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Author Topic: FIXED my failed lateral release! (Exercises for medial patellar instability)  (Read 75015 times)

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Offline WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
BUMP!

Hello, my fellow Patella Peeps!

I am always amazed at how this thread maintains a life of its own…In spite of there not having been a single comment posted here in almost two months, and of it consequently being buried way back in the middle of the fourth page of "The patello-femoral joint" corner, it STILL has received over a thousand visits since the last time information was added here. 

How do people find this??

So, I end up feeling guilty for not supplying info that might be helpful to other sufferers out there...

Here, thus, is a little recap and wee update, with a bissaleh of new info mixed in:

In just a couple of weeks I will be “celebrating” the second anniversary of my ill-fated lateral release. 

I developed medial patellar subluxation soon after that surgery, but did not have it diagnosed until more than eight months later.  It is a rare condition, and therefore hard for anyone but the most experienced patellofemoral specialists to recognize.
There was quite a bit of controversy over that diagnosis, and also on to how I should be treated. 
From the whole experience, reading a ton of peer-reviewed literature, and talking to many very helpful experts, I realized that not much is known, by anyone, about how to treat this.
Options of surgical fixes are all pretty much still experimental at this stage and, therefore, risky.
 
(I did locate an orthopaedic surgeon who would have been my first choice, had I opted to have the lateral release repaired--and who still is my choice, if I ever change my mind... He knows and understands more about the patellofemoral joint than just about anyone alive, and is, in my opinion and in that of all of his past and present patients I have heard from, a wonderful person: extremely intelligent, honest to a fault, caring, witty, and tremendously passionate about patellofemoral issues.  I will not post his name here, but will gladly give his coordinates to anyone who PMs me!)
 
It was therefore very fortunate that, after searching for nearly a year and a half, trying at least a half dozen unfortunate options, and asking half the world about it, I was able to find a Physical Therapist who had the knowledge, interest, and instincts needed to be able to help me.
He put me through an intensive program at his clinic. I worked with him (or occasionally, his associates) for six days a week, two to three hours a day. 
We worked mainly on:

•   quad strengthening—concentrating on the VL
•   electrical muscle stimulation—concentrating on the VL
•   tons and tons of proprioception exercises
•   very specific stretching
•   and loads of core strengthening

At the end of three months, my improvement was phenomenal, and I was able to return to work as a flight attendant! This after almost two years away from the job I love (and which, BTW, I had been doing full time for ten years, and up until the very week before my surgery)...After being screamed at by the surgeon who did my lateral release that I would "never be a flight attendant again", and to "go to pain management and vocational training!"

So, this is where I am at now: 
I have been back at work for almost three months. 
The not-so-good news is that I haven't been able to keep up the same pace on the exercises after returning to work, and slowly I am loosing ground with my newly regained patellar stability...
No one really knows how my knee will do in the long run—after all, I have been told by several of the greatest experts that no one has ever heard of anyone being able to recover from medial subluxations with PT...
 
But I did recover!  I just think I might have returned to a high work load a bit too soon.

So, I might have to reduce my flight hours, and concentrate on building my strength to a level where it, hopefully, will be less time-consuming to maintain. 

…Or, I might have to eventually break down, be realistic about the amount of time I would be have to dedicate for the rest of my life to exercises, and still consider a surgical fix…

In any case, I will most certainly work as hard as I can on the exercises, and continue to try to inform myself.

That’s about it.

Any questions?

Cheers to alls yous,

  8) Angela 8)

« Last Edit: April 21, 2009, 05:50:19 PM by ClippedWings »
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline Silkncardcrafts

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Hi Angela,

I am pleased for your sake that you have been able to get back to work. You must have been so happy to achieve that.

Very interesting all of the things you did in your rehab. I actually tried all of those things, but needed surgery to fix my medial instability because I was at the severe end with my left knee and I was just getting worse and tried that for a good 6 months.

Yes, the surgery for medial instability is often experimental, but not always a risky thing. Last year I had a trochleoplasty which has addressed both my lateral and medial instability. I know of a number of people that have successful surgery for medial instability, mainly under Dr Arendt.
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 WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
Greetings from SleepyLittleOceanSideTown, in Puerto Rico!

Just came back from a lonnnnng walk on the beach this morning: sunny, warm...
Hey, it's a tough job!  But somebody's gotta take care of those passengers coming here...right?   ;D

Hello, Kneefite! And welcome. Thanks for your kind words.
What is your knee-fite story?  ;)

Anyway:
Regarding the doc mentioned (K: wish you would not use names, here), that doctor also told me--as did all the other docs I saw who knew enough about this--that I had a good 25% chance of not improving, or getting worse, after the surgery they proposed to fix my medial subluxations--even under those capable hands.

I am very glad for those people you mention--they were among the 75% on the lucky side...

