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Author Topic: Recurrent dislocations/subluxes  (Read 2298 times)

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Offline tanyap

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Recurrent dislocations/subluxes
« on: July 11, 2007, 09:47:14 AM »
hi kjwilkin,

Have you already had a surgery?

How long have you been dislocating/subluxing (i never really know the difference, my PTs and OS seem to use the terms interchangeably)?

How often does it happen?

How do you cope?
Tanya
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #1 on: July 11, 2007, 12:53:05 PM »
Hi Tanya,

Yeah, to date I've had 4 operations on my left knee and two on my right. Am waiting to see my knee surgeon on the 1st of August to find out the next steps. Probably looking at more knee surgery for medial instability of my left patella. My lateral instability of my knees has been fixed and the medial instability of my right knee has been fixed, just trying to sort out the left knee now.

Unfortunately I've had my knee problems for over 12 years. It has taken a long time, but have a really good team helping me now including my knee surgeon, sports physician, knee physio, podiatrist and sports psychologist. My sports physician understands my problems well and assists my knee surgeon every fortnight which helps greatly. I used to see a GP but really had no idea how to manage my problems. My sports physician basically oversees my overall rehab and liaises with the other practitioners regularly. Fortunately they all work out of the same clinic. Have you thought about seeing a sports physician ? Does you OS specialise in knees ? It's really important that both your physio and surgeon specialise in knees, particularly patella problems.

A subluxation is where the kneecap partially comes out of its place, but a dislocation is when it fully comes out. I've only had a full dislocation a couple of times and had to push it back in place, but had countless times when my kneecap has subluxated.

Mine mainly happens when I'm in bed or getting in and out of bed. It has also happened when I've been sitting in a chair at work when I've swivelled my chair to talk to a colleague. My OS finds that very hard to understand. At the moment I'm wearing a zimmer splint at night to reduce the number of times it comes out.

The way I cope is by keeping active, which at the moment includes going to the gym every second day and the hydro pool every other day. Normally I also do clinical pilates, but am currently recovering from shoulder surgery. Hope to start that back soon. I also keep busy doing other non-exercise related hobbies, such as silk painting and card making. In addition to those things I also write in a diary and regularly meet with a sports psychologist. She has really helped me a lot. What do you find helps ?

What is your situation and where are you at in your recovery ?  :)

« Last Edit: July 11, 2007, 12:55:33 PM by kjwilkin »
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #2 on: July 11, 2007, 02:41:40 PM »
hi,
wow - you really have been through the mill with your knees havent you???

my knee problems started at 12 years of age (Im 33 now). I had a dislocation in school, I didnt know what had happened. When I saw doctors they didnt know what had happened either because it was back in place and I just had a hugely swollen knee!!
That continued for 11 dislocations (bout a year or so) - each time the kneecap returned to place of its own accord. I never had to have it manually reduced. Then I had a modified Hauser procedure (TTT, lateral release, medial plication, some clean up work on cartilage also). It took around 2 years to recover from that surgery. I was never able to run again. In the third year after the surgery Id started getting back to normal activities when I was hill walking and something 'snapped' in my knee. I didnt have a dislocation but it swelled up etc... A little after that I drunkenly jumped off a stage and I had a huge dislocation. The surgeon says I probably ripped up a lot of repair work they had done.

After the stage jump I dislocated a 2 or 3 or 4 times a year for a long time. Always laterally. It became much less severe but instead of my kneecap returning to its usual position by itself I had to manually reduce it myself. That was pretty much the pattern all of my 20s. I was just used to it. Various OS's said not to do contact sports, not to run, not to do anything 'risky' but overall Id a normal life.

I didnt notice but I was compensating like mad and over time I lost lots of muscle on my right upper leg. I had some personal/family issues going on and although I became aware that my leg was getting weaker - there was no pain and I was dislocating more than usual but I just did not get around to addressing it for some time.
Eventually I had a bad dislocation that robbed me of my stability and my knee swelled up hugely, I was on crutches for a couple of months and I finally went to a physio and made an appointment with an OS.
I saw the OS who is considered to be the best knee man in this country (Ireland). He took one look and said - go build muscle. There is nothing mechanical wrong but you have no muscular support.

