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Author Topic: Hypermobility and tilted kneecap: is a lateral release a good choice?  (Read 3265 times)

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Offline wil2

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Hello. It's my first time posting. I finally went to see an orthopedic surgeon after years suffering with a dislocating patella. It got so bad in the last few years that I can hardly go a week without it coming out. I have practically given up all spo except hiking, biking...light stuff. My general practitioner had me in a neoprene brace for a while, but it really did not do much. When he finally gave me the referral to see a knee specialist, the surgeon said I am hypermobile, have a tilted kneecap, and suggested a lateral release if physical therapy and taping do not help. He is giving me six weeks to try the conservative treatment. I really need to be able to move past this. But I was not expecting surgery. I know. Maybe I am naive. Maybe I should see a patella specialist? I have read some posts here that suggest that. Have also read some pretty bad horror stories aboyt the lateral release.
Can anyone help me, here? Anyone had success with physical therapy for this? Success with the lateral release? Should I bother with the specialist or just see how I do?
Thank you for reading. Thanks for any suggestions.
wil

Offline wil2

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I'm in the US, San Francisco Bay area, if anyone has suggestions for a specialist. Thanks.

Offline psych_kt

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Hey! I had the same problems with my left knee and just got the Fulkerson (also referred to as TTT, don't remember what it stands for) surgery to fix it. I've done PT for years with no helpful results, actually it made it worse sometimes! I have heard about the Lateral release but the PT I'm seeing now after my surgery says she's seen people who've had it and it never helps. I'm on the East Coast so I can't give you any suggestions of who to see but it is worth asking your Orthopedic doctor about? If he/she can't give you any helpful information I'd say seek out a second opinion. I went to four or five orthopedic doctors before I found my current orthopedic doctor. Good luck! I hope you find a solution!

Offline wil2

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Hi kt, thank you for sharing your experience. When did you have your surgery? Are you saying you also had hypermobility and a tilted kneecap, and dislocate? And that the fulkerson helped? I have to look it up.

This is what the orthopedic surgeon Dr. Mark commented on the other place where I asked the same question:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52012.msg505509#msg505509
quote author=drmark link=topic=52012.msg505509#msg505509 date=1277682983]
If something is too loose, then you do a lateral release and loosen it up even more.
What is wrong with this logic?
Quote

Offline wil2

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kt, you wouldn't happen to be in California right? Is your surgeon a patella specialist? Did he explain how the fulkerson helps?
I found this - FULKERSON OSTEOTOMY (PATELLA STABILISATION). This
operation is performed to improve stability of the knee cap (patella)
Is that what you had?
Thank you.
wil

Offline psych_kt

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Hey Wil,

No, I'm not in California, I'm in Maryland. All the surgeons in the practice I go to are patella specialists but the one I saw specializes in the Fulkerson.

The way I understand how it helps is that he moved my patella tendon (I think that is what it is called) so that it is straight instead of attached on a slant out to the side like it was. That was what was causing my knee to tilt and dislocated because the tendon was essentially constantly pulling it out of alignment.

He also moved part of the quadricep muscle to help straighten out my kneecap.

I had the surgery May 19th so I'm still recovering but I can already tell a huge difference!

Yes, I had hypermobility, a tilted knee cap, and it liked to dislocate both partially and completely quite often.

I agree with Dr. Mark's logic! My orthopedic doctor who just did my surgery made sure that I didn't have the lateral release because I had had a previous surgery but it only made my knee worse! But the previous surgery was just an arthroscopic surgery and all the previous surgeon did was clean up some loose cartilage (as far as I know....he said that was apparently all he could see that was wrong with it... sigh).

Btw, the TTT that someone mentioned on your other thread is the same thing. And definitely make sure they order x-rays, MRIs and CT scans... I already had a collection by the time I saw my current orthopedic surgeon so all he had to do was look at them!

Good luck! I know how hard and frustrating this process can be!

Katie

Offline crankerchick

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Psych_kt, what practice in MD did you use, if you don't mind me asking? I'm also in MD but couldn't find patella specialist here. I ended up in TX!
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 psych_kt

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Crankerchick,

I don't mind you asking! Isn't it impossible to find a good orthopedic doctor around here? I used Shady Grove Orthopedics; all of the doctors there are awesome but my doctor is Dr. Witte. He did a great job on my surgery; I'm only just now going on 6 weeks out and I am already starting to walk around without any aid (no immobilizer, brace, or crutches!). They have been in The Washingtonian's list of top doctors multiple times! Where in MD are you if you don't mind me asking? I'm in Frederick =)

Katie

Offline wil2

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Hello katie and crankerchick, thank you very much for your contributions.
crankerchick, I just asked on my other post in the patella section weather you were in Texas, but I see the answer here. LOL!
You went all the way to Texas? To see Dr. mark? Wow. I've been learning a lot from doctor mark's website. He seems really on the ball. You seem very satisfied with your choice of surgeon. I am hopeful that I will find someone to help me as well. I asked over there who this specialist is you mention in Sacramento. That would be very easy to get to from San Francisco.
I wanted to say that I have been getting a lot of wonderful suggestions in the patella section so I guess that was where I should have posted my question in the first place. As they say the third time is the charm:
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52012.0
So Katie, thank you for sharing your experience. You and others may also want to check out what is being said there as well. There is so much that people have suggested I am so grateful and think others may find the information useful as well. That section seems to draw the heavyweight "patella specialist patients" and it is fantastic to get their advice and experience.
wil