I do not like those odds.

Hoping everyone is well, and continuing to fight the good fight.
A little luck your way wouldn't be bad, either...So may it come ease your knee woes, and stay a while!

Off to the gym!

 8) Angela  8)




Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline Silkncardcrafts

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Hi Angela,

Great you are able to walk again. Sounds like a beautiful place.

There is nothing wrong with using a doctor's name if they have helped a lot of people. The website is here to tell people how you've been helped. Personally I think you went over the top getting all the opinions you did. That's great if you have the time and money, but a lot of people just don't have that luxury.

You need to realise that different things will work for different people and the conservative approach didn't work for me, so had to undergo further surgery. There was a risk that my surgery wouldn't work last year, but was worth taking the risk as I had no quality of life. I could not walk unaided or sleep very well at night due to my knee cap coming out during my sleep or rolling over in bed. I was in constant pain. 75% change of working is still very good odds.
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 cat

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Beach? Sunny and warm?? I'm soooo jealous!
 8) 8)

"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
Hey guys,
just wanted to mark the date: the second anniversary of my lateral release is today.

-----------------------

Cat,
thanks for your note...you can't seriously be jealous!
You don't have it so bad yourself!  ;)
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
Hello Lateral Release Geeks, and (to borrow a term coined by my favorite PF surgeon)
Fellow "Victims of Limited Professional Knowledge"![/b]

Added to my first post of this thread today, just to help 'new' people coming here seeking answers for their (possibly) failed lateral releases.
I hope that helps spare them having to go through the whole "soap opera" of this thread.

Taking this opportunity to say hello to all of my 'old' friends here, as well.
Thanks again for all that you guys did to help me get to where I am now -- out of the "trail of tears" and back to living my life.

All the best to everyone,

A.

I'm now including my email address in my signature (below)--feel free to write if you have questions.


(link back to the first post of this thread: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=41314.msg353092#msg353092 )
« Last Edit: October 22, 2012, 05:46:43 PM by WorkinWings »
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline WorkinWings

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    • Failed lateral release: medial subluxation of the patella
Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #292 on: September 30, 2009, 06:12:48 PM »
Hey Y'all!

I've been motivated out of my long KG retirement because I just read a post that I thought contained so much excellent information, that I decided I'd just go ahead and usurp it for "my thread" -- this needs to be shared!


I would like to express my great gratitude here to both Dr. Mark Sanders, and to Dr. Robert Teitge. 



Most of the horror stories on this part of Knee Geeks stem from unrecognized torsional malignments of the tibia and/or femur. The credit for bringing this to attention goes to Prof. Robert Teitge, although this philosophy is not in wide use amongst most docs. The innocent patellofemoral joint bears the brunt of the injury, just like the children of a broken home, where Mom goes her way, and Dad goes his.

Four things need to be established:

1. the torsional alignment of the femur (normal antetorsion is about 13 degrees)

2. the torsional alignment of the tibia (normal external torsion is about 23 degrees)

3. the offset between the tibial tubercle and trochlear groove (normal 10-15mm)

All these can be determined in one second by a CT scan NOT AN MRI

4. The height of the patella (patella alta, or patella baja) This is determined by a simple lateral view digital X-ray taken in 30 degrees of flexion.

If more folks had these simple determinations before PF surgery, the Knee Guru probably would have to find a different day job.  (no offence meant to the Knee Guru, I even spelled offence to suit British sensibilities, LOL)


drmark
Mark Sanders MD FACS
Please view the terms and conditions on my Knee Surgeon's profile before reading my posts



Clarifying (since I've moved this quote over here, and it may not be immediately obvious where it came from): When DrMark says "this part of Knee Geeks,"  he means "The patello-femoral joint" section of "The SPECIALIST'S OFFICE."





I'll take this chance to say hello to all of my good ol' patella pals out there. 
Hope you are all doing fabulously!  Stop by and let us know, sometime!


Best wishes to all,

A.
« Last Edit: September 30, 2009, 06:58:45 PM by ClippedWings »
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline DaniHigley

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Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #293 on: November 11, 2009, 12:13:35 AM »
Hi there Angela!
Thank you so much for adding your last post and heading out of retirement to bring this to us! This has most definitley made me question my appointment for a second MRI and will be looking into getting a CT scan as soon as I can find a doctor who knows what the heck a medial patellofemoral ligament replacement is. Sure hoping to figure out my own knee issues and call myself a success story like yourself! Thank you for all  your help!
Hopeful,
Dani

Medial Patellofemoral Ligament replacement June 2008

Offline Silkncardcrafts

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Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #294 on: November 11, 2009, 08:38:56 AM »
Dani,

I hope you find someone to help you soon. Generally MRI scans are a waste of time with someone with patella problems unless there are underlying cartilage problems.