SO - I attented weekly, then biweekly, then monthly physio appointments - I did all my exercises at home. And for the next 2 years I just kept dislocating. I counted 150 dislocations in 2 years.
There has been improvement. In the last year Ive had around 20 dislocations. The previous year was the other 130!

I did some research and got the name of the surgeon who had done the original surgery 19 years ago. I went to see him a month ago.
He said the same as the last guy. No mechanical problem, muscles too weak. He was not happy with my physio that Id been seeing because although they had helped address my my glutes, my hamstring, and my quads to some degree, they completely ignored VMO and in his opinion all my problems are caused by weak quads and specifically weak VMO.
So he sent me to new 'super' physio :)

Ive been on my new exercise program for just over a month. I can visibly see some improvement in how my leg looks - and i 'feels' a little better but its quite early days of new physio to see a big improvement.

The thing that worries me most is that my new physio is absolutely positive i DO need a surgery (as was my last one) but the surgeons over the years and especially in the last 2 years all say no more surgery!!

So im battling away with physio hoping ill get my stability back.
the worst thing is i 'feel' unstable all of the time. And have done since my bad dislocation 2 years ago.

Im very interested to hear your story. I hope when you have your appointment on august 1st that you have some good news - its always good to at least know whats to happen next!!

i see my OS on august 9th. if true to form he will say 'keep up physio' - he said that if i get my right leg as strong as my left and there is still a mechanical problem that he will operate. but not until im up to full strength. and he also bet me that if i do get it to full strength that he wont need to operate. he doesnt believe there is a mechanical problem worth operating for. yes he agrees the tendency to dislocate is there but if i had full strength he reckons i could go back to having an ordinary life - still no running or contact sports but its always been that way.

mind you - he hasnt seen my MRI results yet - I only had that done 2 weeks ago and will get the results when I see him. the x-rays dont look very encouraging :)

thanks for all the info you gave me. i might start a diary. That sounds like a good idea.
I try to just live as normal a life as possible but Im relatively slow moving and my friends are all used to that.
I read quite a lot and my boyfriend and I like to walk to the local park (slowly:) and feed the ducks.

I just got my bike fixed - its been in a friends shed for 4 or 5 years so Im hoping to start using it a little.

I think sometimes its the frustration of not being able to just have freedom of movement that gets to me. I wish i could just move as quick as i wanted or feel safe if i had to hurry. I find it very difficult to be unstable so often.
although i no longer feel too unstable in small environments like my apartment so thats an improvement.
my physio says im trying to repair probably 10 years of muscle atrophy so i guess its a slow process.........
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #3 on: July 12, 2007, 06:22:53 AM »
Hi Tanya,

I was really interested to hear your story.

These days I think knee surgeons are very conservative for patients that have had long standing problems and also had failed surgery. I think in one part your surgeon is right in saying that you need to build your quads up, particularly after a long period of time where your muscles have wasted. However, there comes a point when enough is enough and you need to do something.

My knee surgeon has said that my muscles are quite strong, but physio won't help. So, will be interesting to see what he says.

Will keep you posted ! ;)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #4 on: July 12, 2007, 09:17:56 AM »
Hi,
yes I agree with you - I also had my OS tell me that he would be extremely to do another surgery given my history because it could just start dislocating again after surgery - which would mean id been through a lot of pain and suffering for no gain!!
Also that the tendency to dislocate decreases with age as the soft tissues harden (not a great prospect but a true one!)

Im more than willing to go the distance and get my quad strength up to match my good leg - after that we'll see what happens. I have always found that I can get the bad leg as strong as the good one but somehow the muscles always waste away unless I keep doing something to keep them strong (physio or cyclying or some exercise that ensures i use my legs). I wonder is my brain ALWAYS telling me not to use my bad leg?? Or is it that there has been an imbalance created from the TTT - so unless I always address that imbalance I lose VMO?

