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Author Topic: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010  (Read 86921 times)

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Offline crankerchick

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #30 on: May 10, 2010, 12:43:25 PM »
One thing you can try with the SLR is to have your assistant lift your leg only for the first 2 or 3 and then try yourself on the next one. Also, having them just start it, like, lifting the heel off the bed and then you raising it the rest of way is a good starter. If you are alone you can use a strap or belt or even your other leg to help you get it started. Once it's started, you can finish on it your own and before you know it, you will be able to do it on your own completely.

Sometimes the muscle just needs to be reminded how to work right. Even once I could do the SLR, I would find sometimes I would try and the first one I couldn't do, but just a little help on the first one and then I was back doing them again.
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 naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #31 on: May 10, 2010, 02:33:44 PM »
Hey crankerchick!

Thanks for the advice!  When my friend has been helping, I can tell that she does most of the initial lifting, but then I can tell my leg takes over.  It's just the first inch or two of lifting that I can't quite do.  It is nice to have my whole leg tired after the exercise though, because it means my muscles are working! 

Yesterday while doing that exercise, my friend didn't quite lift as soon as I expected, and my leg jumped up and bit then fell down.  So I know I can do it, but I agree that my muscles just don't remember how.  I keep doing them on my right (good) leg, then trying with my left.   :)  That muscle memory just needs a little reminder.  I will try to do it with a belt or something like you mentioned, though.

Hope you have a great day!
-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline cupcake1007

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #32 on: May 10, 2010, 04:24:48 PM »
Jen- You mentioned that you hadn't been sitting in the front seat...I'm shortish- 5'4"-5'5" and I've been sitting in the front of our SUV since the accident happened...once I'm in it's okay there's room but getting in is hell. What kind of car do you sit in that you sit across the back seat??? I'm wondering if I should try that. I find it really painful to move my leg from side to side right now- it makes my knee feel like it's slipping towards the outside. Not sure if it's muscle weakness or the swelling or what but ouch. I was definitely expecting more stability post surgery.

I'm inspired by your story. My original dr wanted to do a Fulkerson but had much more conservative post-op approach to PT (he "didn't know" if he was going to send me to PT at all...seriously?) so I did a bit of research on it and I can't imagine getting around so much so soon after esp having done both!! I'm trying to cut back from 2 percs every 4 hours to 1 and am dying so I can't imagine how you're doing it on just hydrocodone (which I was on before surgery from my initial injury so know it's not that strong). Good luck keeping up with everything! It souns like you have a great outlook and you're doing amazing =)
8 years old: first dislocation left knee/therapy
teens: first dislocation right knee/therapy
2008: birth of first child/dislocating often even in sleep
03/2010: dislocation/trip to ER with knee dislocated in fully bent position
05/2010: MPFLr & LR

Offline naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #33 on: May 10, 2010, 05:10:23 PM »
Hi Cupcake1007!

I saw your post-oop diary and I remember the problems you've been having.  First of all, I wasn't able to have percocet.  They gave it to me at the hospital and I had a bad reaction to it.  I was soooo dizzy and my eyes were essentially spinning in 2 different directions and I couldn't focus.  I nearly passed out, but I called the nurse in and she lowered by head down below my feet, just in time.  It was scary!  I also ended up throwing up twice, so I didn't have the option of using the percocet.  So from Day 1 I've only had the option of hydrocodone.  The first few days were pretty painful, but at about Day 4 it started getting better.  I also think having the PT exercises help, although they do hurt sometimes,  it's nice to be moving.

As for the car-I'm about 5'3", and I definitely agree that getting in is hell.  With the Fulkerson I've been conservative about bending too much, as my OS recommended.  I had pain at the Fulkerson site with bending it a few days ago, and he told me to lighten up on that exercise, so I have.  And just bending to get in the car door was hard.  I can't believe you've been getting in an SUV!  I've been in the backseat of plain old cars, which are low enough to the ground that I can slide in easily.  The one time I had to get into an SUV was hard, but as I slid in the backseat I kind of laid my foot on the inside of the door handle so I could slide and keep my knee straight.  A little tricky, but easier than the front seat!  ;)  Keeping the leg extended is helping a lot with keeping the pain away.

