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Author Topic: TTT-type Surgery suggested--weighing options  (Read 18867 times)

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Offline Leentje

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Re: TTT-type Surgery suggested--weighing options
« Reply #75 on: July 29, 2009, 10:43:59 PM »
I am indeed the bamintonplayer and I had a LR/scope first wich failed, then a TTT wich was successfull!

All the best,

Helena
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline fraud_ninja

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Re: TTT-type Surgery suggested--weighing options
« Reply #76 on: July 29, 2009, 11:04:36 PM »
Dr Teitge is hard to get in with as he is now only seeing paitients for office visits once a week, but its worth the wait.  I would recommend going ahead and booking your appointment now and letting them know you would take a cancellation.  I waited nearly 3 months to see Dr Teitge, but looking back I would have waited 3 years for the results I have gotten. 

Dr Teitge is one of the top Patella Femoral Specialists in the country.  He is the top rotational issue guy, but even if you have no rotational issues you would be in good hands as you do have patella issues.

Dr T has some of the best bedside manner I have ever witnessed.  He is down to earth and explains things to you in very basic and simple terms.  He'll make sure he answers all your questions even if it takes a couple of hours.  He is humble, thoughtful, creative, and a genius. 

You are being wise to think about these things before having any surgery.  A word of warning, Dr Teitge's surgery wait time can be 3-4 months if not more.  Do not let this deter you.  I waited 4 months for my first surgery with him and again, I would have waited 4 years.  Plus, once you are a paitent and have surgery, Dr T will take good care of you.  Many if not most of his paitents come from out of town and dr T does an amazing job of accounting for this with everything.

Let me know if you have any questions.

Brianne
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline doublemom

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Re: TTT-type Surgery suggested--weighing options
« Reply #77 on: July 30, 2009, 02:36:39 AM »
Ditto the PatellaMD.com website.  I had emailed Dr. S. at PatellaMD.com just asking if he could recommend someone here in the Seattle area, expecting an email back from a nurse or office person.  Instead I got an email directly from him saying he didn't know of anyone specific here, but asking if he could help.  I emailed him a very brief (1 paragraph) email with my diagnosis of patellar tilt and subluxation and an attachment of my x-ray.  He sent me back a really nice email discussing what he would do if I were his patient, explaining the reasons for why he would recommend what he did, etc.  I never expected to have a discussion with him via email, but it basically turned into another medical opinion that I could rely on.  He's fixed a lot of PF problems for kneegeeks here, with a very good reputation and I like the fact that he was extremely easy to "talk" to via email and didn't blow me off like I think many other doctors would have.  The website is very informative, worth the time to read through. 

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #78 on: July 30, 2009, 08:20:01 PM »
So it sounds like I have 3 referrals here. I appreciate the help. It sounds like MI is where I should be going instead of Houston. But then again, the best answer is probably both opinions, rather than just one. Just not exactly nice on the pocket if you know what I mean. Just taking it one day, one doctor at a time. I feel good about my choices right now, of course that is probably because I don't have to make any decisions right now, LOL.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Hooligan

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Re: TTT-type Surgery suggested--weighing options
« Reply #79 on: August 04, 2009, 10:48:57 PM »
Hi there -
I just read through this thread and just want to say how helpful it is.
I have patella alta and a shallow trochlear groove. The condition is in both knees but I've only ever injured my LK (18 subluxations in 19 years). Knock wood for me that the RK stays stable!!
I am also weighing the options of surgery - and I'm leaning towards having a TTT. "I can fix this," said the surgeon. And he has a track record of fixing it for many people with this condition. It's just scary - I know you can all relate.
I've always been active and fit - but my last knee injury shattered my confidence and hurt like hell. It's been a year and a half of physio and being scared just to walk around, plus I compensate so much that my back is constantly going in to spasm. You have to wonder - could surgery really make things worse? But scarily enough, I guess the answer is yes. But then again, as I read through this board....it can also make things BETTER.

