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Author Topic: surgery for kneecap disclocations and sublux thingy  (Read 3936 times)

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Offline martina1

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surgery for kneecap disclocations and sublux thingy
« on: February 09, 2009, 02:27:01 PM »
Hi there,

I dislocated my right kneecap 3 times in my 20s , went through the usual PT and then looked after my knee - or so I thought, now 41and about 2 years ago my right knee started to partially dislocate and then on the 8th of January it dislocated completely- painfully , while on holidays with 2 young kids! So got home, saw the OS and I really don;t want this to happen again, did a full examination and I am due to have an op op in 3 weeks time - slit the knee open, tighten something on both sides of the knee cap to keep it in place - 6 weeks in full leg cast and I kind of frget what else he said after that! - has anyone been through this? he also slipped in that there is a 4 out of 5 chance this will work other wise it is a more serious op to sort it out! - anyone out there been through this, I would like to get a handle on time frame to full recovery and how much PT is necessary??? - I do get paid when I am out sick from work - but this could really drag on and put that to the ultimate test! - NOT a good idea considering the current work enviorment here in Ireland!

Offline spurs27

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #1 on: February 09, 2009, 02:50:48 PM »
Martina,

Welcome aborard!  First, I know what you are going through with the dislocations and all..been the story of my life!  My left kneecap had dislocated once and my right lneecap has dislocated 5 times and last week I had surgery to repair it.

It sounds like your OS has been fairly scant on details provided to you, but the good news is that you are in the right place on this website.  There are a TON of people on here with lots of experiences in many types of knee ailments.  Your particular problem can sometimes be a difficult issue to tackle and really requires an experienced orthopedic surgeon (OS) to correctly diagnose and treat.

It sounds like your OS is going to be doing a medial patellofemoral ligament (MPFL) tightening and what's called a lateral release (LR).  It's basically a procedure where he will tighten the ligament on the inside part of your knee (the MPFL) and loosen the ligament on the outside part of your knee (the LPFL) that holds your knee cap centered on your knee.  By doing this, it should track properly and not dislocate.  I had a medial patellofemoral ligament reconstruction.  The difference is that my OS completely re-built the ligament on the inside (medial) side of my knee using a piece of hamstring from a donor.  There are many differnt ways of doing the surgery as you will find out by reading post on this board.  My rehab diary is in the post-op diary (<100 posts) section and it's called "Brian's MPFL Reconstruction."

Alot of questions now...when is your surgery?  Where is it being done?  Is your OS doing an MPFL tightening and lateral release (LR) or some other surgery?  If you can answer these qyestions and find out the specific name of the surgery being done, then the people on this site can better prepare you for the surgery and let you know what to expect.  Until then, I'd just be guessing cause I really don't know what surgery your OS is going to perfom.

Regards,
Brian
History:
1992:  L kneecap dislocation
1992:  L knee Arthroscopy & MCM repair
1998:  R kneecap dislocation
2002:  R kneecap dislocation
2004:  R kneecap dislocation
2007:  R kneecap dislocation
2008:  R kneecap dislocation
2009:  R MPFL recon

Offline adlottis

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #2 on: February 09, 2009, 07:39:07 PM »
Martina,

Your history is similar to mine, but I started dislocating at age 10, had 1st surgery at 14 didn't work but I didn't know it, Finally had a surgery at 40,  2 years ago.  Like you I have small kids and this really turned our llife upside down for  while.  I had what is called a proximal/distal realignment which included a Lateral Release, Medial reefing, and a TTT and then on top of it all I had a chondroplasty because of damege I did to my knee because of all the dislocations.  I was in a locked hinged brace for 6 weeks, NWB for 4 weeks and on crutches to some degree for 11 weeks.  I spent 2 nights in the hospital.  I was in PT for 6 months, I did have some issues that popped up that slowed my progress down so that is why I was on crutches and in PT for so long. 

Ask any questions you'd like.

Annette
1976 first dislocation 10 years old
1980 14 yrs old LR, MR, remove chip bone
1980-2005 numerous dislocations
March 2007 Proximal/distal realignment, chondroplasty
July 2007 MUA
July 2008  synvisc
Sept 2008 patellar tendon tendonitis
June 2009 hardware removal, LR, debriedment

Offline martina1

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #3 on: February 12, 2009, 09:47:39 AM »
hi there,

thanks for that, what you have both written is what I am having ... loosening on one side and tightening on the other side of the kneecap to hold it all in place - .  injury took place on the 9th of Jan in France- very effecient health system there, have been in a full l brace ever since, on crutches and now I hve been told my OS is away for the next couple of weeks so it will be 9th of March before they do the op - I am going to completely seize up , and go mad by that stage - it also doesn;t help to know that he told me I will be in a full leg cast for 6 weeks after , Will I ever be able to drive again!!!  I live in Ireland - we have a public and private health care system, and I have access to both, so came home from France and went in through the public system- I had no option as I got seen to within a week of coming home - if I had gone private I would have been a minimum of 6 weeks waiting to see an OS! - crazy eh!