Good luck with the pain, and feel free to ask me any questions.  At some point you'll turn a corner and feel a lot better quickly.  Getting to that point is hard though! By the way, your original OS sounds...not so great.  No PT?  Hmm....I don't think that would be a good idea.  And recommending that surgery without and MRI and X-rays (if I am remembering correctly)?  Scary!

-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline doublemom

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #34 on: May 10, 2010, 05:12:24 PM »
Jen - That first SLR is the hardest thing... but once you get it, it's amazing how the muscles will start waking up and realizing what they're supposed to do.  With my first one after surgery, at 13 days (I think), I did ONE in PT and my entire body was shaking.  I was exhausted for the rest of the day LOL, but it felt so good to finally be able to do one.  Keep up with the quad sets and you'll get there before you know it :)

As for sitting in the front seat of a car, isn't that fun??  I hated being in the back seat, especially with my 15-year old girls driving me around to the store and PT and not being in the front with them.  They're both excellent driver's though, so I'm very fortunate they had their permits and could take me where I needed to go.

As for the mental fog with the pain meds, yes, it's wonderful once that all clears away and you can actually complete a thought without your mind wandering around a bunch.  It took me several days after stopping the meds to be totally clear again, but it was sure a nice feeling when it did :)

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: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #35 on: May 10, 2010, 05:24:00 PM »
I'm 6'2" and always sat in the front seat. What wasn't fun was the shape of the dash in some of the vehicles in addition to the leg room variations in some of the cars. In TX I rented a sonata which has decent leg room and the dash is designed decent enough and wasn't all up on my shin. When I left the hospital, the nurses and aids (and me LOL) were surprised how I just basically got right in the car with no issue.

In Atlanta with my in-laws, same with my father-in-law's honda accord. But my mother-in-law's lexus truck, OMG, I hated getting in that thing. The height obviously wasn't an issue for me, but just the leg room is less and the dash/glove box is poorly designed and felt like it was like only less than an inch away from my shin. My mother-in-law is kind of a scary inattentive driver and all I kept thinking about was her crashing and my poor leg going into the dash. ::cringe::

I did find it easier to get in the car taking off my shoe first, but for the most part could get in fine, I just had to bend my knee myself because after a certain point I couldn't actively bend it any further to get in.

What was the worst for me were those first few weeks where turns felt like they were twisting my leg and would hurt. Again with my mother-in-law taking sharp turns rather quickly I wanted to just ring her neck sometimes. I just always braced with my hand and eventually i had the leg strength to brace without holding my leg.

Now the seatbelt on my thigh where the femoral incision is. U-G-H! That sucked no matter what car i was in.
« Last Edit: May 10, 2010, 05:28:05 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

Offline naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #36 on: May 10, 2010, 05:48:31 PM »
Hi Andi and Crankerchick!

Front seats are definitely much nicer than the back.  :) Luckily, my Mom is a great driver and I had no fear of smashing into the dash.  Turns are still a bit scary though.  I also help my brace just to avoid jarring and twisting.  Better safe than sorry, I suppose!

