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Author Topic: Is there a surgery for this ?  (Read 6137 times)

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Offline Sore knee

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Is there a surgery for this ?
« on: April 08, 2008, 06:46:40 PM »
Ok deep breath.

Some of you know this story and it sounds familiar here but anyway here it is

Had a LR last May, persistent swelling etc and pain
Aug knee re-scoped to see why, cleaned it up, rough areas under knee cap sent off to do physio all will be fine

Fast forward almost a year. Still in knee brace now since October last year. Finally have quads working but now the outside quads pull is so strong that it pulls my knee cap out the way and I feel a bump and click when it contracts. Pain is still there and some swelling. Brace makes it worse as it compresses the knee when it swells and makes the gind worse.

We have done loads of VMO work and my PT tries to hold my knee cap in position as we do the quad work but the muscle pull is so strong that he can't. My legs don;t even look muscley. We have tried months of physio now and they expected good muscle action to help knee pain and problem but it hasn;t.

I said I never wanted surgery again but we sat and discussed it and he has referred me back to the OS next Monday. He said even if it could be tethered medially and said just keep remembering what could be a very positive move ( as he knows how fearful I am of surgery) but wold not go into detail anymore.

Can anyone tell me in their experience what options there are ? I get very intimidated at the OS and would like a little knowledge of what is possible and what it involves so I can ask proper questions. If you can advise or give input in anyway I would appreciate it.

Thanks
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #1 on: April 08, 2008, 06:50:08 PM »
Hi Joanne,
If your physio is telling you that the muscle is pulling the knee out too far then perhaps the LR didnt do what it was supposed to do? What about your MPFL - ask your OS about this.
Im so glad they are sending you back - you do need answers!!
xx
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 Sore knee

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Re: Is there a surgery for this ?
« Reply #2 on: April 08, 2008, 06:52:07 PM »
What is MPFL  Tanya ?
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #3 on: April 08, 2008, 07:13:51 PM »
Best for you to look over in Briannes Post Op Diary Joanne - youll get much more info - basically its reconstructing the Medial Patello Femoral Ligament so that it tethers the kneecap medially - the risk is that overtightening it could cause medial dislocation, under tightening it could just leave the lateral instability (or pulling laterally) there. Its worth asking your OS about though if your physio feels that your kneecap is being pulled to the outside. They may also think about  re-alignment surgery like TTT - thats where they cut the bone of the tibia and move the patellar tendon over a bit and this results in a better Q angle (quadriceps angle) - so that the forces that happen when the quads pull the kneecap upwards stop it from being pulled both up and sideways. Again Brianne has had this done on both knees - so her diary will give more info.

But - a simple answer to your original post is yes, there are things they can do to improve the alignment besides an LR.

Are you dislocating or just tracking badly?
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: Is there a surgery for this ?
« Reply #4 on: April 08, 2008, 07:18:29 PM »
Theres a link to Briannes Diary Joanne - its long but worth a read.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=40953.0
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 Sore knee

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Re: Is there a surgery for this ?
« Reply #5 on: April 08, 2008, 07:25:00 PM »
Thanks Tanya

I don;t believe it dislocates as I assume I'd know all about it pain wise. It does sometime spop out but straight back in. Its just the clicking and when I put my hand on my knee gently and feel as the quads contract I feel it click and go over a bump as such.

Do you kno what I mean ???? The pain is worse, I say pain its always there but worse when my leg is bent for a while. Its not excruciating but its a constant ache that gets more and more at times and if I could find it I would dig it out. All I know is I cover the front of my knee with my hand and say in there.

Thanks Tanya will go and read it now.
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline *Margaret

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Re: Is there a surgery for this ?
« Reply #6 on: April 08, 2008, 07:26:31 PM »
joanne,
 i agrees with tayna, briannes MPFL/ttt revison diary will help you out. i just sent you a PM.

margaret
"ALWAYS LOOK ON THE BRIGHT SIDE OF LIFE" ~SPAMALOT

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #7 on: April 08, 2008, 07:50:49 PM »
Joanne,
that does sound suspiciously like what I refer to as a sublux - I have 2 modes of sublux, one as you describe and one where I have to manually manipulate it back into position (accompanied by a big CRRRRACK!!).

I have that bump - but in my case its more like a pot hole - I feel like my joint is dipping into a pothole slightly and theres a little area in extension where it tries to slide out of place.

Clicking and going over a bump definitely sounds like maltracking doesnt it?

Is your OS a knee specialist or a general OS? You could ask your physio who is a good knee specialist only in the area for you if youre not happy with the OSs answers - and as Ive just found out - a second opinion can make all the difference!!

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 Sore knee

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Re: Is there a surgery for this ?
« Reply #8 on: April 08, 2008, 08:18:48 PM »
Thanks Tanya

trying to catch up on Brianne's thread. I am unsure has she already had a TTT and if so when do they usually do that ?

Someone else said VMO advancement, what is that ?

You are a fund of information Tanya....keep up the good work :)

Thanks MArgaret for the message. I don;t have yahoo unfortunately but will look into it.

How are you all ? How is Donna doing and ALison, are they still here ?
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #9 on: April 08, 2008, 08:40:32 PM »
Brianne had two TTTs that didnt work (one on each leg) and she was still dislocating after so she had them revised and MPFL recons done too.

TTT is done for alignment problems, sometimes for dislocations, sometimes for chronic maltracking. I had one 20 years ago - but they dont do my type of one anymore cos it leads to arthritis. If youre not dislocating they can try LRs - I had one with my TTT - thats just releasing tissue on the Lateral Patello Femoral Ligament so it stops pulling so hard to the outside, a VMO advancement (i also had!!) moves the VMO so that it gets a better angle of force on the patella (its the main stabiliser), and possibly the force of that can overcome the force of the lateral pull. Some docs are against moving muscles about though.