My fear is that my knee will have completely siezed up and musclese will have waisted away by the time I even have the op, and God only knows how that will effect my recovery- any views on this??






Offline Calimero

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #4 on: February 12, 2009, 10:20:24 AM »
Hey Martina welcome to the board :)

I'm from Ireland too, from Dublin. In a few years my surgeon says he would like to do the same thing to me, as my knee is too unstable and stands a good chance of dislocating again. They want to wait and see what happens again but the annoying thing was the doc who saw me (instead of my usual OS) didn't even explain properly what the patella stabilization surgery entailed! But your post has cleared that up for me. I am kind of reluctant to have the surgery anyway, but partly I am also like, if they feel I need it anyway, why not do it *now*? (now being more convenient as I am unemployed anyway  :P My OS is into treating conservatively I think which is why he likes the wait-and-see approach.

Where are you having your Op on the 9th March? Are you happy enough with your current OS?
Whereabouts in Ireland are you? I went to Mater A & E after my first dislocation, I was only waiting 20 minutes but they diagnosed me with a bad sprain and gave me two paracetamol and sent me home(!!).

Becca x
« Last Edit: February 12, 2009, 10:24:38 AM by Calimero »
Oct31:fall in kitchen, dislocated right patella
Nov21:diagnosed after MRI
Dec23:Quads still asleep. Ultrasound shows frayed meniscus
Dec24: electro-stim 'wakes up' quads. Begin intensive PT
Feb5:RK scope,cartilage removed.

Offline martina1

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #5 on: February 12, 2009, 11:53:16 AM »
Hi there,

I'm in clare - l have been very happy with my OS - best around this area.  I just can't believe that I have to wait until the March, hanging around in a brace, crutches and totally depending on my mum to bring me everywhere! . Besed on what I have been through - I'm glad I waitied until now to have the surgery - I got an extra 10 years before they had they had to do this surgery ...much better , now I will have a scar down the centre of my knee! - better to be 40 than 30! .   Just look after the knee do exactly what they say and then just wait - you may never have trouble again with it....

Hope you get a job soon,


Offline adlottis

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #6 on: February 12, 2009, 03:42:40 PM »
Martina,

Did your OS say you can take the brace off your leg when your sitting down not doing anything?  Are you currently doing any home exercises?  Your concern for your muscles to atrophy and leg to seize up becasue of no movement is valid.  Home exercises would help with this.  Quad sets, SLR's etc. 

Yes, I have had an 8 inch scar down the front of my knee since i was 14, I can tell yout it is truly lovely HA.  Actually it bothers me less than it seems to bother others. 

Annette
1976 first dislocation 10 years old
1980 14 yrs old LR, MR, remove chip bone
1980-2005 numerous dislocations
March 2007 Proximal/distal realignment, chondroplasty
July 2007 MUA
July 2008  synvisc
Sept 2008 patellar tendon tendonitis
June 2009 hardware removal, LR, debriedment

Offline spurs27

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #7 on: February 12, 2009, 07:13:39 PM »
Martina,

Annette makes a good point about the loss of strength in your knee from being in the brace.  I would think that if you don't have to have your knee in a brace while sitting, then you could try some simple exercises like straight leg raises and heel slides to at least keep a bit of strength and mobility in your knee.

Just a thought...

Brian
History:
1992:  L kneecap dislocation
1992:  L knee Arthroscopy & MCM repair
1998:  R kneecap dislocation
2002:  R kneecap dislocation
2004:  R kneecap dislocation
2007:  R kneecap dislocation
2008:  R kneecap dislocation
2009:  R MPFL recon

Offline tanyap

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #8 on: February 13, 2009, 04:02:04 PM »
Hi Martina,
Im in Ireland too.
They didnt have such a thing as MPFL reconstructions when I started my dislocations so I had a TTT, Lateral Release and medial reefing 20 years ago at age 15. (started to dislocate age 12)
I felt I was never right after the surgery - always had a weak knee. Never had a full dislocation after the surgery but continued to partially dislocate/sublux but now thats beginning to look as though a nasty fall off a stage that caused a partial dislocation at 19 years of age left behind a bucket handle tear of medial meniscus which was the cause of my subluxes over the years since. Had a scope to fix that last May and knee feels great now (bit crunchy but thems the breaks when youve had years of problems eh?) - before the scope I literally couldnt walk or move my leg for 3 years, had a prick of an OS who just kept shouting at me that nothing was wrong and my quads wasted away til I only had skin covering bone on my leg.
Eventually went to new OS who operated within 6 weeks of meeting me and fixed me with a scope last year.

