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Author Topic: Failed LR, What next?  (Read 1937 times)

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Offline mickb

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Failed LR, What next?
« on: March 24, 2008, 07:16:50 PM »
I had an LR back in August 07 suffered after with a bleed into the joint, spent 8 weeks on crutches and had many months of failed PT. My OS stopped the PT because he felt we were going backwards, 6 weeks ago i had a steroid injection and the results have been the same. I have no quad power what so ever, as every time we try to build the pain becomes to intense.
On the last visit to the OS i mentioned what do we do next, to which he was reluctant to say. Is my only option now a TTT or does anyone have any other comments, i just cant continue to try and build my quad through fear of causing more damage and the obvious pain.

Any advice would be greatly appreciated.

Mick.

fawn2388

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Re: Failed LR, What next?
« Reply #1 on: March 24, 2008, 09:15:49 PM »
NEVER do surgery going into with weak quads/muscles... I wouldn't say it's failed if it's not 'giving out' I would say try pain mgmt/and PT or even try a second opinion, the TTT is a very invasive surgury. I've had 2 and a revision after an unfortune fall.

Offline clkimbro

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Re: Failed LR, What next?
« Reply #2 on: March 25, 2008, 02:57:27 AM »
I would get a second opinion and keep trying the excercises.

I had a LR in 7/07 and I don't think it helped me much.  My quad had wasted away and one doctor recommended a TTT, but I went ahead with another doctor's recommendation of a LR because it was less invasive.  After surgery, physical therapy started to work but everything went downhill about a month into it.  My doctor and another have since said they cannot give another diagnosis until I build up my quad.   I started private Pilates classes at the beginning of February.  I worked through the pain and believe me I was in a lot of pain.  I left each class in tears because of the pain.  Through this process my quad has quickly come back.  I can now do some exercies I never thought I would be able to do again (I'm still scared to run through).  The exercises given to me in PT just did not do a very good job targeting my quad.  I am now at the realization that I may have done more harm to my knee by having the LR.  I waited a year after my knee went out to have the surgery and I went ahead with it because I thought I was out of options and I was in so much pain.  My mind was clouded from the pain and I think I rushed into it.  I really should have explored other non-doctor and non-PT treatments before making that big decision.  I am so glad that I did not go through with the TTT.

Offline Silkncardcrafts

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Re: Failed LR, What next?
« Reply #3 on: March 25, 2008, 03:01:52 AM »
Hi Mick,

A lot depends on your own anatomy. CT scans are one of the best scans to get to decide the next steps. In my case my groove is very shallow, so am having a trochleoplasty to help rectify that. Then, hopefully no more subluxations or dislocations.

Each person is different. For example in my case I wasn't a candidate for a TTT which my surgeon initially thought I was, but when the scans came back my surgeon said I wasn't.

An injection is unlikely to help with instability. Have you been doing a gym program ? If not, I would start one to help build up your quads. Clinical pilates is a good way to strengthen up your quads too.

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 mickb

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Re: Failed LR, What next?
« Reply #4 on: March 25, 2008, 08:39:57 AM »
Many thanks for the advice, i will try anything to build the quad back up rather than more surgery. i will look into the Clinical pilates option to,

Thanks again.

Mick.

Offline TwoBadKneesUSA

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Re: Failed LR, What next?
« Reply #5 on: March 25, 2008, 01:54:21 PM »
Hey there Mick,

Weak quads can cause pain issues too.  I've had a bear of a time getting mine stronger (still not there yet).  I had a LR in July 2007.  I have found that some of the PT exercises can aggrivate the pain.  Straight leg raises are boring, but they are a good place to start.  Quite ofen PTs want you to do short arc extentions and leg press machine (these cause me a lot of pain, so I don't do them).  You can help your knee by getting the hip muscles stronger too.  It's possible your PT didn't really understand how to rehab a knee after a release.  I've had one of those myself.  Try straight leg raises without weight and see how they go.  Keep trying to get the quads working.  They like to get lazy after injury or surgery.

