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Offline Doc79316

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Ruined knee!
« on: August 30, 2005, 09:29:58 AM »
Hi all - I'm now getting desperate for any advice help anyone can give. In June 2002 I had an arthroscopy with lateral release. This seemed to be completely unsuccessful from day one and in August 2003 I had a Fulkerson Osteotomy. My knee remained unstable, subluxing laterally several times daily and so on June 5th this year I had a stabilisation and medialisation of my left knee. The lower tendon was detached from the bone then reattached across my kneecap to prevent it from moving around and to increase stablility. My OS said this was a "last resort" surgery and if it didn;t work I'd be in the realms of experimental techniques.

Since the surgery my kneecap has dislocated completely twice and wobbles about as before. My surgeon is aware of this but has told me to carry on with my physio. I try many times every day to complete my exercises but it seems to be going from bad to worse. Straight leg raises are now non-existent, whereas I could do them without too much effort after the surgery. Some of the most basic exercises are impossible for me.

That aside, the pain is excruciating. There are days when I have to take painkillers just to get out of bed. I feel like I walking a tightrope - on one side there is pain relief, on the other, liver damage because of the number of painkillers I have to take. I've tried all the major painkilling and anti-inflammatory drugs readily available both over the counter and on prescription. It's got to the point where if my surgeon said there was nothing he could do for me anymore, I'd agree to him taking the leg off above the knee - a little drastric to say the least! :o But that' s how it is now.

Has anyone experienced anything similar? Is there a point when I should throw in the towel and resign myself to a lifetime of kneepain? How long should rehab normally take after this type of surgery? Please help :'(

regards,

Laura
« Last Edit: October 10, 2005, 07:45:25 PM by laura79316 »
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline My Sister Sam

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Re: Ruined knee
« Reply #1 on: August 30, 2005, 12:21:44 PM »
Hi Laura

My situation seems similar in that both medial and proximal realignments have not stopped my patella from subluxing. Like you, my kneecap goes out all the time, every time I bend my knee.

I don't know why your kneecap refuses to stay on track. Has your OS explained to you why this occurs? Or, does he/she have any opinion? Mine continues to sublux due to trochlear dysplasia - the groove is essentially flat. There is no lateral wall (so to speak) to act as a buttress to hold it is place. I think you'd need to know the cause of your subluxations first. Can you give more details?

Thanks.
« Last Edit: November 03, 2005, 10:27:07 PM by My Sister Sam »
'70 Auto accident - Salter Harris IV fracture distal femoral epiphysis - R knee
'71 R - Bony Bar Resection femoral epiphysis
'78 L - Epiphysiodesis
'79 R - Distal Femoral Osteotomy/LR
'04 R - TTT/Medial Reefing 
'05 R - Trochleoplasty/Medial Reefing/TTT
'05 R - AIR/LOA
'07 R - TKA

Offline Doc79316

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Re: Ruined knee
« Reply #2 on: August 30, 2005, 04:42:36 PM »
Thanks for that Liz,

I originally dislocated my kneecap 17 years ago - twice! It gave me no trouble at all until 7 years later when I started going to the gym and built up my leg muscles - that's when I started getting pain. I tolerated it until 2001 when I was first referred by my GP to my OS.

Apparently, some people are prone to dislocations as a result of physiology and I just happen to be one of those people. What bothers me most is that this most recent surgery is supposed to mean that it is physically impossible for any dislocation to occur now. Don't do things by half do I?!  ???

There's no underlying cause for this - it's something that just happens.


Laura
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline My Sister Sam

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Re: Ruined knee
« Reply #3 on: August 30, 2005, 07:40:01 PM »
Gee Laura,
I certainly don't do things halfway either, I'm afraid. I have to wonder if your trochlear groove is too shallow, or perhaps your patella is sitting high or low (patella alta or infera). It's really hard to know, particularly when you can't put your finger on an underlying cause.

It seems that after the proximal and medial realignments, you often hear that there is nothing more that can be done for you. The truth is, they simply do not know what to do for you. I think you need to learn what the root cause of your subluxations is, then you can look for an OS who can tackle the problem from there. Can you get a second opinion?