Ill be very interested to hear what your OS has to say to you - if your muscles are good then its clearly mechanical - are medial dislocations harder to fix than lateral?
Tanya


1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #5 on: July 13, 2007, 06:12:16 AM »
Hi Tanya,

I'm exactly the same, I need to continually keep my VMO active and strong. Otherwise it goes pear shaped.

Medial instability is a bugger to fix as it's so rare and there's not much other than surgery that can fix it. Sent my OS a list of questions I want answered at my next appointment so will be interesting to see what he says.

I've no doubt that the TTT would be made your muscles weaker. My left side is much weaker compared to the right, probably because I've had double the operations on it.

In relation to your OS saying it could still dislocate post-operatively that may be true, but I think it's worth taking that risk. My knee couldn't be much worse than it is now.

Have a good weekend !! :D
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #6 on: July 14, 2007, 08:14:03 PM »
hi kjwilkin,

wow - i always wondered if that was a 'normal' thing to happen to VMO for people who had surgery - i do wish they had told me to keep it big and strong after they operated!!! then again perhaps the did but i was only a kid, im sure i didnt listen to anything i was told at the time.

thats great that you sent your questions in to your OS - give him a chance to read them before youre sitting in front of him.

my OS is saying he doesnt think my knee was ever brought back to full function after surgery - i felt like saying to him that thats really the hospitals fault for discharging me from physio and telling me to get on with my life!!!
im most confused by the fact that my physio is convinced i DO need surgery but the OS is convinced I dont!!! i do wish they would communicate properly with each other!!! i have asked her (the physio)  to tell him what she has said to me before i see him again.

on the plus side i had a small breakthrough today, i tried out my bike, havent cycled it in 7 years, i was so nervous, though tid wobble everywhere and maybe fall off. but i just took off like the wind!! it was great!!
so my legs tired after a couple of minutes, but i can work on that - i didnt feel unstable and it didnt hurt my knee - yeeaa!!
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline kimmyxs

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Re: Recurrent dislocations/subluxes
« Reply #7 on: July 15, 2007, 03:33:09 AM »
I hate to be a bother, but for me, the dislocations never slowed down as I aged, in fact they increased.  Most of the time I was able to reduce them myself, but I have had two that required reduction.  Unlike most everyone here, my quad are in great shape even though I am almost 49.  A year ago the patella dislocated and ended up on the back side of the joint.  In the process my quad reactted and broke the patella vertically.  I thought that the dislocations were bad, but....   I had a VMO advancement in January in conjunciton with a LR when the screws were removed from the patella (6 months after the original injuty).  My OS orginally intended to only do a LR, but he could not get the patella to stay in place so he opted to do a the advancement   He chose not to do a TTT because of the damage I already had in there.   At 10 weeks, I was released from both my PT and by my OS.  They both said that I have great muscles because this was the fastest they have ever seen anyone (young or old) recover from a VMO advancement.  The hardest of the quad to keep strong.  Today life is good, although the patella tends to sublux a bit lately.  My main issue now is the arthritis that has been caused by years almost 20 of patella instability.

Keeping those muscles toned is important, especially the VMO!  It usually helps, but not always.
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #8 on: July 15, 2007, 03:42:48 AM »
Hi Tanya,

It's interesting that your knee surgeon doesn't think that your knee was brought back to full function after the surgery. That's part of the problem sometimes. Make sure that your physio communicates with your surgeon. It makes a big difference. I also see a good sports physician that works closely with my knee surgeon and does make a big difference. Have you thought about going to see a sports physician/doctor ? Am actually going to ask my sports physician to speak to my knee surgeon about having some more specific scans done.