Best of luck.
'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline tanyap

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Re: Failed LR, What next?
« Reply #6 on: March 26, 2008, 09:58:55 AM »
I had so little muscle bulk on my right leg last June that my OS was visibly shocked and said he had never seen atrophy like it. Now Ive a bigger right leg than left leg. It took months of hard work, sweat and tears.

One thing you might try is e-stim. My VMO would not fire. Id been attending a different physio practice for 2 years and no VMO. Then onto new physiotherapist and an e-stim and suddenly muscle growing all over the place. Lots and lots of pain though. The quads like to shut down - they are lazy!!!

Now Ive lovely big healthy bulky quads. And Im still dislocating everytime I extend my leg. So I need next steps. My OS told me when he saw the muscle wastage that there was absolutely no way he would operate with the quads that bad - it only sets you up for failure.
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 mickb

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Re: Failed LR, What next?
« Reply #7 on: March 26, 2008, 01:15:44 PM »
Thanks guys,

It is so frustrating when you know the weak quads can be a major part of the failure, i had such strong quads prior to surgery. 
I have been using e-stim for months, can fire up now, i will add the straight leg raises to my workouts, i suppose i am being a little impatient after 8 months compared to other experiences!

Thanks again.

Mick. 

Offline tanyap

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Re: Failed LR, What next?
« Reply #8 on: March 26, 2008, 01:54:46 PM »
mickb - at one point physio was hurting me so much that i could only do the exercises then ice the joint, then take pain meds - my PT told me I HAD to fight through it. Lasted a couple of months - i got used to the pain, then suddenly it all became less painful. So maybe back to basics and start over with the simple exercises and fight to get through them.

About the workouts - just do the exercises that use the quads - dont be overloading yourself with too much exercise.

Out of interest - what exercises are you doing and how often are you doing them? And how many reps etc...
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 mickb

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Re: Failed LR, What next?
« Reply #9 on: March 26, 2008, 03:43:56 PM »
Tanyap,

I think you are correct, i need to go back to basics.I am so confused with all the different exercises, have been doing different hip raising with heel lifts, calf raising, minimal squat and holding, hip exercises, hamstrings, e-stim, and on and on.
I am happy to start with the basics again, I need to find the excercises that are only for the quads.
Any suggestions welcome.

Mick. 

Offline tanyap

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Re: Failed LR, What next?
« Reply #10 on: March 26, 2008, 03:56:19 PM »
mick theres a thread of mine around here somewhere that details the exercise program i started on last June when I had NO vmo at all and very badly atrophied quads - its a back to basics program.

Give me a little time to find it - I cant even remember what thread its in, it has worked for me (using e-stim too) - and all the exercises are for building quad strength.
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 tanyap

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Re: Failed LR, What next?
« Reply #11 on: March 26, 2008, 04:04:23 PM »
have a read of this thread mick - my exercise program has not changed since last June - all thats changed is the amount of weight I use (no weights to begin with).
If youre doing too many exercises you wont be targeting the right ones with the right intensity. I had a whole heap of different ones til I went to the new physio last June - she threw my old program in the bin and said 'look heres the standard set i use for quad strengthening to rehab knees'. And now my quads are in pretty good shape compared to before.


http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38609.0
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 mickb

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Re: Failed LR, What next?
« Reply #12 on: March 26, 2008, 04:04:54 PM »
Thanks for you time.

Offline mickb

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Re: Failed LR, What next?
« Reply #13 on: March 26, 2008, 04:12:52 PM »
Thanks for your time even!

I will try these and see how we go, keep you posted,

Mick.

Offline tanyap

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Re: Failed LR, What next?
« Reply #14 on: March 26, 2008, 04:17:04 PM »
no worries mick - my quads were in a terrible state from all my dislocations but they have come back pretty good.
it takes time though - i didnt really see any proper results for around 3/4 months. But in 10 months they have gone from none to same as the good side.

good luck with it - come back and tell us how you go.
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