon in my ankle in August...I guess I was having too much fun!

So, if your daughters surgeon has tested for all of these things then the surgery should go quite well.  If your daughters surgeon has not tested for these things then you should consider inquiring about them.  There are a lot of us with a lot of personal knowledge if you head to the "patella femoral" section of the bulletin board.

Good luck, I hope I did not scare you completely.  I am only offering my experiences and what I learned the hard way.  I wish I had known more before I had my first surgeries.

Title: Re: 15 yr old daughter having TTT & LR soon...need advice!
Post by: doublemom on November 25, 2009, 06:10:25 PM
Ditto what Brianne mentioned... there are many different reasons WHY a kneecap will not track properly, and you have to find out exactly why it's not lined up in order to know what surgery will correct it.  Different causes mean different surgical approaches.  There are some great posts and a lot of information in the Patellofemoral forum here on KneeGeeks.

Title: Re: 15 yr old daughter having TTT & LR soon...need advice!
Post by: PAULSDAWN on November 30, 2009, 08:22:46 PM
Thank you so much for all the info...after being on these boards for over 3 hours I did start to question what the OS was telling us.  Through the boards I came across a name of a Dr. at the Hospital For Special Surgery in NYC.  Her name is Dr. Beth Shubin Stein and she is a patella specialist.  I made an apt. that day and just got back from from the apt. a few hours ago.  It was the best call I made. 

She is absolutely wonderful and my daughter loved her.  For the first time we are now completely able to understand what is happening to her knees.  She really spoke to my daughter, in words she could understand and she felt the Dr. truly knew what she was feeling.  A LR is not needed but she does however need the bone cutting procedure and will also have the MPFL reconstructed.  What we found out:

She has "knocked Knees"
The kneecap sits too high
The groove is too shallow to keep it in place
She did measure the distance between the Trochlear groove and TT and it is not normal
The MPFL is damaged
She has very soft tissue

I needed to be scared by the posts here because it pushed me to keep searching for more answers.  Something just wasn't feeling right for me.  The hardest thing to hear was that she needs this on both her knees and it will be at least a year before my daughter can return to her skating, which is heartbreaking for her but deep down she knew this was coming and just wants to feel better. 

Dr. Shubin Stein did give her a 98% success rate where the other Dr.'s told her 85%....
The other Dr's also said it would be a 1 day procedure, where Dr. Shubin Stein will keep her overnight...which makes me feel better.
She will also address the cartlidge issue, we know she has lost some under the patella and has the early signs of arthritis.  So we a setting up an apt for another MRI and she'll have the surgery as planned over Christmas break with Dr. Shubin Stein at the HSS.  We are still scared for her but feel much better about this decision.

I plan to keep on online diary of her procedure & recovery and post it on here.  I hope it will help and give answers to someone these boards have done for me.

Thanks again!

Title: Re: 15 yr old daughter having TTT & LR soon...need advice!
Post by: fraud_ninja on November 30, 2009, 10:16:10 PM

I am so delighted to hear that the boards helped you and that you feel more confident about your daughter's upcoming surgery.  Unfortunately so few people ever take the necessary steps before surgery to make sure that they are doing the correct procedure.

Sounds like your daughter is having a TTT and MPFL reconstruction.  I have had the same on both knees.  My left surgery thread is still active (I have been updating about my ankle surgery recovery...I tore a tendon this summer).  That diary is in the >100 posts section of the Post Op diaries and is called "Brianne's left TTT revision and MPFL reconstruction."  If you have any questions about the surgery or the recovery...I can try to answer from my own personal experience.