Andi-having the mental fog gone is amazing!  I'm still on the meds a bit, but it's gotten so much better.  That's a good thing too-I have 5 papers due before the end of the semester on Friday.  :o  Luckily 4 over them are over half done or only revisions are needed.  I have no real final tests this week, so I have no classes, etc to go to.  Lots of time to rest, write, and work on recovering!  I also have my 1st Post-Op appointment on Thursday.  I hope he says I can start doing weight bearing.  I really want to be able to do an SLR just so I can prove my quads are getting stronger.  ;D

Off to write more!
-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline cupcake1007

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #37 on: May 10, 2010, 06:05:38 PM »
I guess I should clarify. I'm in a knee immobilizer and not allowed to bend my knee at all right now...which I know is unusual but I think my case was pretty bad as far as looseness goes or something? Like I posted in my diary- I went to 3 doctors. The first guy (yep he said no PT and no MRI- only an xray done at the ER which my OS had redone in his office because he didn't think they were clear enough) didn't want me to bend my leg at all. I dislocated my knee mid-march and didn't get in to my second opinion until April 1. He wouldn't give me a second opinion until I got an MRI...he had me start bending it but when he got the written report of the MRI it said I tore a bunch of things (which I didn't) so he told me not to bend it if it hurt. So, I got it to about 90 degrees. Then I saw the third guy and he didn't say anything and I guess I forgot to ask. He had me bend it right before surgery and said we would get aggressive about it when I came in for my post op. I had my surgery done at Georgetown in Washington, DC...which is a pretty good hospital and both my referring surgeon and my OS surgeon seem to be pretty well known etc but I don't feel like they sent me home with as much info about everything as they could have. I mean I was basically sent home and told to do my quad exercises and get up as much as possible and take lots of pain meds (ah I'm almost out and I don't think I'll be able to get another script until Friday oops lol)...I called them about 20 times last week to ask about things =) Anyway, my point about the straight leg was that I'm keeping it completely straight to get into the front seat. I have plenty of leg room and my dh stabalizes my leg with pillows which helps (we've been perfecting comfortable car riding since my initial injury)...and I was doing okay getting in until we came home on Friday...it was my one and only car ride since surgery without the nerve block and OMG it hurt getting in and out. I may try the back seat...the only problem with that is we have a 21 month old so if she's with us I'm not sure there would be enough room...How do you sit though? Just across the back seat with your leg up? Ugh, I'm not looking forward to getting in the car again on Friday...on the bright side- the swelling is going down a lot! How's your swelling now? I think I may be turning the corner. I got through the first 4 hours with just one perc and was in a lot of pain about 2-3 hours in but then it started going away. I took another one at the four hour mark and feel fine so maybe part of it is the process of weaning off it.

And cranker- what femoral incision?? You mean from the block? I didnt have an incision...don't think I even have a mark from the needle. Ah I was all doped up during that and it's one of the last things I remember- thinking yay they're getting my leg to jump a lot hopefully that means it's working lol.
8 years old: first dislocation left knee/therapy
teens: first dislocation right knee/therapy
2008: birth of first child/dislocating often even in sleep
03/2010: dislocation/trip to ER with knee dislocated in fully bent position
05/2010: MPFLr & LR

Offline crankerchick

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #38 on: May 10, 2010, 06:17:27 PM »
cupcake, you are in the DMV area? So cool, so am I! I'm just south of Baltimore in Howard county!

I had a TTT along with femoral and tibial osteotomy. So i had my femur derotated (unspun?!?!) and my tibia derotated along with the TTT to bring the patella down. That is why I have the femoral incision. One of these days I'll put a picture up, LOL.

If I were to sit on the backseat, I would sit with the surgery leg against the seat rather than the other way, less the surgical leg fall off the seat on a stop, ouch! I sat like that a few times after my other surgery. I used pillows to elevate.

If the car ride is that awful, perhaps drugging up before hand? And also, ice for the car! Let the numbing powers of ice work in your favor!

6 days after my surgery was the day I left TX and I had PT and a visit with the doctor that day then a 1 hour ride south in the car to the airport. We filled up my cryocuff and used it in the car even though I couldn't plug it in for compression, just having it fill up with icy cold goodness helped for the ride. My mom was worried about the bike ride and exercises from PT causing more swelling and pain. I just wanted the numbness from the ice!
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 naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #39 on: May 10, 2010, 06:41:07 PM »
Hey all!

I'll be studying in DC next semester...so excited!!!  :D Anyways...