« Last Edit: November 03, 2005, 10:26:25 PM by My Sister Sam »
'70 Auto accident - Salter Harris IV fracture distal femoral epiphysis - R knee
'71 R - Bony Bar Resection femoral epiphysis
'78 L - Epiphysiodesis
'79 R - Distal Femoral Osteotomy/LR
'04 R - TTT/Medial Reefing 
'05 R - Trochleoplasty/Medial Reefing/TTT
'05 R - AIR/LOA
'07 R - TKA

Offline Doc79316

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Re: Ruined knee
« Reply #4 on: September 09, 2005, 08:01:27 PM »
Hi, I could get a second opinion but at the momentI'm not really unhappy with my consultant so far. I have to see him on 19th. September, so I'll ask him for more info then. The pain is still bad and seems to be getting worse generally, particularly at night. If I could knock myself out with something blunt an dheavy I'd cetainly consider it!!
Any more advice from anyone woul dbe greatly appreciated.

Regards

Laura :-\
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline kath

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Re: Ruined knee
« Reply #5 on: September 09, 2005, 08:18:08 PM »
Laura..it will be interesting to hear what your OS has to say.  In addition to some of the reasons Liz gave regarding dislocations, it can also be because of the patella being shaped flatly or too small.

Does your other knee dislocate or only the one?

kath
Bi-lateral unicompartmental Nov 2004

Offline Doc79316

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Re: Ruined knee
« Reply #6 on: September 20, 2005, 10:46:33 AM »
Hi again,

I saw my OS yesterday - and his registrar also came to fumble around with my kneecap! In the next couple of weeks I have to have an MRI scan. I've already had an u/sound scan which showed absolutely nothing. Now, apparently, they're looking to see if the trochlea is deep enough. This may seem a strange question - shouldn't they have picked up on the posibility of this before???? ??? :o
Still trying to do my physio exercises. One option I've been given is to consider that it's all just down to muscle weakness. But if this was the case, then why could I do most of my bed exercises after surgery and it's got worse since. In my experience muscles get stronger the more you work 'em.
I'm now fast approaching the point where I'm starting to think - "Why bother?" I did manage to ask my OS "IS this as good as it's going to get?" He told me he honestly didn;t know but would do his utmost to try to do something for me. I suppose I shouldn't give up all hope until the Consultants do!  ::)
Any more ideas/advice would be gratefully appreciated.

Regards,

Laura
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline My Sister Sam

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Re: Ruined knee
« Reply #7 on: September 20, 2005, 01:28:03 PM »
Laura,

It's positive news that you will be going for MRI. Will it be a dynamic MRI scan? I hope you'll learn the underlying cause of your dislocations/subluxations, and can move to correct things.

I have just undergone a procedure to essentially re-construct my trochlear groove. I have my first post-op appointment this afternoon.

I sure do hope you'll find some answers, and be able to return to an active, pain-free life.

Please keep us posted. I'll be thinking about you.

« Last Edit: November 03, 2005, 10:16:00 PM by My Sister Sam »
'70 Auto accident - Salter Harris IV fracture distal femoral epiphysis - R knee
'71 R - Bony Bar Resection femoral epiphysis
'78 L - Epiphysiodesis
'79 R - Distal Femoral Osteotomy/LR
'04 R - TTT/Medial Reefing 
'05 R - Trochleoplasty/Medial Reefing/TTT
'05 R - AIR/LOA
'07 R - TKA

Offline Doc79316

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Re: Ruined knee
« Reply #8 on: September 22, 2005, 02:12:07 PM »
Hi again all,

It has been suggested to me that until my OS works out precisely what is going on with my knee I should wear a knee brace. I haven't considered this before, surprisingly. I've worn knee supports before but they don't seem to do much good other than stopping my skin from breathin gproperly and my leg gets all sticky and hot - BLAH!  >:(
I've been told I should get a hinged knee brace. Since I''ve not worn one before - how do they work? Any of you had any experience of this type of knee brace? Are there different types? How will I know what to get? Are they expensive? Is it a good idea?
If it will provide a lot of support to stop the dislocations then I think it'l lbe worth it, but at the same time I don't want to do anything to hinder my recovery.

Ideas/comments/advice please.

Regards,

Laura.
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline Doc79316

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Re: Ruined knee
« Reply #9 on: September 22, 2005, 02:14:47 PM »
Hi Liz,

I hope your recovery is going better than mine. What's a dynamic MRI?