Dont worry too much bout your quads - believe me you can get them back after things are fixed. It does mkae life easier to have good quads before a surgery but sometimes if the joint wont let you do anything then thats the way it goes. Mine are great now and thats after 3 years of disuse, and only able to use them properly since last year. I still have a ways to go with the physio but I feel 90% normal again.

Maybe see a physio to see if there is anything you can do to prevent atrophy. But try not to worry - getting the knee fixed is the biggest thing - you can always work on muscles.

I also used a kneehab and that helped me. Its an e-stim machine - you can rent them. Stimulates the muscles with electrical pulses. Really works!!!
http://neurotech.co.uk/kneehab_home.php
Thats the link to their homepage - I think Becca has used one too?

How long a recovery and how much PT is really an individual thing, depends on state of the leg before surgery (muscle strength), how hard you work at physio, how quick you heal etc.... But a ballpark guess is 4-6 months to get to 80 % but probably back at work long before that. And then another 6-12 to pull that last little bit of strength back. Total guesswork on my part - but surgery is surgery and it could easily be longer - or shorter.



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 Calimero

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #9 on: February 13, 2009, 05:25:38 PM »
I also used a kneehab and that helped me. Its an e-stim machine - you can rent them. Stimulates the muscles with electrical pulses. Really works!!!
http://neurotech.co.uk/kneehab_home.php
Thats the link to their homepage - I think Becca has used one too?

Quote

Yes forgot to mention Kneehab- I'm using it up to three times a day and it was the only thing that got my quads back when they were *completely* shut down, I can't talk highly enough of it, it's brilliant.

Becca x
Oct31:fall in kitchen, dislocated right patella
Nov21:diagnosed after MRI
Dec23:Quads still asleep. Ultrasound shows frayed meniscus
Dec24: electro-stim 'wakes up' quads. Begin intensive PT
Feb5:RK scope,cartilage removed.

Offline adlottis

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #10 on: February 13, 2009, 08:34:32 PM »
hi there,

Tanya: Your history sounds similar to mine except I'm a bit older.  I had a LR and Medial reefing at age 14, surgery never quite worked, I thought it was due to the fact I wasn't very dedicated to doing my home exercises and this is what I get for not doing them.  It wasn't until I dislocated 2 more times and could literally feel my kneecap sliding up the grove every step I took that I finally went to seek and opionion of an OS.  He couldn't believe I had dealt with this so many years, ended up with ttt, Medial reefing, Lr and a chondroplasty cause it was like bald tires behind the kneecap because of subluxing so many times.  I'm doing well, not perfect but okay.

My muscles were so atrophied that I couldn't even get the quad to fire for several months, I too had e-stim.  At last check my bad leg was at 64% of good, I'm supposed to go in and check again but haven't go around oto it. 
My delay in recovery of this surgery was dut to two things 1 lack of ROM due to scar tissue build up ended up with MUA and 2. lack of quad strength,  If those 2 things were non-issues I would have fared quite well.

Martina, You'll have to work hard to recover from this surgery, but as long as you know that and are willing to do what it takes you'll do great.

Annette
1976 first dislocation 10 years old
1980 14 yrs old LR, MR, remove chip bone
1980-2005 numerous dislocations
March 2007 Proximal/distal realignment, chondroplasty
July 2007 MUA
July 2008  synvisc
Sept 2008 patellar tendon tendonitis
June 2009 hardware removal, LR, debriedment

Offline SarahMN

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #11 on: February 14, 2009, 08:35:51 PM »
I would get a 2nd opinion, to be sure.  Even if you trust your OS. 

I had two opinions, had a LR on 11.12.08, and the kneecap dislocated on 1.2.09.  It continues to move around, and I am in a lot of pain.

The lateral release is very controversial, as to whether it works.  Read up a lot before you do it.  I wish I had never done mine.  I am in worse shape now. 