That's fantastic about the cycling ! You just need to build it up gradually. Can't wait until I can get back onto my bike again. Just have to wait until my shoulder is further down the track with rehab. Let us know how you progress with the cycling ! 8)

Kimmyxs, my instability has become worse as I get older too. As you get older your ligaments are meant to tighten up, but still waiting for that to happen. I had shoulder surgery in early May and my shoulder surgeon said that I will have to do regularly exercises for it until I'm 40 !!! Fortunately my lateral instability has been fixed, but not the medial instability of my left patella. Just waiting to finding out what will be the next step !
« Last Edit: July 15, 2007, 03:46:49 AM by kjwilkin »
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #9 on: July 16, 2007, 10:13:15 AM »
Hi,

kimmyxs - i cant believe your patella broke vertically!!! you poor thing - just goes to show you how strong your muscles really are!!! to break bone!!!
Well Ive found my dislocations/subluxes are more frequent as I get older actually - although my OS says its cos my muscles have been weakening since i got older!! my lifestyle changed, i used to work on my feet through college and after i cycled to my desk job for the first 3 years. makes sense really, i started driving 7 years ago and my knee started playing up more and more from 5 years ago or so.

kjwilkin,
yes i was never able to run again after surgery - nor was i ever able to play contact sports again - I was told not to.
now the OS says - why didnt you run again? im like - i was told not to..... its confusing!!
yeah im excited about using my bike again - its such a faithful old machine too - i had it stored in a friends shed for the past 4 years and it was all cobwebby and dusty when i dug it out - all shiny again now!
whats wrong with your shoulder?



1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #10 on: July 17, 2007, 05:00:38 AM »
Hi Tanya,

I have a similar problem with my shoulder, loose ligaments and very unstable before the operation. It's now much more stable and much tighter now. Rehab is going well and gradually getting the strength back. My pain is now under control which is good.

Today I saw my sports physician and have a clearer idea on where things are heading. He spoke to my OS yesterday and apparently I don't need a bony realignment, so my OS has to decide whether a soft tissue operation is going to help. My OS isn't keen to operate and neither is my sports physician keen about me having another operation. I'm not either but just want my knee fixed and get back to normal. My knee physio was talking about other options so my sports physician is going to talk to my physio about them. So, hopefully I'll know more soon.

Can't wait to get back onto my bike soon. Hopefully once my shoulder has recovered more I can get onto the bike.

Catch you later !  :D
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #11 on: July 17, 2007, 08:47:05 AM »
Hi Tanya,

How's your physio going ?

I'm feeling really relieved. Got a call from my surgeon's rooms to say he's had a cancellation tomorrow at 4:50pm. It is such a relief. The last month has been really tough in many ways. We had a scare with my Dad, but turned out to be a viral infection. He had a heart attach last year so it's always a worry when he has a scare like that. Also been applying for jobs and trying to do my shoulder rehab. My knee has got worse and has really knocked my confidence around.

Today I saw my sports physician and was very helpful. He spoke to my knee surgeon yesterday and said that I don't need a bony realignment, which is a good thing. However, my only options are soft tissue procedures but isn't keen on operating again. If he suggests more surgery it will be the last time I do as it is so mentally draining and I can't keep going through this much longer.

Will keep you posted on what my knee surgeon says.  ;)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #12 on: July 17, 2007, 10:51:53 AM »
hi kjwilkin,
what did your knee surgeon say?? thats great you got a cancellation!
Im like you in that Id rather avoid surgery if at all possible - it takes so much out of you to have a surgery and then the healing, rehab - its difficult. A bony realignment would be a very tough operation - thank god you dont need that.
Im sorry youve had such a difficult month - these things always seem to come together dont they?

Thats great that your shoulder is behaving itself more now - you poor thing, youre joints seem to want to live their own lives!!