I mean - there are plenty of procedures available and seeing as your biggest surgery to date is an LR - thats not bad going, for me the case is overly complicated by my previous 3 procedures rolled into one.

Apparently the MPFL recon is a relatively new procedure, think of the knee like a hinge with a number of different pulleys and strings that are supposed to work together to ensure the kneecap tracks properly in its groove, a lateral release loosens things up on the outside, an mpfl recon tightens things up on the inside, a TTT changes the whole alignment of how any of these pulleys work - its all about a doc who understands all these different forces and how your anatomy affects things - the guy today examined how i stood, were my legs bowed or was i knock kneed - it all depends on your own anatomy what surgery may or may not suit 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

brianne

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Re: Is there a surgery for this ?
« Reply #10 on: April 08, 2008, 09:30:23 PM »
Joanne,

There are any number of things that could be causing your continued instability in your knee.  At this point you would probably be best to seek out the opinion of a Patella Femoral Specialist.  Since you do not want more surgery and if you have to have more you want to make sure it will be the right one, a PF Specialist really is your best option. 

I had had one failed LR and two failed TTT's and so then I went off to a PF Specialist who has been able to really help me with my knees by taking a look at the whole picture and what could be causing my problems.  I said I would never have more surgery but I ended up with TTT revisions and MPFL recons done 2 and 4 months ago.  So far I am very glad that I made the decision to have the surgeries, but it is still early. 

I had the thing where my lateral quads were so strong and when I contracted my quads you could feel the patella jump over the lateral condyle.  Even if I was using e-stim on my VMO or my PT was holding my kneecap it would still jump the condyle every time.  The reason why this happened to me was mostly because my medial structures (MPFL mostly) were torn completely.  This prevented my VMO from firing properly. 

If you have any questions, please feel free to ask.  it is possible to fix the problems.  I have not had either patella try to jump over the condyle since my surgeries 2 and 4 months ago.

Brianne

Offline Sore knee

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Re: Is there a surgery for this ?
« Reply #11 on: April 09, 2008, 08:40:37 AM »
Brianne

I am so pleased for you, what a relief that must be. You have been through enough you are due good knees now.

I have not ever had a full dislocation where my patella has come out and stayed out. My VMO muscle is still not great at all, but its not for lack of trying. My quads are working I can do SLR and do hundreds of static quads every day but even when they try and hol the patella in place you still feel it jump and click over something. I have got to the point where I don;t notice it unlness I put my hand on top of my patella and you feel the click although granted sometimes it is loud and others can hear it but this is not the case all the time.

I have had the insoles for my shoes, steroid injections, brace to try and hold it in place. From what you guys are saying they may suggest surgery. He is a private OS who deals maninly with sports injuries and knees and does a lot of work with our national teams so I figure I am in good hands.

In your opinion given I have had a LR would a VMO advance be an "easier" procedure if there is one than a TTT ?

As I don;t dislocate fully (and if left could it move onto full dislocations) is there need for a TTT?

I see from BRianne's thread that recovery can be bumpy...well all surgery can be I guess, but does one have a better chance of fast recovery ?

Sorry for all the qauestions, I am really nervous and exvited. How sad is that, excited that something maybe done to help and I can get back to living fully again and nervous cause I don;t know what they will say. I dread the thought of him saying nothing or keep trying PT as I even my PT says he doesn;t know what more to try.
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #12 on: April 09, 2008, 09:28:23 AM »
Hi Joanne,
I think youre best to wait and see what he says - he sounds like he is the right person to be seeing, the thing is - we are telling you about stuff we had done or what possibilities exist but really its gonna depend on your own anatomy and also what exactly is happening and what the OS sees when he examines you and your x-rays, mri etc...

If you invextigate too much you will do your head in!!! The really important thing to remember is that you have been doing loads of physio, and if you continue to do that no matter what the outcome of the OSs appointment is  you will have a much better recovery from ANY procedure if your muscles are in good shape.

Is it this monday coming that you are seeing the OS?

Try not to worry - see what he says first.
xx
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 Sore knee

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Re: Is there a surgery for this ?
« Reply #13 on: April 09, 2008, 02:46:38 PM »
I know I know......its a bit like having hope sort of but dont want it to be dashed. A bit like you with your previous OS.

However next Monday afternoon at 2.40pm is D day I guess.
How are you today ?
11/5/07 LR right knee and cartilage tidied up
6/8/07 Knee aspiration, steroid injection- more physio
22/8/07 Knee to be scoped for answers
16/5/08 Patella stabilisation for  subluxations
24/6/08 Infection -hospitalised for a week. Debridement surgery
21/11/08 Repeat patella stabilisation performed

Offline tanyap

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Re: Is there a surgery for this ?
« Reply #14 on: April 09, 2008, 03:05:54 PM »
i know what you mean - but you dont want to over research it or you will only worry yourself more and think you have all kinds of different conditions!!!
I was able to give the new OS a very clear description of what happened with a sublux and what it felt like - but what it feels like is only my subjective experience. He did say that I sense it as a feeling of dislocation but the kneecap isnt dislocating. He said the symptoms indicate ACL problems but the ACL looks good on mri and the test was ok - thats why he wants to take a look inside - naturally today I looked up ACL problems - and it DOES match my symptoms!! arrrgggg...... so who knows!!

hey listen - if this guy doesnt listen, fight for it til you find one who does!
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















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