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Author Topic: Have they finally figured it out after 20 years - fulkersons and derotations!  (Read 1096 times)

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Offline devylcat

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Some of you may have seen me complaining around this board here and there.  I have had chronic knee pain for over 20 years now (and I'm only 27!) and multiple trips to doctors, OS's, and PT's have never given any real answers (other than, you're a young woman, it's common, you'll grow out of it!).  I have dislocated my left knee, have chronically suluxing patella bilaterally, maltracking patella, and I had lateral releases on both knees done last year to no avail.

So a few weeks ago I was taken to a orthopedic surgeon's conference at a local hospital to be presented as a problem case.  I was put up on a stage in a pair of shorts, questioned and prodded by a number of surgeons who determined it was a limb malalignment issue.  I was promptly sent for CT (prompt being 3 weeks later) and was then told I have external rotation of both tibia (left 46 degress, right 30 degrees) and that my tibial tubercles are too lateralized (left 2cm from normal, right 1.4cm).

So now I'm looking at either a) fulkerson's on both knees to be followed by distal derotation osteotomies if the TTTs don't manage my discomfort, or b) high tibial osteotomies to correct both at once?

Now I'm a veterinary surgeon and I specialize in orthopedics, so I know that a lateral high tibial osteotomy is no walk in the park, I don't really want anyone messing around my peroneal nerve, so I think I'll go with option A.  Now as my dogs walk out of our surgery after bilateral TTTs without support or bandages, I'm a bit surprised to hear about the immobilization and the aftercare people on this board seem to experience.

Would love to hear anyones point of view.  I'm sure I can't be the only one out there who has had their definitive diagnosis missed out on for most of their life.  Anybody gone down the fulkerson's/derotation route, or had HTOs?

Looking forward to hearing from you.

devylcat
devylcat

L dislocation - 2000
L LR - Mar 07
R LR - Jun 07
pain relief - transdermal fentanyl 24/7

Offline cat

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Another twistee??  Hello and welcome to our elite group.  I have internal rotation of my femurs and external rotation of my tibias- aka miserable malalignment and I had to go through several docs to find this out. I let the one who diagnosed me do a medialization of my tibial tubercle- something similar to a fulkerson. Also had some soft tissue work done at the same time. This did not fix me and I was told, when I finally decided to travel to see true patella femoral experts, that I now had too much load medially, that my tib tubercle would need to be moved back to its original position, and that I needed a derotation done. Teitge in MI was recomended as the top expert for derotations so off I went and had the procedure done in Oct. If you're anywhere near MI, and even if you're not, I would highly recomend a consult w/ teitge. I have only good things to say about the man.

As for my medialization, I was pwb for about 2 weeks though I did do one legged balances in therapy at 1 week. I think the crutch use has to do w/ the type of tibial tubercle transfer, how it was done, and the surgeon's post op protocol.  I suppose having 4 legs could be an advantage. Perhaps dogs have more common sense too- unless there are squirrels, birds, cats, rabbits, road kill, hot dogs ect involved.

 ;D cat  ;D
"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 Dale

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Offline FormerlyActive

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Cat - thank you so much for your informative posts. We have much in common except you are so much younger. I think the term miserable mal-alignment has not been around that long. Dr. Arendt wrote about it in 1996 but I'm not sure where it originated. I only heard it from her this month and never knew other people had the same structural problems I did. I worked at a health club for 10 years and never saw anyone even remotely resembling my condition. No OS I ever saw had seen someone with my mal-alignment. No one has ever known what to do.
I'm from a big family so I blame it on BAD GENES. It is in part genetic and my father has it although not nearly as bad as I do. It does seem to be more prevalent in women.
The PT explained to me that all the moving of the patella might not help if the problem is that the femur is rotated. What I don't understand is why can't I just do my "poor man's de-rotation" i.e. walk with duck feet, or ballet feet, and knees straight ahead? This is what the operation does? Why not just walkt that way.
Take good care and thanks for all of your caring and posts.
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together

Offline Lyndsey

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Hi!

I am a fellow twistee that like Cat has been diagnosed with miserable malalignment. My femurs are internally rotated and my tibia's are externally rotated. I am 6 weeks post op. of a femoral derotation of my right femur. I had it done in MI by Dr. T who did Cat's surgery. It went better than I ever expected. My foot now sticks out some because I only had the femur derotated. Dr. T is not sure whether we will need to do anything with my tibia or not. It is only externally rotated 23degrees and he doesn't like to operate on anything under 25. He did say that it may affect my walking and cause me pain, but I hope not. I will find that out when I can start walking again. I agree with Cat, that Dr. T is really good. I won't let anyone touch my legs but him. I am really happy so far with my derotation.

Good Luck!
Lyndsey
5/15/08      R femoral derotational osteotomy
1/19/09      L femoral derotational osteotomy
12/17/09  hardware removal (L&R femoral blade plates and screws)
10/28/10 removal of bone chip and cleanup of scar tissue on left
4/2014 15 deg. Re-rotation of L Femur
9/2014 L. Plate Removal & Fix Fracture

Offline FormerlyActive

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Thanks so much Lyndsey
I have been following your post-op thread and am so happy for you that it is turning out well (and that you are young!). If this surgery had been offered to me at your age I so wanted my legs straightened out, especially with all the issues I have had since then. Now I'm not as sure however I do need to see Dr. T, even if I am afraid of de-rotation recommendation, because it is clear he knows probably the most about the miserable malalignment and could tell me where I fall in the spectrum, long term implications, etc.

I'm actually originally from MI and my brother lives on a kind of horse ranch quite near to Warren (near LaPeer) so I can easily combine it with a family trip as I travel often to MI to see my parents as well. Do you know how far out Dr. T books? Is it months and months?

I had a gait analysis done at Gillette Children's hospital in MN but they have not yet gone over the results with me (July 14) so I don't yet know the severity of my rotation. My right leg is more severely rotated, however at this time it is ironically the left leg which is injured/disabled. Definitely my femurs are rotated inwards, I'm not sure how to assess about the tibia. But when I turn my hips out so knees are straight ahead, my feel point out at different angles to the sides, so I have started to develop a bunion on left foot to compensate. Perhaps when you start walking you will want new orthotics as your gait will most certainly be different.

I'm so glad for you Lyndsey and really wish you all the best. I'll PM you with some good restaurant recommendations in MI near the area! Warm wishes
3/82 - Medial Synovial Plica removal both knees
9/89 - Lateral Release both knees
3/08 - Reinjury left knee hiking Asia Pac
5/08 - Miserable Malalignment diagnosis
4/08 - 9/08 Five doctors diff. opinions
7/08 - 02/09 - In PT, no chg.
4/09 - Dr. 6 opinion femur & tibia derotation together















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