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Author Topic: Recovery with a knee brace?  (Read 2024 times)

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Offline dennisdun

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Recovery with a knee brace?
« on: February 12, 2009, 08:45:03 PM »
I'm writing this for my 79-year-old mom, who's not computer-savvy.  The overall question I'm asking is whether anyone here has had experiences with wearing a long-term knee brace following the diagnosis of subluxation.

The basic story is that my mom was diagnosed as having very little cartilage in her knees, which did cause her occasional pain.  Her orthopedist suggest replacements of both knees with the Otis knee.  He did the right one last year and she had total recovery.

The left one he did this January, and it's been a hellish mesh, whether because he made some error or simply due to her advanced age.  The first time she tried to walk, she had a buckling sensation.  Her surgeon told her the knee couldn't do that and counseled more therapy.  Since the hospital (and Medicare) didn't want her there for that process she went to a rehab center, though she didn't do a lot of therapy there.  Roughly two weeks later a therapist figures out she's got too much play in the knee and sends her back to the doctor for an X-ray.

This time he diagnoses that she has a "ruptured ligament."  No explanation as to how it occured, since she was walking normally before the operation and did not, as he so blithely suggested, suffer any falls since the operation.  Back she goes for a second operation to put in an artificial ligament.

That seems to work for a week, though from the 2nd operation she contracted an infection and had to stay in the hospital roughly two weeks.  Once she was largely past that, she tried to walk again, and at least once managed to get a fair distance with a walker.

Then the day after that minor success, the surgeon re-examined her-- straightening her leg out for rewapping-- and she experienced a lot of pain and the buckling sensation once more.

Now he says she has a subluxation and can't explain it.  Surgery with a new prosthesis was the first thing out of his mouth, but after questioning he said that sometimes one could try a knee brace for a few months and see if scar tissue formed so as to counter the subluxation.  His only personal experience in that department was with hip braces, though.

Today she'll try to walk with the custom-made knee brace, and I'm frankly afraid to find out what happened.

But is the doctor correct?  Has anyone managed to cope with a subluxation with the use of a brace, whether or not they have to wear it for the rest of their life or not?

gigi67

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Re: Recovery with a knee brace?
« Reply #1 on: February 14, 2009, 02:23:13 AM »
heres some info I copied n pasted : did the Os say anything about strengthening the weakened muscles that are allowing the subluxation? did he say anything about rehab? taping? too long in a brace without strengthening the muscles will produce very atrophied muscles which of course will only worsen the problem and can cause other issues. my b seek a second opinion if your  moms Os doesnt want to elaborate. make a list of questions. but for sure find out about rehab or other strengthening options you dont want that leg to atrophy badly. anyway read throught this n maybe itll help a bit.Regards to your mom.

 Patellar Subluxation / Dislocation
Patellar subluxation occurs when the patella slips away from the front of the knee - almost always to the outer side(lateral). The slip may be minor (subluxation) or major (dislocation). The patella may return by itself - or be stuck. Often the under surface of the patella is injured during a sublux or dislocation. The patella is scraped against the outer rim of the femur. Either or both surfaces may be bruised, abraded or fractured. Loose chips of cartilage or bone within the knee are common after a dislocation. As the patella slides laterally the ligaments and muscle are often torn free from the inner portion of the patella. This muscle injury is a common reason for difficult rehabilitation, quadriceps atrophy and poor patellar tracking afterward.

Risk factors include a person with generalized ligamentous laxity, prior dislocations, a long patellar tendon (high riding patella - "alta"), knocked knee posture, externally rotated tibias (duck footed), and flat or pronated feet.

The diagnosis is usually made by the patient;"my knee cap went out". Tenderness may occurs on both the inner and outer side of the patella. Usually the knee develops a large amount of fluid (effusion). X-rays are usually negative but may show a subluxation or loose body.

Early treatment involves bracing and early range of motion. Strengthening should also start within a week - consisting of quadriceps tensing, straight leg raising, and advancing to cycling and closed chain strengthening.

Some catching or a mild sense of grinding is common after any knee injury. Severe or persistent catching, locking or grinding may indicate a damaged joint surface. Further diagnostic tools such as an MRI or arthroscopy may be necessary.

McConnell Taping or knee cap taping may be extremely useful to allow earlier return to aggressive training and earlier return to sport.

Patellar bracing is also very helpful as a protective tool during the first few weeks and during early return to sports.

Multiple dislocations may require surgical stabilization. (Extensor mechanism reconstruction).


Offline dennisdun

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Re: Recovery with a knee brace?
« Reply #2 on: March 03, 2009, 06:55:09 PM »
Thanks for the response, Gigi67.

Since I last posted my mom has finally left the regular hospital for a LTAC to monitor her infection.  She'll be there two more weeks, and during that time will get physical therapy 5 days a week.

It's my impression that she's responding to the therapy reasonably well and that her muscles are not yet in danger of atrophy, though by doctor's orders she always wears the brace.  She's walked fair distances now but only while using a walker.  I asked her yesterday if she had yet tried standing without support and she said she'd only had occasion to do it once while getting weighed, for just a minute or so.

She hasn't had a repeat of the extreme pain she had the weekend when the surgeon may have (according to my brother) hyperextended the knee. 

The info about subluxations that just occur due to weakness may not be relevant since I can't be sure whether or not surgical error was involved.  Maybe it's encouraging that he used the term "subluxation" rather than "dislocation."  Anyone have an opinion?

And has anyone had experience walking with a knee brace for a significant amount of time (months, years?)  Presumably while exercising to keep away atrophy of muscles...

Offline Lvc595

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Re: Recovery with a knee brace?
« Reply #3 on: March 08, 2009, 07:57:19 AM »
Hi,

What is McConnell Taping  or Patellar bracing ?
Is there a product I could buy?

How about a no load knee braces?

I'm not sure where to purchase one.
Lori