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Author Topic: Had Patella Proximal Realignment. Trouble with therapy!  (Read 1018 times)

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Offline pattiann

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Had Patella Proximal Realignment. Trouble with therapy!
« on: January 01, 2007, 12:16:28 AM »
Had Knee surgery on the 6th of Dec. 2006.  Worse thing I ever did. Knee dislocating since I was 12.  47 now. Thought this would help but I am having trouble lifting my own leg.  Quad muscle will not work.  Just starting to bend the knee now in therapy but I am slowly losing hope.  Can someone tell me this will soon get better?  Or will I always have a limp and never be able to bend it again.

Offline d1ckey

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #1 on: January 01, 2007, 02:40:45 AM »
It will come.  You've definitely got some work ahead of you.  How much muscle did you have in your quads before surgery?  The more the better. 

Make sure you are doing whatever exercises outside of PT that they give you.  Some movements will be easy and some very hard.  Stick with them though, the hard ones are the ones that will get the strength back.  You have to keep moving it though otherwise the LR will seize up with scar tissue and then it's all for nothing.

Hang in there and just keep moving it.

Offline plantgeek58

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #2 on: January 01, 2007, 03:21:04 AM »
Hi Pattiann,
Don't panic, OK? It's normal for the quad muscle to partially shut down after the trauma of surgery. It will come back, but it's going to take time. You probably still have quite a bit of swelling in there, and that tends to hinder the functioning of the muscle. Like Dickey said, you have to hang in there and do your PT exercises faithfully. Just because the leg is weak now doesn't mean that the surgery was a failure. It can take several months before you regain full strength and mobility, depending on how much work you had done. Try to be patient and just keep plugging away at it. You'll get there.
Terre
RK 7/04 part. m. menisc., plica resect., MF
    3/05 part. m. menisc., open OATS
    1/07 part l. menisc., MF, patellar chondroplasty
    9/08 MF
LK 11/04 & 8/06 part m. menisc.
     7/07 LR, patellar tendon debrid., part m. menisc.

Offline pattiann

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #3 on: January 02, 2007, 12:43:58 AM »
Thank you for the advice and encouragement. I guess I am being impatient. My surgeon wasn't truthful when he told me how long I would be out of commision.  I work at a gym for 8 yrs now and I was strength training my quads right up to the day of the surgery.  Scar tissue is a problem now.  That is what is keeping me from bending it all the way. My knee feels so tight. Quad is flabby.  I will keep up with all my excercises.  Thank you!

Offline Kris

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #4 on: January 02, 2007, 01:23:57 AM »
Have faith!!!!  You'll do fine.  I had my proximal reallignment in May of 2005.  I was on crutches with no weight until mid July.  I was allowed to toe tough, but not bare weight on it.  I was also in a locked brace.  I was discouraged with therapy too at first and it took awhile for improvement, but I'm almost two years and althought the proximal did it's job, I had too much damage behind the kneecap to feel the full affect.  I wouldn't have changed my mind about having it at this point.  I had another surgery last may and a possible two more this coming year.  Keep the faith and take it slow.  Don't force anything, sometimes that makes it a lot worse.

Kris
Right  LR on 2/8/02,  7/11/03, and 11/5/05
Left leg LR on 5/02, 4/05
Right achilles tendon lengthened on 2/01.   Synvisc injections on 2/17/03. 
Cortisone on 12/03 and 3/04, 12/05. 
Proximal Reallignment Right 5/23/05
R Microfracture 5/19/06
PFJR 6/20/07

Offline amy1

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #5 on: January 02, 2007, 11:15:51 PM »
Hi, I had a proximal realignment on December 19.  I am 50.  I will definitely need a TKR in the future. I went for a total of four docotrs for opinions, all of whom said that I will definitely need a TKR.  All are hoping, not hopeful that I can wait till my late 50s.  The goal of this surgery is to allow me to wait 5-7 years before having a TKR. I had the same surgery plus spur romoval about 18 months ago.  For awhile, it really made a difference and then the same pre op problems returned.  The doctor said that scar tissue had formed where he did the lateral releas, anchoring it.  This placed additional pressure on the medial plication which resulted in the plication stretching out.  In a nutshell, I was in the same position as before the surgery.  This time, he used a different technique for the plication in hopes of preventing the same scenario again. If this operation doesn't work, then the only option left is a TKR.I had a medial plication and lateral release.  What exactly did the surgeon do? Were you in a brace post op or allowed to bend your knee right away?  For both surgeries, I was sent home in an imobilizer and started using the cpm machine within two days of the surgery.  For both, the surgeon said to use the imobilizer for my own comfort but to keep it off, especially when sitting or laying on the couch as soon as possible.  This prevents the joint from stiffining up too much and leads to less muscle atrophy.  The pt that I am seeing agreed with this approach. The first surgery, it took about three weeks for me to be able to do straignt leg lifts without my husband holding my leg to help me.    Right now, I am about 10 days post op.  My extension is at about 9 degrees and flexion between 70 and 80 degrees.  The staples will be removed on Thursday.  The pt feels that my range will improve once the staples are out.  I am walking around the house using one crutch and am able to weight bare as tolerated.  I can stand in the shower and at the sink to brush my teeth without using crutches.  I can take two or three steps (to get into the shower)  without the crutch.  It does take awhile for the quads to start firing again.  Don't worry it is still early for you.  My doctor said to expect about 6 weeks to return to about 70% function and up to 6 months to return to 100%.  That was pretty much accurate the first time around.  I plan to return to work the last week in January as long as things progress the way they did last time.  Hopefully this gives you some helpful information.  Good luck and feel free to ask me any questions.
6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week