Hooligan
May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)

Offline WorkinWings

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Re: TTT-type Surgery suggested--weighing options
« Reply #80 on: August 07, 2009, 12:46:04 AM »
Hi Cranker!
Been anxiously keeping an eye on this thread, hoping for an update from you...
But, first of all:  hope you are well.
Then: been wondering if you did in the end go with the LR + TTT, or if you really stuck with the decision to keep trying to find the root cause of your patellofemoral problems?
Would you mind letting us know how you are doing?
I suspect I'm not the only one out here rooting for you :-)
Angela
Feb'00: Twisting injury (w/"pop")
dx - bone bruise of lateral tibial plateau
Apr'00 to May'07: intermittent pain; NO instability
7/May/07: Lateral Release (which created instability)
17/Jan/08: dx - iatrogenic medial patellar subluxation s/p LR
16/Jan/09: Back to function!
[email protected]

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #81 on: August 07, 2009, 02:59:35 PM »
This will be long, sorry for the length!

Hi everyone! Sorry for taking a break from the forum, I was busy booking travel arrangements and heading out to Houston :-)

I just got back yesterday, and it was so pleasant to log in this morning to post my experience and see the replies from you all. It's really great to be able to talk to people about the knee problems--people who can really understand and relate.

So I saw the doctor on Wednesday. Had x-rays, ct scan, and more x-rays (leg lengths). The diagnosis is moderate patella alta, internal femoral rotation, and external tibial rotation. He was very adamant that a TTT to move the tibial tubercle medially wouldn't be addressing my root problems, which are the torsions and the high riding patella.

On the first set of x-rays, he showed me on the computer my "knock knee" and compared it to my right knee, which isn't as severe. He had me lay on the table on my stomach, bend my knees to 90 degrees and he then proceeded to separate my legs, making a V where my lower limbs where the sides of the  V and my knees were the connecting point. He said most people don't make more then about a 90 degree angle (45 degrees per leg). Mine were approaching 150 degrees easily, indicative of femoral rotation.

The results of the follow up imaging indicated 37 and 32 degrees of torsion of my left and right femurs. He is still waiting for measurements of the tibial torsion and offset of the tibial tubercle from the trochlear groove. My CT scan images were provided to me on a CD, but the leg lengths were provided as flims in my hand. The doctor indicated the he needs these numbers from the doctor that did the imaging, or at least electronic versions, not films in hand, if he is to calculate them himself. The doctor that normally does the imaging was on vacation, and the doctor on call that did the imaging wasn't responsive or familiar with what was being requested.

So basically, the doctor is waiting for the right numbers to give the rest of the results and indicate his surgical recommendations. He said for sure that the patella needs to come down, but there are a few possibilities for addressing the torsion, so he was hesitant to give a specific plan on that until he has all of the information he needs. I can understand that, and as the patient, I would prefer he get his information from the doctor he trusts to do the right measurements, and do them correctly.

So that is where I am. I'm happy that I went out to Houston. I feel so much more like I'm being treated as an individual--like my specific body make up is being taken into consideration. With the previous doctors, looking back, I really felt like I was just being thrown into that pool of people that have subluxations that don't respond to conservative treatment, so the doctor's just say, "this is the next thing to try, and after that, we can't help you." The reality is, there are many different reasons why this same symptom of pain around the knee cap and lateral subluxations can occur and it's important to address each person individually and get to the root cause to fix it. I feel like I'm on that path now, finally.

One curious thing is I got my surgical reports and mri and xray reports in hand to take to Houston, so I perused them myself. My MRI scan indicates "moderate patella alta" right on it, yet the doctor that called for the MRI (the one who suggest doing just a LR), never mentioned patella alta specifically to me. He just said, "Look, your knee cap is tilted and traditionally, the next thing to treat this after therapy has failed is with a LR because it's less invasive than the TTT." In all of my years, not one doctor has ever specifically said "patella alta." Honestly, I feel a bit disgusted with myself that I wasn't requesting these reports to read on my own and ask more questions. I was poised to let a doctor chop my leg open just based on him saying, "You're knock kneed and are a strong candidate for a TTT."

This is the first time a doctor has provided specific measurements of things, and indicated what "normal" is and where my measurements fall in relation to "normal." I'm just so thankful for all of the encouragement on here to seek out more opinions, because looking back I can say that I wasn't as informed as I thought I was.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #82 on: August 07, 2009, 04:04:58 PM »
Wow, so I just got off the phone with my insurance company. I called to find out if Dr. Teitge is in network for me, and he is not. Something in my mind encouraged me to ask again about Dr. Sanders, since I would be seriously considering him for the procedure given that Dr. Teitge is out of network.

She told me that Dr. Sanders is NOT IN NETWORK either!

Last week, when I decided to call Dr. Sanders, I phoned my insurance company first to find out if he was in network and I was told YES. Now I find out that I was misinformed! I do have out-of-network benefits with my insurance plan, so that is good, but it just sucks to now have to deal with the insurance company to sort this out and also now money will (forcibly) weigh as a factor to me because in addition to travel expenses, I now have to consider just the cost of the surgery and all of the associated tests I've had and may have to have.

I'm not sorry I went, at least I'm better informed and it saved me a surgery that might have been (and probably was) the wrong choice, but now I'm really going to have to think about if I want to fix this, and when I will be able to given the cost.

The drama never ceases, it seems!
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline doublemom

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Re: TTT-type Surgery suggested--weighing options
« Reply #83 on: August 07, 2009, 04:06:17 PM »
Wow Cranker... sorry to hear about the torsion, but SO happy to hear that you've found someone who has been willing to really work with you, down to measuring angles and really digging to get to the root cause of what's going on.  At least now you know the specifics and had someone really go through it all with you.

It's amazing, isn't it, how so many OS's don't have a clue about patella problems and just do the "old school" surgeries like they were trained to do decades ago, without looking at the whole picture.  That's truly a scary thought, which is one of the reasons I've been holding off for so long for my surgery.  

Glad to hear you're back, keep us posted on what the next step is.  And yes, this forum has been a lifesaver for me, both when I'm frustrated with my own knees and also when I know I can talk to others and try to help through their problems.  Hang in there!!!

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #84 on: August 07, 2009, 08:10:35 PM »
Well, the original OS I had lined up to do surgery does quite a few TTTs a year and he indicates it as one of his research areas. But as I learn more, I just keep seeing that the best imaging to truly see patellar tracking issues is a CT scan, a test that doctor never called for. I'm hearing numbers for how much my knee cap needs to move, how much my limbs are twisted, etc and it makes me wonder, how was the previous doctor supposed to know how much to move my tibial tubercle if the only imaging he did was an x-ray?

Regardless of who's right, the thought that I almost had a surgery without being well-informed petrifies me to death. These doctors give you half ass information and offer no opinion so the onus of a failure is on the patient, not them, and then expect us to make these huge decisions as if we are doctors. I'm just happy that it seems on the path now of being in touch with a doctor that doesn't pull any punches and seems to genuinely care about his patients.

There's still a lot to be done of course, including hearing the full verdict on what the surgery will involve, as well as me asking lots of question about the procedure and the rehab and the risks long term. And I'll need to resolve things with the ins co if necessary. I hope not to let the cost influence my decision, so hopefully it all will work out.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #85 on: August 11, 2009, 06:30:53 PM »
Well, I've been in contact with my current OS over the last few days. From the CT scan I was told that basically my femur is rotated internally about 20 degrees too much and my tibia is externally rotated about 20 degrees too much. The tibial tubercle offset from the trochlear groove is NORMAL. That means, that the TTT would have resulted in moving something that was normal, as far as the CT scan is concerned. That is a really scary thought to me, that a doctor was going to do something to me that medical imaging suggests isn't even necessary.