I had good news yesterday at the physio - they strapped me into the isokinetic testing machine and my pure strength has improved 103% since the last test!! so ive more than doubled my quad strength!! My knee has been feeling a lot more stable the past couple of weeks - I still feel like I dont have much speed in it but it doesnt feel like its going to pop out with every step these days if I take things at a reasonable pace.
The test shows the comparison between my bad and good leg and then a comparison of improvement in my bad one. My good leg had improved somewhat in strength too - from the wall slides I guess. There is still a deficit but its not what it once was. The last time I had the test my bad leg had a 44% deficit against my good one.
Their photocopier wasnt working so they didnt give me the printout - the only figure I can remember is the 103% increase in pure strength!!
So Ive to continue my exercise program for the next 2 weeks and then they will test me again - and send all results to my OS, for my appointment with him on the 9th August.
The physio sid that Ive to speak to my OS about what kind of functional outcome I should be looking at - she said we can continue with conservative treatment but if I expect to be running and skiing that might not be a realistic outcome - so to ask OS what he thinks is possible and we can work towards that.

I hope you get on well with your appointment today!!!
Tanya



1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #13 on: July 18, 2007, 10:07:10 AM »
Hi Tanya,

I was so pleased to hear about the progress you've made with your knee strengthening. That's great !!!

Today I saw my OS and the news isn't good !!! My knee surgeon doesn't think he can do anymore. Am absolutely shattered as I was really hoping he could do something. Was also pretty annoyed that he thought my questions were a bit much. I have the right to know what's going on with my knee. I've done a lot of research and want the best for my knee. My job is to analyse and research things so it's just natural to want to know as much as I asked. Before I sent the questions to him I checked them with my sports psychologist and she thought they were ok.

Am soooooo upset right now. Am probably going to get a second opinion. I am seeing my sports physician on Monday so will be interesting to know what he says. I will write more about what my OS said when I am not so upset.

Keep up the good work in your rehab !!!  :D
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #14 on: July 18, 2007, 10:21:15 AM »
Hi kjwilkin,
oh Im so sorry to hear that. Absolutely get a second opinion - he is just one surgeon! Perhaps his skills have reached their limit and he cant do anymore for you because he simply has come to the end of his road. but that doesnt mean youre at the end of your road - you can get a second, third, fourth opinion if you want to.
Im surprised he thought your questions were a bit much - of course you are entitled to know every minute detail - its your body!!! Then again surgeons can have very bad interpersonal skills - their skills are in dealing with unconscious people - so perhaps he just spoke out of turn, take no notice, you have every right to ask whatever questions you want.
Definitely speak to your sports physician - he might have some new ideas for you - and maybe can refer you onto an OS who will be able to do more for you.
Youre not done yet, youre just done with this OS. I just dont believe that there is nothing more can be done - he just isnt able to do it.
Do something nice for yourself today to take your mind off upsetting news. And just remember that there IS a way forward - you just gotta find it.
xx
Tanya
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #15 on: July 19, 2007, 08:59:48 AM »
Hi Tanya,

Thanks for your kind words. They really helped me. I am feeling a lot better today but still can't believe my OS can't do anymore. He said he's not closing the door, but said unless my knee drastically changes or he sees something that can help me there's not much more he can do for me. He did suggest a new brace that Donjoy have just released. I spoke to my Orthotist today and is looking into it for me. So, that's a plus. He was nice about it and knows what I've been through. He just doesn't want to put me through more surgery if it's not going to work. It's also a fairly rare condition and there's not much research out there.

This morning I saw my sports psychologist and can see that it is really wearing me down. She said I have to leave it in their hands to do all the research. So, she is going to work with my sports physician, knee physio and shoulder physio to work out some other things to try. I don't believe in giving up. There has to be something that will work. I am seeing my sports physician on Monday and will ask about a referral to another OS that specialises in knees. My knee surgeon recommended a number of different surgeons that specialise in knees and said he had no problem with that.