Cupcake-Sorry that you weren't given much information about what to do Post-Op.  I had pretty good instructions and still had to make a few calls!  And I hope you can get more meds before then! I am impressed that you can get in the car without bending though.  I sit with my leg stretched out across the backseat, which probably won't work with your child.   :-\  And like Crankerchick mentioned, I sit with my bad left against the seat so it doesn't slide off.  Pillows are good for elevation for long rides too.

Crankerchick-I almost had to have the femoral derotational surgery.  The OS discussed that and the Fulkerson, but decided that the Fulkerson should be enough to fix the problem.  I should put pics up too...if I figure out how.  I've been taking lots of pictures just to compare the swelling and bruising.  It'll be interesting when the steri-strips can come off and I can really see the nice, 10 inch incision.  I didn't quite expect the incision to be that long...oh well!

-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline cupcake1007

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #40 on: May 10, 2010, 11:41:33 PM »
Yep, I'm about 1 1/2 hours from DC (no traffic) in VA. I grew up in Alexandria though. Where are you studying Jen?

It's frustrating because I'm not sure like where I should be...I still can only do the quad sets - no SLRs though I'm going to have my dh help me a little later. I have a feeling it's going to be really painful though- yuck. What I'm really unsure about is how often I should be getting up. I get up about every 2 hours to go to the bathroom and walk around a little. I just ate dinner at the table (we have a pub table so I'm practically standing) for the first time since surgery. But, I have a feeling I'm not up and about enough. I am putting some weight but not full weight on my leg yet. I am cleared for full weight but my leg is still pretty wobbly. Thanks for the info about the car- I think I'm going to try that on my post op visit- which is 1 1/2- 2 hours away.

Wow a 10 inch incision sounds pretty long. Mine is only about 2 or 3 where they did the MPFL and then a couple where they put the arthroscope in/did the LR. It seems like most people get the MPFL with a TTT (which is the same as a Fulkerson right?)...my drs said I didn't need it because I wasn't misalligned very much. Supposedly the MPFL should be quicker recovery time...I think mines a little worse because I was already swollen etc from the initial injury and didn't have ROM beforehand...sigh. I'm looking forward to and scared to bend my knee. ugh.
8 years old: first dislocation left knee/therapy
teens: first dislocation right knee/therapy
2008: birth of first child/dislocating often even in sleep
03/2010: dislocation/trip to ER with knee dislocated in fully bent position
05/2010: MPFLr & LR

Offline naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #41 on: May 11, 2010, 12:31:41 AM »
I'm not really familiar with East Coast/DC area, and all I know is that I'll be in the Capitol area interning somewhere.  I'll find out the specs over the summer.  I'm super excited buy super nervous at the same time.  I'm really looking forward to living in a big city again.  I studied abroad in Mexico for a semester in a city of about 1 million, then moved back to my college town of 10,000.  It's been hard and I really miss the action in a large city.  Thus, I can't wait to go to DC.  I also can't wait to have the option of public transportation again-I hate driving!! 

Anyways, I also don't get up and move a whole lot.  Part of that is because my arms have been so sore from the crutches.  I have pathetic arm strength, so using the crutches has been hard.  I intended to get out today, but it's cold, windy, and rainy.  I'm hoping there's no tornado warnings tonight.  Ugh!  At least when I go to the bathroom I have to go down the hall of my dorm, and I'm a Resident Advisor so I've had to help a bit with getting stuff from the RA closet, which is down 2 stories.  Yay for the elevator!  I may force myself to go down to the computer lab or vending machines, just to get some movement in today.  I think tomorrow I'll get out and get my own food from the dining hall about 1 block away.  We'll see!