Post my surgery I have seen two OS that said I should not have had the LR for my condition.  As a result of multiple opinions, I am flying across the country to a specialist for exam and advice.  My other knee also needs repair.

Read everything you can on this site, and look at the forum's Information Hub.  Lateral releases are not all they are hoped for, with at best a 70% succcess rate.  Too many OS do them for the wrong reason, or just hope it works.

I wish I would have found the forum before my LR, but I didn't.  You may wish to do a search on LR, so see what people's experiences have been.  Not all so great. 

Good luck.  When you found this forum, you hit the right place to get information and resources.  Just be sure to use them.  I believe in 2nd and 4th opinions now!
3/25/09: R Knee: Arthofibrosis (LOA), chrondoplasty, excise plica, anterior interval release.
11/12/08:  L Knee: LR, Chrondoplasty of patella & MFC, Excise Plica, Synovectomy - 2005-2008: 12-16 weeks bi liateral knee injections with steroids. 
---& tried Synvisc, nothing but cost & 9-10 pain.

Offline martina1

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #12 on: February 14, 2009, 10:22:32 PM »
Hi everyone...

God where do I go from here - first of all I have taken all your advise on board and have made an appointment for PT privately just to keep things moving and my knee in the best possible shape for the op.  To get or not to get a second opinion - I have had the OS in France and another in Ireland both recomend the op in order to avoid further disclocations and pain.  and believe me I will do anything to avoid them happening again - apart from the pain which I can get over it's the inconvenience to my life ( mother of 2 young kids and widowed so depending on very very good neighbours and family to help me through all this mess)

To have or not to have the op - I am taking the risk either way - if I don;t then I will always be wary of my knee, I love to ski, climb mountains and surf - so would I really be able to do those comfortably without the op ... , and maybe the answer would still be no with the op but I suppose that is a chance I have to take - a 4 out of 5 chance of it working is better than always being worried about my knee and wondering if I could sort it out once and for all.

It's such a complicated joint by all accounts! - It really is a bugger of a thing, cause apart from a gammy knee the rest of you is fine - mentally physically etc - and yet it completely imobolises you . 

how do you keep yourself sane - I reckon by all accounts I will be out of work for about 3 months, so I still have another 8 weeks to go - any suggestions on keeping sane!!!




Offline tanyap

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #13 on: February 16, 2009, 06:13:43 PM »
Martina - I say do it. You cant live with it the way it is right? So go for it. An mpfl recon is soft tissue only - a TTT involves sawing bone etc... so the mpfl recon (while not to make light of it!!!) is not the biggest and worst op you could have on your knee!!
Plus you have had 2 surgeons say the same thing. Its about quality of life - can you live with it the way it is? If not then do it.

Annette - you really do sound like me!!! At last check my bad leg was only 50% of my good one (it was 33% before the op) but my good kept getting stronger alongside my bad so I keep chasing moving goalposts!!! I too am supposed to go back to be checked again but havent gotten round to it yet - I was basically sent off for a few months and told to come back for a review after xmas - or if any problems. No problems so far thank god besides minor aches and pains.


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 Calimero

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Re: surgery for kneecap disclocations and sublux thingy
« Reply #14 on: February 17, 2009, 12:47:28 AM »
Martina...re.suggestions on keeping sane!
I was so bored out of my mind while immobile I actually googled 'keeping sane while on crutches' which in a roundabout way lead me to this site. You sound like you have a lot on your plate. The hardest thing for me when I was laid up and out of action (pretty much for three months) was relying on my mam doing everything for me, she has a pretty serious illness and while I am not strictly a carer I would help out a lot more that I am able to now.
What kept me sane was this site, books, music and I draw a bit too.
If you are eligible for Illness Benefit definitely look into it..they are really great, I had to get mine backdated because for the first six weeks I was too immobile to sort it out, but it came through within 3 days. 3 days!! Considering social welfare is taking about 13 weeks to process in Dublin right now, I was amazed at the speed of it. Here's a link if you're curious.
http://www.citizensinformation.ie/categories/social-welfare/social-welfare-payments/disability-and-illness/disability_benefit

Having money to pay off my loans when I couldn't work played a definite part in keeping me sane!!
Looking forward to seeing how you get on if you choose to go ahead with the op. Good luck!
Becca x
Oct31:fall in kitchen, dislocated right patella
Nov21:diagnosed after MRI
Dec23:Quads still asleep. Ultrasound shows frayed meniscus
Dec24: electro-stim 'wakes up' quads. Begin intensive PT
Feb5:RK scope,cartilage removed.