Will let you know how we go. Again, thanks so much for your support. It is so helpful right now. 8)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #16 on: July 19, 2007, 09:40:53 AM »
hi kjwilkin,
you know something - there are so many positive things in your last post - you have such a brilliant attitude - thats going to take you further in life than a knee ever will!!
Thats great about the new brace - i like braces, an external non invasive no risk way of helping out!!
The OS is right about not wanting to put you through more surgery unless he thinks theres a chance of it working. Ultimately every surgery is risky, takes a lot out of the patient and its better if it can be avoided. I understand that you or me or anyone would want a surgery if it was gonna fix the knee(s) but if the surgeon is dubious about another surgery working then he is right to tell you that - surgeries can make things worse too.
Its great he is giving you names of other knee specialists - someone else may have seen your problem before and know how to tackle it. one OS is never going to know everything there is to know or experience patients with every possible condition.
Im so glad youre of the mindset of not giving up - youre dead right, there is always something more to be done. With your positive attitude you will definitely find the way forward. It sounds like you have a great team working with you as well!!
Try not to worry - view all this as a necessary step on the journey, you need to hit a few dead ends to make you turn round and find the right road.
xx
tanya


1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #17 on: July 20, 2007, 04:03:09 AM »
Hi Tanya,

Thanks for the kind words. They really help me. How are you doing with yours ?

I am starting to feel better each day. Guess it's just really hard to accept that my knee surgeon can't do much more at the moment unless my knee changes dramatically or he sees something that he think will help. Initially I was very upset and angry but can see where he's coming from. I'm seeing my sports physician on Monday so will see what ideas he has. Will also ask about getting a referral to another OS who specialises in knees. That way I know I've covered every option.

Have a good weekend !!  :D



11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #18 on: July 20, 2007, 11:54:50 AM »
good for you - youre keeping an open mind and checking out all options available!!
something will come of it, someone will know where to go next.

Its hard when you are really hoping for good news and then the surgeon just tells you what you dont want to hear. I had to fight hard not to just collapse in tears on my OS last time because I wanted him to tell me he could fix me but instead he told me I had to fix myself. I dont mind fixing myself but it just hadnt been working with the phsyio Id been seeing.
Big difference with the new physio!!

Yeah Im getting on good. Still building strength, I notice small differences like I can walk on my tiptoes again.... Im less wobbly in everyday life, but Im still slow and sometimes limpy. But Im only 6 weeks into my new physio program, and in 6 weeks I notice considerable difference in how my leg feels, so hopefully in a number of months therell be a HUGE difference!
Ive a sore area on my right lower back/upper buttock. The physio isnt sure is it a back pain or a glute pain - she thinks because I have weak glutes I might be unconsciously compensating during some of my exercises and straining myself. Unfortunately it never hurts while i exercise but its tender afterwards :)
Its not killing me though - I only notice it now and then.

Have a good weekend you too - next week is another week to review options!
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #19 on: July 22, 2007, 04:03:20 AM »
Hi Tanya,

Thanks for your kind note. I'm feeling better each day and putting things into perspective.

Glad to hear you are progressing so well, that's fantastic news !!!

I have decided at this point I want to try things that are least invasive. So, am going to suggest trialling clinical pilates together with a different strengthening problem to see if that helps as well as the knee brace my knee surgeon recommended. Don't feel like introducing too many new people at the moment. Just had enough for a while. It's very draining seeing new people and trying new things all the time. My left ankle has still been very stiff since I had surgery last year and think that's part of my problem. This year I've already a couple of hydrodilation injections and my ankle specialist said the next thing would be an arthroscrope. So, am going to see him in a couple of weeks. Also, the sports kinesiologist I saw last year suggested I had pelvic instability. Didn't quite agree with it but my left hip has been sore for a long time. It's the same side as my bad knee so am going to ask my sports physician about it tomorrow. Never mentioned it before as I've had enough to deal with.

Once I've totally rehabbed my right shoulder I have decided to see my knee surgeon to work out what sports I can do. He's known me the longest and I trust his judgement more than anyone. The suggestions he's already made about not wearing the zimmer splint at night and bending my knee when I sleep have already helped a lot.

I've had a nice weekend catching up with friends, which has been really nice. This morning I went to one of the local markets.