As far I as can tell, with a bit of research, the Fulkerson is a type of TTT (correct me if I'm wrong people!).  I'm guessing the incision length is normal, although it seems that on my short legs it's very large! :) 

-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline crankerchick

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #42 on: May 11, 2010, 03:12:20 AM »
A TTT is a tibial tubercle transfer. Jen, you are correct. The Fulkerson procedure is a type of TTT. There are multiple ways to transfer the tibial tubercle. The fulkerson procedure moves it anterior (out of the knee) and medial (toward the inside of the knee).

My TTT was not a Fulkerson. My TT was just advanced distally (toward the bottom), ie it was moved down on my shin, to correct a high riding patella. CT scan revealed it did not need to move medially at all.

I don't know if there is some amount a person should get up and move around or not. I wouldn't worry too much about it cupcake. Everyone heals differently and different doctors have different protocols too, so it is kind of hard to compare yourself to others, even for a surgery like this that is common for people to have.

After my surgery i was up moving around pretty much every hour. My doctor has his patients do a knee-to-chest stretch every hour they are awake, so every hour I was doing that stretch. I pretty much could not wait for that hour to come because I was so ready to move and bend and get up and around. In that first week, I didn't sleep but 1-2 hours at a time. Shoot, in those first days I didn't even sleep a whole hour. Hindsight I should have taken the ambien prescribed to me. Anyway, so yeah I got up often and went to the bathroom, stretched, and just sat on the edge of the bed, etc. That whole elevating with nothing but air under the knee really made it so i didn't want to stay in one place for too long anyway. After about 10 days it started getting a little easier to sit for longer periods. At some point I made it to probably 2 hours at a time and then I would have to get up and crutch around the house, do some exercises, etc.

I mean, I wouldn't advocate just laying around all the time, but don't overdo it either. Challenge yourself to do as much as you are allowed to do, but take time to rest too. Find your balance.
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 naturegirl

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #43 on: May 11, 2010, 05:11:22 AM »
Day 11
Today has been a very uneventful day.  It was campus wide study day, as finals start on Tuesday.  So I pretty much just stayed in my room and relaxed and wrote a paper.  It was windy and rainy outside so I didn't really want to wander out on crutches, with no umbrella and at the mercy of the strong winds.  It was nice to relax after a long weekend though!

This evening I wandered down to the lounge for a hall wide event.  I ended up standing up for about 20-30 minutes without feeling sore or tired-yay!  My energy level is a lot higher and I'm getting stronger in my arms.  About time!  I hope to head over to the student union tomorrow to check mail/get food/get out of my room.   :) I just hope it's not raining!  Right now it is thunderstorming, and I really hope it's not a severe storm!

Crankerchick-
Sounds like you had a rough time sleeping after your surgery!  I've been lucky in the sleep department and the last several nights I've been out like a rock, other than having to stay up late for Resident Advisor reasons and also being woken up by the fire alarm in the dorm across the street.  Oh campus life...always something interesting going on!

Anyways, elevating with nothing under the knee is a pain!  My knee gets sore at night and aches quite a bit in the morning, and just getting up and about really does help. 
-Jen
1999-ish: L knee hyperextension on trampoline
4/30/2010 Fulkerson Osteotomy and MPFL/LPFL reconstruction
Serving with Peace Corps July 2011-September 2013 in South Africa-knee is happy :)

Offline crankerchick

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Re: Fulkerson Osteotomy/MPFL reconstruct 4/30/2010
« Reply #44 on: May 11, 2010, 03:06:08 PM »
Congrats on being able to stand up without soreness or pain or fatigue. You are rolling along now.

I am very envious of yours and Andi's sleeping abilities. For me, sleeping, in a word, sucked, and honestly still kind of does. But I guess I'm getting enough rest because I'm not really all that tired in the daytime, otherwise I'd be going crazy.

When I was where you are, I used the cryocuff through the night. That helped with the aching. First thing in the am I got up and got myself presentable and went to the exercise bike. That kicked me off and got me feeling good for the day. It definitely helps to just get moving.

And yes, air under the knee is really a pain but it works. Glad I listened to the doc.
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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