A skilled and experienced PFJ specialist will normally get plain x-rays and CT scans to determine what type of treatment is appropriate.

If you have medial instability from a lateral release a medial patellofemoral ligament reconstruction will not fix the problem.

Good luck !!!
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 DaniHigley

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Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #295 on: November 11, 2009, 06:54:47 PM »
Hi there!
I have postponed my MRI until I speak with a specialist.

Since my MPFL replacement in June 08 I have hit a brick wall in terms of progression. I was in physical therapy making great strides in terms of flexibility of my new ligament but the strengthening of my thigh was less then progressive. My physical therapist attempted to allow me to run on the treadmill with about 1/3 my weight 6 months into my pt when my knee began giving out. From then on my knee began grinding as if my knee cap was bone on bone. I now have poping evertime I lift my leg for things such as to put a pant leg on or lift my leg to get out of bed.

I'm sure there is a possibility of cartilage damage as the x-rays the ortho had taken last march showed no answer for the problem I am describing. I can deal with the poping, my knee has been "poping out" of place since I was 14 it's just the feeling of it makes it seem as though I'm chipping away at the knee cap.  Has anyone encountered this problem after having a MPFL replacement or reconstruction?

Thank you!!!  ???
Medial Patellofemoral Ligament replacement June 2008

Offline Silkncardcrafts

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Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #296 on: November 11, 2009, 07:38:42 PM »
Hi Dani,

It sounds like your rehab has not been adequate. My quads were really bad after my MPFL reco and took about 3 years to come right. Could be that your muscles just aren't strong enough. I had bone on bone before I had the MPFL reco. I wouldn't worry about the popping unless it is painful. That is what my OS has told me.

After this type of operation it can take a while for the knee cap to settle. It may be that this just hasn't happened yet.

My advice would be to go and seek another opinion from a top PF specialist.
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 WorkinWings

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  • Fixed my failed lateral release: back to flying!
    • Failed lateral release: medial subluxation of the patella
Re: FIXED my failed lateral release! (Exercises for medial patellar instability)
« Reply #297 on: December 08, 2009, 11:54:18 PM »
Hey Dani,

It's been a real pleasure to put you in touch with those fabulous PF specialists. 
If I was able to find a way out of my mess with their help, so will you!

Thanks for your kind words, and please stop by again sometime and let us know how you are doing.

Can't wait to hear your success story!!  8)

All the best,

A.
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline crankerchick

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So I'm just posting to give this thread a bump. I finally managed to make it through all 20 pages to learn of my dear "friend in knees"s entire "soap operetta" and I so just needed to bump because there is a lot to be learned here. The most important thing is that we the patient are our best and sometimes only advocate. We really have to put in the work to make informed decisions about our health.

I shutter when I think about how ill-informed and uneducated I was previously, even when I thought I knew what I was undertaking. Thankfully fellow KGs, quite a few who posted in this thread through the whole journey, helped "learn me" so that I could graduate from the title of "Victims of Limited Professional Knowledge" before going under the knife for a procedure I might have been very well-informed about, but not adequately examined for the need of such a procedure in the first place.

Wow A., way to go, and kudos to everyone who hang around through the ordeal to offer encouragement and support. KG is really an awesome place for those that choose to embrace the full power of the forum.
« Last Edit: April 05, 2010, 04:59:57 AM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline WorkinWings

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    • Failed lateral release: medial subluxation of the patella
Dear cranker!!

It sure took me a while...I'm sorry  :-\
Here goes a copy of the thanks I just posted on your thread for your very, very kind words:

(In: Derotational Osteotomy + TTT - 10/20/2009)



Wow! it's been sooooo long since I've been here, that I had a hard time remembering my password  :-X

But, I had to come offer my public mea culpa...Apologies to both of you! I have not been able to keep up with my email in the last few weeks, but I was very honored by your words on my thread, cranker, and touched by your email, acheek71. Thank you both. 

acheek, I did call my physical therapist so that he could pass along  my exercise plan to Dr Sanders. I hope that has reached you by now, and that it might help you.
I am glad you are moving towards that light at the end of the tunnel. That ain't no train, it's your life calling you back  ;D
I wish you the best. Please keep in touch, and let me know how you do?

cranker, here's a BIG thank you for what you've done for Doc!! He deserves it!  You haven't mentioned your special project here, so I am OUTTING you, now!! Check this out, people:

http://www.facebook.com/group.php?gid=344833852780&ref=ts


It's a beautiful thing!


Rooting for both of you!

And for you too, Dani!!! That message you sent was the sweetest ever, and it made me so happy to have been able to help steer you in the right direction. Please let us know how your surgery (or surgeries) go?



I feel it's a great privilege to now be in a position to make a little bit of a difference for others, here. 
That's the silver lining in this whole "soap operetta," right??

Good luck to you all. Stay strong, and stay in touch!

A.

Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]















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