Speak soon !!  :D

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #20 on: July 23, 2007, 09:34:13 AM »
hi kjwilkin,
Im glad to hear youre doing well.
That sounds like a good plan - less invasion the better. I know what you mean about it being draining seeing new people and trying new things, it can be easy to just want to throw in the towel rather than chase yet another 'possible' helpful idea.
But its important to keep on trying and keep positive - you certainly seem to be doing that!
My right hip used to get very sore - they tell me it was from compensation, I was walking and swinging my leg 'around' the hip rather than 'through' the hip - and not using my quads at all - my hip didnt like that - it used to ache all the time. I must admit, I really noticed the difference in how my hip felt when I started physio (2 years ago now - unfortuantely that physio program only worked for a short while but at least it solved some problems!!)
Its amazing how one damaged joint in the body can have such an impact on the rest of them. My boyfriends dad had a bad motorcycle crash when he was 18 years old (he's 60 now) and one of his ankles was pretty much destroyed. From years of walking differently because of his damaged ankle he managed to destroy both of his hips and just last year had both replaced - he needed it done for at least 5 or 6 years but they kept holding off as long as they could. His hips are fine now - but only for that ankle they probably never would have needed replacing!
I had a 'ooooh' moment over the weekend - I was doing my exercises as usual and suddenly I realised that my knee 'felt' different - in a good way. Doing the squats I always felt a nervous moment going down where it almost felt like my knee was gonna go out but then through sheer force of concentration and will on my part and contracting the muscles as hard as possible - it never did. But over the weekend I suddenly realised that that feeling of it 'almost gonna go' wasnt happening!!! So hopefully this physio program is starting to really show a difference!!
I also went shopping for a couple of hours on saturday morning - before the 'shopping walk', stop, start, turn, stop, go slow, stop, start... would have me feeling unstable within half an hour. Now it just made my leg feel stiff and fatigued - but not unstable!!! now thats real progress for me!!!
xx
Tanya



1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #21 on: July 23, 2007, 11:08:07 AM »
Hi Tanya,

That's awesome about your knee. Hopefully you won't need anymore knee surgery.

Feeling very relieved after seeing my sports physician.

We are going to simplify things even further. Am going to concentrate on my shoulder rehab and just maintain my knee and ankle. My sports physician said not to worry about any knee physio and just do as much as I can in the gym and the home exercises. He said to not worry about seeing my ankle specialist as ankle arthroscopies don't work all that well and can cause further problems especially since I had a problem with an unstable ankle. So, that's one less thing to think about.

At a later stage we may introduce an Osteopath once I start back at work, but will wait and see.

I was due to start pilates in just over a week and a half but my sports physician wants to wait until I see him in 2 weeks before we embark on that. Frustrating, but I just need to be patient.

So, I'm feeling much better about things. Still waiting to hear back from the Orthotist about the knee brace.

Speak soon !! Keep up the good work at physio !!  :)



11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #22 on: July 25, 2007, 10:23:21 AM »
hi!
how are you feeling about things? good i hope?

i have to say i agree about the ankle arthroscopy - my current mantra is : if you can avoid surgery - avoid it!!!!

im doing fine - just plugging away at the physio - i get the 'test' again on monday - so the results of it will be sent to my OS - he can see the comparison of strength from 3 tests over 8 weeks.

hope all is good with you!


1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #23 on: July 25, 2007, 12:02:40 PM »
Hey Tanya,

Feeling much better about things. Thanks so much for your kind words of support over the last couple of weeks. Has really helped me get through the tough patches. I guess because my knee surgeon has always been able to fix it I was in a lot of shock. Just hard coming to terms with it all.

Glad to hear you're doing well. Pleased I don't need to bother about seeing my knee physio. Spoke to him today over the phone about riding my road bike again and how much I need to build up in the gym before doing that, which is good. Forgot to ask about the running though and if it's safe to do. My sports physician has agreed for me to get another opinion on my knee from another top knee specialist in Melbourne once things settle a bit. He really trusts my knee surgeon's opinion and is one of the surgeons he recommended. So, I feel happy about that.

Made a silk painted scarf for my Mum's birthday for tomorrow. Was a lot of fun to make.