Laura
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline smeagol

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Re: Ruined knee
« Reply #10 on: September 22, 2005, 02:20:51 PM »
I dont know why it is your knee is doing this, but my cousin had problems with her knee cap popping out because ther was no groove for it to run in.  She has had problems and many operations for 35 years.  last year they decided to operate and cut out a deeper grove (im not big on the technical terms here, sorry) and after a few months of rehabilitation, she is now fine and has no problems at all with it.  i dont know why they didnt do it sooner.  they said it was a new operation, they had only been doing it a few years, but theyve been doing it in cats and dogs far ages!  Anyway, thought i might mention it.
Charlotte
About 10 years of pain, 3 arthroscopys, and still no help with my condition or my current problem. And I'm only 20!

Offline Doc79316

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Re: Ruined knee
« Reply #11 on: September 22, 2005, 02:27:28 PM »
Hi Charlotte,

Thanx for that. It's nice to know there are other people about with similar problems - although I wouldn't wish a kne problem on my worst enemy. Today I've made a list of questions to ask my OS next time I see him, which I think will be in a few weeks time.

For some reason I get the feelin gthat the MRI scan will show nothing and I'll just have to grin and bear it for eternity   :'(

But on the other hand - a few people have mentioned the trochlear groove not being ddeep enough. Maybe this is the problem. Maybe the MRI will show something after all. I'll just have to wait and see.

Laura.
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline My Sister Sam

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Re: Ruined knee
« Reply #12 on: September 22, 2005, 03:10:54 PM »
I've just undergone a trochleoplasty essentially a rebuilding of my trochlear groove.

I think these procedures aren't commonly done for a host of reasons. I'm not totally on top of what all the reasons are, as I've only been able to find a couple of papers on the subject (and both have been in languages that I'm not fluent in....LOL). What I do know is outcomes have been fair, at best.

After a new groove is created, either by deepening the trochlear groove, or by building up the trochlea, the fit of the patella into the new groove has been problematic - often like fitting a square peg into a round hole. I suspect there are a number of other problems that can rear their ugly little heads. I will make it a point to learn more very soon.

The procedures are considered "salvage" work. My hope is that more surgeons will begin to work toward better outcomes from these procedures. This means, more surgeons need to start doing the procedure again. And, from what Ive seen in this forum, I'd say there are a number of individual's who would be greatly helped by these procedures.

All my best.
« Last Edit: November 03, 2005, 10:13:37 PM by My Sister Sam »
'70 Auto accident - Salter Harris IV fracture distal femoral epiphysis - R knee
'71 R - Bony Bar Resection femoral epiphysis
'78 L - Epiphysiodesis
'79 R - Distal Femoral Osteotomy/LR
'04 R - TTT/Medial Reefing 
'05 R - Trochleoplasty/Medial Reefing/TTT
'05 R - AIR/LOA
'07 R - TKA

Offline smeagol

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Re: Ruined knee
« Reply #13 on: September 22, 2005, 10:22:01 PM »
ive seen vets do it to dogs (deepening the groove) when they have a knee cap that repeatedly slips out, so why are they having so much trouble?! Sometimes i think we might be better off seing a vet!
Charlotte
About 10 years of pain, 3 arthroscopys, and still no help with my condition or my current problem. And I'm only 20!

Offline Doc79316

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Re: Ruined knee
« Reply #14 on: September 23, 2005, 03:13:11 PM »
Thanks for that   :o

Ya know - I think maybe I should register with a vet and get it over and done with. Probably cure the problem a whole lot quicker too!   :D

The worst part is, my job is as a Planning Inspector. I have to make site visits and measure building volumes. My employers won't let me out on site at all. Not even to take a photo. I have to spend all my time in the office. It's demoralising to say the least, particularly as I seem to have been demoted to skivvying for everyone else because I don't really have anything specific to do.

I've been referred to Occupational Health but don't get to see them until 11th. October. Then they'll write to my GP & OS for medical reports. Then I'm going to see them first before they're sent so a decision on when I can go back out on site won't be made until the beginning of November at the earliest. What a pain.   :'( If I didn't know any better, I'd think someone had it in for me.

I'm also a Special Constable with West Midlands Police. I can't go out on duty with them either. I seems as though every time i go out, it's either to work to do someone else's job or to the hospital. What a life!  ::)


Laura
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation