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Author Topic: TTT, LR or MPFL?  (Read 1994 times)

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Offline hayden31

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TTT, LR or MPFL?
« on: April 09, 2010, 04:14:11 AM »
Sorry for the length of this. I've been a lurker here for years and finally decided post.

 My left knee has dislocated since I was 5 years old. I saw an OS for the first time in 1995 when my knees were swelling and dislocating during basketball games/practices.  The first OS did x-rays, MRI and scope on the left knee in 1996 and said he the only thing he could do to try and fix it might result in me limping for the rest of my life. He told me to do 'leg lifts' to strengthen my muscles, and to avoid any activities that made my knees swell or caused pain.

 I laugh when I think about this because my knees swell when I walk for longer than 30 minutes and they hurt every day.  Over the next 10 years I didn't modify my activities  and the dislocations and subluxations continued. I have had so many dislocations and have always put them back in myself.

In 2008 my right knee dislocated for the first time and I finally sought the opinion of a new OS.  The new OS (#2) thought I should try a few months of Physical Therapy, which I did diligintly, but my dislocations increased in frequency.  I went back to the OS who recommended bi-lateral LR, medial reefing and tightening and POSSIBLY a TTT, but he wouldn't know until he opened me up.  ??? I told him I would have to think about it because of the length of immobility and time in a wheelchair was not possible in my busy life.  I have two young children 5, and 8, and am the president of a very busy company. Sitting still is not something I do well.

In April of 2009 my right knee dislocated and the pain after I pup it back in place was worse than I've ever had. It felt worse throughout the day (I have never worn a brace or used crutches) and I thought it was time to get another opinion. On Wednesday I saw a new OS who took new x-rays of my knees and explained why my knees dislocate so easily.  She said along with having hyper-moblie joints, I have a high riding patella, almost flat trochlear groove along with an flat patella, and a large Q-angle. She thought that with all of these factors a TTT or LR would not be as effective as an MPFL reconstruction.  She also wants to do one knee at a time so that if it is not successful,  I don't have to fix both twice.

 I really want to be active again and know that I must have some sort of surgery to get back to my old self. I guess I'm wondering if there are any others out there with similarly 'messy' anatomy who have had success with MPFL or TTT?

Thanks for your comments!  Hayden
6/11/2010 MPFL recon on Right knee
11/2008-03/2009 PT- attempted but dislocations increased in frequency
2/1996 scope L
1985-2010 Chronic recurrent dislocations on both knees

lindseym27

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Re: TTT, LR or MPFL?
« Reply #1 on: April 19, 2010, 05:14:01 PM »

Hayden!

Oh My....I've had knee problems for quite some time too! I've severely dislocated both knees several times. Each time...I'm in an immobilizer for a couple weeks, swollen, etc. You know the drill! I've also seen my share of OS in my time. I've done the physical therapy, trying to strengthen my muscles around my knee as much as possible. However, December 23rd of this year I took a huge fall on the ice, twisted my leg like never before and really threw out my left knee. That being said...it was my last straw. I've tried the conservative non-surgical approach, but the time has come for me to do something about this MAJOR problem. It’s not going away on its own and every time I dislocate a knee…more and more damage is being done. So for me..enough is enough. I want to regain my quality of life, do things without the fear of dislocating!

That being said...I have found an amazing OS (after seeing a couple! And choosing the one I liked the best!) who has recommended a Fulkerson Osteotomy, LR, MPFL repair and a arthroscopic cleaning of my joint to remove some loose bodies on April 29th. I am having it all done in one shot on the left knee to start. I've reached a point that I can't take another dislocation. My quality of life SUCKS and the OS says I'll have a 90% chance of never doing it again once this is all done and over with. So I'm taking my chances! If I were you, I'd talk to a few OS's and seek some different opinions. I've never heard of just doing a MPFL and nothing else, because the MPFL reconstruction is just to repair the torn ligament. That's not going to prevent another dislocation. The TTT and LR actually will realign how the patella sits in the groove, so if I were you, I'd seek out another opinion. It can't hurt, it’s better to explore all your options!! IMO..

Read through the posts on this forum..you will find A LOT of information and posts by people with similar situations! It’s amazing! I believe if you head over to the patella femoral section you’ll find a lot of valuable information that may help you sort out your questions and concerns. You can read and post to those who have been through it!

Offline Silkncardcrafts

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Re: TTT, LR or MPFL?
« Reply #2 on: April 20, 2010, 12:58:51 PM »
Hi Hayden,

It largely depends on the anatomy make up of your own knees.

When my OS was working out what to do he thought that I would definitely be a candidate for a TTT. However, after looking at the CT scans I wasn't a candidate for one, which really surprised him. He worked out that I would be a good candidate for a trochleoplasty. Now I have had a trochleoplasty on each knee and is the best thing I did. A trochleoplasty is when you have a shallow groove and deepen the groove your knee cap sits in. You may want to look into this as well is your groove is shallow.

It is not uncommon just to have a MPFL reconstruction. Often it can be to repair a ligament but other times it is a way of tightening up the joint, particularly if you have loose ligaments.

Good idea about getting one knee done at a time. I would also ask about getting some CT scans done.

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline abazaba22

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Re: TTT, LR or MPFL?
« Reply #3 on: May 04, 2010, 05:31:18 AM »
I have had the same problem, but with dislocations since I was about 10 years old, I have even dislocated both knees at the same time. I am 27 now, and finally found an OS I like too, In July of last year I had a MPFL, TTT and LR on my right knee. My grove is very shallow, and my patella was very high also. I had a good 5 weeks in an immobilizer, and it took me about 8 weeks to be able to drive. I feel very good about my surgery. The only unfortunate thing is that I don't have full range of motion yet, I can get to about 115 degrees, I was not ever able to be a terribly active person before because of all the dislocations and risk of dislocations. But I feel more confident in my motions and exercise. I rarely have pain, but I didn't have a lot of pain in normal times anyway- usually after a dislocation and during the healing time only. I am able to get my next knee done, but I will wait till next summer, because I want to save up sick leave, and I am getting married, and want to wait till after that also. There are some really great blogs of what people went though for this surgery also. To get a good idea of what to expect. I don't know what I would have done without these blogs in preparing mentally for my surgery and getting through it. If you have any questions you are welcome to ask me any also.
Abbey
Patella Alta
Hundreds of dislocations to both knees since 1994
July 15, 2009 MPFL reconstruction, TTT, lateral release

Offline fraud_ninja

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Re: TTT, LR or MPFL?
« Reply #4 on: May 04, 2010, 06:55:42 PM »
The issue with an isolated MPFL becomes that a torn MPFL is the result of a dislocation and having a torn MPFL is not the cause of those dislocations.  If there are other issues in your knees, and you seem to have them, an isolated MPFL is only going to be a "bandaid" on the situation. 

My recommendation, seek more opinions.  Find a patella specialist who can evaluate the entire situation and look at your entire legs and not just the unstable knee caps.  There are numerous surgeries that can fix patella instability and finding the right combination of surgeries for your particular situation can often be tricky.  I would definately not recommend having both knees done at once.  To put it simply, you need a leg to stand on after surgery.  Additionally, if you have the surgery done on both knees and its does not fix the problem (or god forbid it makes the problem worse) then you are faced with having both of your legs corrected.  One at a time is the way to go in my opinion.

I cannot stress enough the importance of finding a patella specialist.  This is the key to a successful outcome from surgery and a non successful outcome.  It can be easy to place to much trust in a surgeon, to think they are more skilled than they really are. (I am guilty of this).   You can put in all the time on the front end before surgery, but once you have any surgery you cannot undo it.

As for me, I have had 4 TTT's, 2 MPFLs, and 1 LR.  If I had gone to a specialist in the beginning, I would have been able to avoid having my TTT's revised.  I regret having the LR altogether.

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 crankerchick

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Re: TTT, LR or MPFL?
« Reply #5 on: May 04, 2010, 07:26:38 PM »
I agree with Brianne and was just about to post but she's awesome and beat me to it. It is imperative to be dealing with a patella specialist and to be thoroughly evaluated and have the right surgical approach to address the root problem.

A torn mpfl is more like the effect of the problem rather than the cause. If the cause isn't addressed, the problem is bound to persist. Without putting words into the mouths of the best patella specialists out there, I gotta say of the ones who's literature I've read, they don't put a lot of stock in the Q-angle.

A good set of x-rays and a CT scan along with a good patella specialist will go a long way in deciding what to do. Second (or third or fourth) opinions are never a bad thing.

Your OS gave you a lot of useful information about your knees, but the MPFL recommendation without addressing the patella alta is a bit concerning to me. I would want to know why reconstructing a ligament that totally makes sense that it is torn given your history of dislocations makes more sense. I would also want to know what my TT-TG offset is (will tell you if your tibial tubercle deviates one way or another and could benefit from a Fulkerson TTT). Last I would want to know if I have any kind of malalignment such as femoral anteversion, tibial torsion, knock knees, or bowed legs is present. Your history and the age it started definitely lends to the idea that your issue is structural, yet the proposed fix is to reconstruct a ligament that is almost certain to be torn with all of your dislocations.

Just my $0.03 (inflation).
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 hayden31

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Re: TTT, LR or MPFL?
« Reply #6 on: June 10, 2010, 07:11:10 AM »
Thanks for all of the replies.   I decided to go with just the MPFL reconstruction because it seems to be the best option for me. I have hyper-mobile  joins so my MPFL was NEVER tight, even before the Right knee dislocated.  The doctor I am seeing does specialize in patellar problems and I feel very confident that she has made a good decision based on my anatomy.
 
 I'm having the procedure done on Friday, June 11.  I'm excited to get my knees back in working order, but I'm also very anxious about being unable to do what I want, when I want (type A personality). Sitting still is NOT an easy thing for me to do. Luckily I am allowed to put weight on it the day after surgery if I want and PT will start on Monday.  What are somethings I can do that will help keep me comfortable while I'm healing? As much as I hate the look of recliners, I think I might be wanting one Friday afternoon.
6/11/2010 MPFL recon on Right knee
11/2008-03/2009 PT- attempted but dislocations increased in frequency
2/1996 scope L
1985-2010 Chronic recurrent dislocations on both knees

Offline LoosePatellas

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Re: TTT, LR or MPFL?
« Reply #7 on: October 23, 2010, 04:37:23 PM »
Hello! I just found this forum after deciding to have MPFL reconstruction with an achilles allograft on  my right knee. Both of my knees are unstable and have dislocated all my life. I went a good 3 years without any problems, but then had a flare up again over the summer, and have had three dislocations in 4 months. Yikes! Time to get this fixed!!!

I know that the surgery doesn't have a 100% success rate, and reading about "complications" on here has been frightening, for sure. However, I'm hoping for the best and wondering how everyone is doing after their surgery!

Because of my insurance situation, I have to be able to teach my undergrad classes by January 31st when the semester starts! The surgery is on January 3rd. I don't mind sitting down while I lecture, but I'm wondering if you all think I'll be able to get to and from campus (my husband dropping me off and picking me up) about a month after the procedure?

Additionally, I work at a bar a few nights a week to help with grad school. I know I won't be able to be on my feet for a long time for a great amount of time after the surgery, but if things go as planned, do you think I'll be back after about three months?

Finally (I swear!) how long is a good amount of time between the right knee MPFL and left knee MPFL? I kind of want to get it over with and have this hellish year behind me, but I also don't want to rush anything when the other knee hasn't fully recovered.

Would be really grateful to hear from any of you!
Unstable kneecaps, dislocations since age 6
1992: Arthroscopic Surgery on right knee to remove loose body
No dislocations from 2005-2010
Three dislocations in 2010
RK MPFL Reconstruction schedule for 1/3/2011!!!

Offline Kmcsmiles

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Re: TTT, LR or MPFL?
« Reply #8 on: October 24, 2010, 09:47:59 PM »
I had my mpfl and my lpfl reconstructed 6 weeks ago. A hamstring allograft was used.  I am not sure how much I have been affected by also having my lpfl reconstructed.  I keep trying to wean off my pain pills but still need them, and my os encourages me to use them to be able to keep up with pt.  That being said I was still using pain pills at 4 weeks which would have made it hard to work.  It would also depend how close you can get dropped off by your building, waliking or "crutching" won't be easy.  I teach ecse and make home visits so my job requires me to drive, do stairs, etc.  My dr said to plan on 12 weeks off of work, but I can sit when I ger into the homes, I don't know how much you van sit while waitressing. Let me know if you have other questions.  Good luck with your surgery!
12/20/89: diagnosed hypermobility joint syndrome
88-96 numerous checks/mri's on knee pain
91- left knee dislocate
93-96 rt and lt knee lateral release, plica removal
12/09 dislocated rt knee
09/10 rt knee mplf and lpfl reconstruction
06/11 rt knee repair nerve damage and ligament
10/10 MUA
6/11 r

Offline LoosePatellas

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Re: TTT, LR or MPFL?
« Reply #9 on: October 25, 2010, 03:36:48 PM »
Thanks, that's helpful! I hope my students can handle a professor who's a little loopy on painkillers ;)

Unstable kneecaps, dislocations since age 6
1992: Arthroscopic Surgery on right knee to remove loose body
No dislocations from 2005-2010
Three dislocations in 2010
RK MPFL Reconstruction schedule for 1/3/2011!!!