Chat soon !! :D

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #24 on: July 25, 2007, 12:40:31 PM »
hi ,
Oh Im so glad youre feeling better, its a HUGE shock to hear a surgeon saying things you dont want him to be saying!!! I felt a lot like that last time I saw mine as well - I just wanted him to tell me he could fix me!!!
I think we get hardwired by people in general who dont have knee problems. A lot of my friends say things like 'oh theres loads they can do with knees these days - cant they just give you a new one?' and Im like 'eh, no, it doesnt work like that - sure there is a lot they can do - but there is also a lot they CANT do!!' - but we only find these things out when we research it!!
Its great that you have a new path to follow also - perhaps the new knee surgeon will have some new answers for you? And even if he doesnt - he may be able to suggest next steps. I do believe there is always more that can be done.
Wow - thats great about the bike - well done you!!
that sounds lovely for your mums birthday - fair play to you - to get enjoyment from making a gift is fantastic!!
I spent some time in Melbourne a number of years ago - stayed with friends in St Kilda, did the Great Ocean Road trip, went to Phillip Island, saw Ramsay Street - I loved it! Great climate - and a nice laid back city too.
We've been rained out of it here in Dublin for the past few weeks - I cant remember a day it didnt rain in over a month!!
Talk soon!
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Recurrent dislocations/subluxes
« Reply #25 on: July 31, 2007, 08:50:32 AM »
Hi Tanya,

Just thought I'd drop you a quick line. Been busy with other stuff and not spending much time on this site.

Things are going well, my knee has improved a lot over the last couple of weeks and starting to get my confidence back again. My shoulder has also improved a lot of the last couple of weeks. Seeing my shoulder surgeon tomorrow and hoping to get the all clear to return to my sports trainer role on the weekend.

I am spending less time at appointments and feeling so much better about it. How are you going with your knee rehab ?

How is the weather in Dublin ? Is it still raining a lot ? It is getting a bit warmer here now.

Anyway, must run. Not literally ! Off to the hydro pool.

Speak soon.  :D

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline tanyap

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Re: Recurrent dislocations/subluxes
« Reply #26 on: July 31, 2007, 04:17:52 PM »
hi,
Im so glad to hear all is going well for you!!! That will be fantastic if you get the all clear from your shoulder surgeon!
It can be very depressing going to all these appointments in sterile hospital type athmospheres!!! When I was in college I used to have to go to physio in a local hospital, the only time that suited my schedule was the time when they had their geriatric physio class, so I used be down the back on an exercise bike with a bunch of old ladies and gents up the front doing extremely mild exercises - i looked like a top athlete in the room - then id go back over to my college and look like a girl with a gammy knee again :)

knee rehab is going fine, the physio has told me to go away until after I see the OS (9th Aug), to see what he recommends, will he want to do a surgery, or send me for more physio etc... she said regardless of what he says that i need to just carry on at the level Im at now for 3 or 4 weeks - before moving onto anything more difficult - to be sure that i have the best control i can have on the exercises im doing now. ive the technique fine, but ive less control on some.

they strapped me in the machine for testing again. i was very happy about the results. theres 3 different speeds of test, and each one measures both extension and flexion - so 6 different results.
first time round my right leg was weaker on my leg leg for all 6. the deficit was 44% for the first test on extension, getting increasingly worse for the faster speeds. (a little less on flexion).

this time the deficit is 18% for the first test - increasingly worse on the faster speeds but same overall improvement. but get this - my flexion on my right leg is STRONGER than my left on ALL tests!!! so i dont need to do any hamstring work :)

the physio said that to close that 18% gap I need to just carry on working the program - maybe 2/3 more months before its closed. the higher speed tests should improve too -but apparently that might take a little longer.

so ill see what the OS says next week with all that info in front of him - including MRI, X-Rays etc... I still FEEL quite unstable - but actually - mostly at higher speeds, i dont feel unstable slowly moving - so that matches with the test results.

my stamina isnt great either - but once i get full strength up stamina can be worked on.

we've had 2 days so far where there hasnt been rain - TWO!!! must be a record!!!

talk soon!

1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app