Offline pattiann

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #6 on: January 03, 2007, 02:22:31 AM »
Message for Amy1.  When I read your message I was more upset and but greatful to hear from another that had the same procedure.  I am confused though.  Why did you get the PPR?   Did your knees dislocate also?  Just to show how all doctors are not the same.  I had to strength train my quads before the surgery. Then I went to a same day surgery center and had the procedure done in one hour.  Went home with an imobilizer and was told not to take it off till I got the staples out 6 days later. Then I can take it off for a shower and to sleep. Always leave it on for walking.  PT did not start till the 3rd with week of post op.  My knee is so tight and I cannot lift my leg at all.  I am put in that machine that bends your leg for you and it goes to 75%.  I try my hardest to lift my leg but no luck.  It will be one month since surgery on the 6th of Jan.  I don't see the surgeon till the 18th of Jan.  I have a bad feeling he will be going in again.  Listening to your story, I am in trouble.  You movment is much better.  I am sorry for your fall.  I walk with a soft brace. I do not want the imobilizer on.  Keep in touch and I hope for the best for you.

Offline amy1

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Re: Had Patella Proximal Realignment. Trouble with therapy!
« Reply #7 on: January 03, 2007, 03:27:31 AM »
Sorry to hear about your troubles.  I have tricompartmental grade 4 arthritis in both knees and severe patela femoral syndrome.  I have severe lateral tracking, patella alta and severe tilt.  I also had chronic subluxations and dislocations.  Prior to surgery, I was experiencing a lot of pain and spasms on either side of my knee due to the chronic subluxations.  By the end of the day at work, I was barely able to walk.  5 out of 7 nights, I would come home from work and lay on the couch with ice on my knee till bedtime.  In the past, pt, taping or bracing helped but by the time I had surgery, my knee was way beyond those things helping.  It is weird how different doctors have such different protocols.  I have a rental CPM machine at home and am still in it two times a day for about one hour at a time.  Today, I set the machine to 80 degrees.  My walking is far from normal.  When I stand up, I have to wait a few seconds before walking. Even with the crutch, I am only able to walk for a little bit.  I do the steps twice a day and other than that I walk to the kitchen or bathroom etc.  The first time I had the surgery, it was probably about 4 weeks post op before I was able to lift my leg to do straight leg raises.  This most recent surgery was done same day also.  The doctor had me come back two days post op for my first incision check and all looked good.  Later that evening, the incision started to bleed enough to saturate the dressings.  The doctor had me come into the er where one of his interns met me.  They did blood work and found that my sed rates were very high.  The doctor admited me about 2am.  About 7 am he came by my room and said that he wanted to go back in to see where the bleeding was comming from and also to clean the joint out.  The elevated sed rate could either be just my bodies response to surgery or a sign of infection. He opened the incision to check for bleeders.  The doctor said that there were no bleeders and he thought that the bleeding from the incision site was due to a hemotoma.  I was kept in the hospital for two more days and started on IV antibiotics while the culture was growing out.  Basically, they did not know whether I had an infection but decided to treat me agressively for an infection....just in case.  The doctor didn't want to wait until the culture grew out because the more you delay treating an infection, the harder it is to treat.  I went home and saw the doctor again 5 days post op.  He said that the culture was negative and that I could stop the antibiotics.  I am going back this thursday to have the staples removed.  Then two weeks later,he will see me again.  The first two months, he wants to see his patients frequently and then gradually increase the time between appointments.

It is weird that you had your staples removed in six days.  My doctor waits until two weeks post op to take the staples out.  I had the imobilizer wihich I was supposed to use for my comfort or if I was doing a lot of walking.  It was not necessary for sleeping, laying on the couch or walking to the bathroom or kitchen. The doctor gave me the rx for pt at my 5 days post op visit.  Due to the vacation, today was the first day I was able to get into see the PT.  My doctor said that the delay was not a problem as long as I used the CPM machine at home to keep the joint from stiffening up. Our doctors  really do have very different approaches. You are still just a month post op.  Now that you are in PT, I am sure that you will see rapid improvement. My pt said that it takes awhile for the quads to fire again.  Everything is so traumatized due to the surgery, swelling.  In my case, I had two surgeries within three days so my knee is really really angry.  Good luck and keep us posted.
6/2004 partial lateral meniscus removal and microfracture left knee
7/13/05  open lateral release, medial plication, spur removal right knee
12/06  re do proximal realignment right knee (scar tissue formed ) 5 days post op - fell and fractured elbow
08/2009 - feeling good so far work 50 hrs a week