I've asked pretty much every question I can think of including the details of the procedure, the anesthesia method, long term risks, short-term potential complications, post-op rehab and recovery (no immobilizer, no CPM, moving on my own in the recovery room, pwb with crutches for 6 weeks), and i guess that covers it. Being that I feel i was so underinformed and undereducated for the previous surgery I almost had, are there any questions I'm forgetting to ask?
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline doublemom

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Re: TTT-type Surgery suggested--weighing options
« Reply #86 on: September 01, 2009, 07:16:06 AM »
You nailed it when you said that your husband isn't the type to go over and over and over the conversation with you. My DH has said "let me know when, and I'll take time off work to help out"... He'll be great in taking care of me, but it's up to me myself and I to decide when.  Which is why I'm going to go over this all with my sisters next month, and I have to put in a plug here that I'm so glad I found Sharon (Snorunner), who lives not 10 minutes from me :)  We can both relate to each other and our knee problems, and we can sit down and talk face to face about it.  It really really helps to have someone else to talk through these things with :)

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline bumkneeblonde

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Re: TTT-type Surgery suggested--weighing options
« Reply #87 on: September 02, 2009, 10:02:05 PM »
I'm so glad I found Sharon (Snorunner), who lives not 10 minutes from me :)  We can both relate to each other and our knee problems, and we can sit down and talk face to face about it.  It really really helps to have someone else to talk through these things with :)
I know how that is!! I have a friend who is on this board too soxgirl, hehe, and we are there for each other through everything. We met b/c of our knee/legs! Now now only our "knee/leg problems" but everything else as well.  It's so "bonding" if that makes sense... I DO NOT KNOW what I would do without her! (Hi, Kara!lol)
-Sarah
25y.o.
06'-R Knee arthroscopy w/chrondroplasty
07'- " ",resulted in Femoral Nerve Damage (d/t tourniquet)
2/10/09-scope &open TTO
8/28/09-screws removed
12/23/09-LOA&cartilage biopsy for Carticel,dx'ed w/ Severe AF
4/12/10-Patella ACI
6/2/10-LOA
9/22/10-LOA
1/31/11-LOA
L knee pain worsening
:*-(

Offline slmac

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Re: TTT-type Surgery suggested--weighing options
« Reply #88 on: September 12, 2009, 03:49:19 AM »
crankerchick...wow, you've come a long ways to the point you're at now. It was good reading your postings one here. It gave me a few more things to think about and some questions to ask the doctor. I hope your surgery and recovery go well in October.

It's really helped me that I found agresknee on here who's daughter used the same doctor I am and is doing great all things considered at about 12 weeks post op. A success story is a mighty thing for encouragement.

I hope you'll continue to document your journey. sandra
Knee pain and issues during HS...played tennis
7/30/09 dislocations began
9/18/09 TTT (Fulkerson Osteotomy), MPFL Repair, and arthroscopic debridement
12/29/10 hardware removal
8/12 dislocations started
9/11/12 MPFL recon with allograft

Offline crankerchick

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Re: TTT-type Surgery suggested--weighing options
« Reply #89 on: September 12, 2009, 05:31:38 PM »
Hi!

I'm glad you found my post useful. I've gotten so much help and advice here and I really hope to be able to pay it forward. I just reread my whole thread and even I am still amazed at my journey. Of course it's not over yet, but I feel a lot more confident about my course of action now. When I was scheduled for the TTT, the "peace" I found was somewhat of a "forced" peace. I willed myself to be ok with that surgery. But with this one, the "peace" has been more natural. I have normal surgery jitters, but the gut-wrenching fear that I'm doing the wrong surgery is thankfully absent this go around. I really feel confident that I have done better research now and gotten opinions from the right people. Although I'm not going to have the procedure done with Dr. Teitge, this is only because after reading over his papers and corresponding with him, there are few things that Dr. Sanders does differently and I prefer his approach on these key details.

I've been following your thread, your surgery date is approaching. I wish you good luck and good healing. Definitely ask lots of questions and make sure you understand and are comfortable with the answers. We are the decision makers for our bodies and its in our best interest to educate ourselves and question everything and do what we think is best instead of blindly following the advice of a doctor. I'll be following your post-op journal if you do one, especially considering we'll be "laid up and bored" around the same time, LOL!

I plan on starting a post-op journal as I get closer to my surgery date. I think it will be helpful on the forum for people to be able to read about my derotational experience, considering most of the girls on here have had their procedures done by Dr. Teitge. Hopefully mine will be a success story too. I believe it will be. At the least, I'll be able to say I gave it my best effort and made the decision that seemed right to me.
« Last Edit: September 12, 2009, 05:35:12 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor















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