Offline wil2

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Katie,
please don't think that I am trying to bust your you know what (well, you don't even have them), but I really am trying to figure this out. You said all of the doctors in the clinic where you go are patella specialists. How does one tell weather a surgeon is a patella specialist after all? I went to the website for Shadie grove orthopedics, and I found the following surgeons listing the following specialties:

Brett J. Hampton, M.D.
Specialty-Arthritis and Reconstructive Surgery, Total joint Replacement of the Hip and Knee

R. Marshall Ackerman, M.D.
Specialty - Hip & Knee Arthritis

Jeffrey F. Witte, M.D.
Orthopaedic Surgeon
Specialty: Foot & Ankle, Sports Medicine

Steven L. Tuck , M.D.
Orthopaedic Surgeon
Specialty: Pediatrics, Hand, Elbow And Shoulder Replacements

Andrew W. Bender , M.D.
Orthopaedic Surgeon
Specialty: Hip & Knee

Mark A. Peterson, M.D.
Specialty - Sports Medicine, Knee & Shoulder

Brett R. Quigley , M.D.
Orthopaedic Surgeon
Specialty: Spine

Craig A. Miller, M.D.
Specialty - Sports Medicine, Arthroscopic And Reconstructive Shoulder, Elbow And Knee Surgery

I think that is all of them. None list patella as a specialty. I also read through all of their blurbs and did not spot the word "patella" anywhere.  I ask because I too went to a knee specialist, but he is not turning out to be a patella guy, apparently. help!

Please don't take this the wrong way, and thank you for reading.
wil


Offline psych_kt

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Re: Hypermobility and tilted kneecap: is a lateral release a good choice?
« Reply #10 on: June 28, 2010, 10:52:13 PM »
Wil,

It's okay! I was confused at first too. I just asked when I called them for a doctor that specializes in knees (patella is the name for the kneecap and when just talking to the people who make the appointment I figured it would be easier to use knee) and they told me everyone there does. Dr. Bender is the one I saw initially, and even though it doesn't mention anything on Dr. Witte's about knees, Dr. Bender told me to see Dr. Witte about the knee surgery since he is the best at that particular surgery! All of the Doctors there are just so experienced and knowledgeable!

It is really hard to tell, I went to another doctor at another practice who was supposed to be one of the best and he was totally baffled by my knee! He just gave me a cortisone shot and told me to come back in a month. The cortisone shot didn't do ANYTHING and needless to say I DID NOT go back to him in a month. The wait and see method just doesn't work for me!

All I can say is call around, ask about the doctors and what kind of surgeries they do. Go for an initial appointment, and don't be afraid to ask questions! If something doesn't seem right or it seems like the doctor is clueless, move on to another doctor!

I wish I could help more. I didn't find the websites for the different practices very helpful... they said a lot of things that made the doctors sound great and then I got there and the doctors were clueless as ever.

Katie 

Offline psych_kt

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Re: Hypermobility and tilted kneecap: is a lateral release a good choice?
« Reply #11 on: June 28, 2010, 11:20:37 PM »
Wow so after reading the other thread you started and everything everyone else said, I'm a bit confused if people are using "patella specialist" and "knee specialist" interchangeably or not. I still suggest calling and asking the offices though and just trying as many doctors as necessary. Good luck and let me know if you have any more questions that I can try to answer!

Offline KW

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Re: Hypermobility and tilted kneecap: is a lateral release a good choice?
« Reply #12 on: June 28, 2010, 11:21:03 PM »
OK...I don't want to just jump in here...but I do need to clarify something.

A OS that is a Knee Specialist is NOT a Patella Specialist.  Being a Patella Specialist is actually a SUB-Specialty of the Knee.  Calling a asking for a Knee Specialist is not going to get you a Patella Specialist unless you luck out and call one of the very few that out there practicing.  Honestly, In the US I can only name 4 off the top of my head (there are a few more).

Read the posts by Crankerchick and Fraud Ninja....Both these ladies will provide fantastic information on the difference between a Knee Specialist and a Patella Specialist.    

Best of luck,
Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline psych_kt

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Re: Hypermobility and tilted kneecap: is a lateral release a good choice?
« Reply #13 on: June 28, 2010, 11:52:07 PM »
Karen,

I understand the difference now after reading the other thread. However, like I said in my previous post, I'm confused who is using the terms interchangeably and who isn't. There are probably a lot of people like me who assumed since patella=kneecap that patella specialist and knee specialist are the same. Maybe I did just luck out. I will have to call the office tomorrow and ask specifically if there is a patella specialist in the practice just to see what response I get. Either way, my advice to Wil still stands that he just keep trying doctors until he finds one who can help him. Just because someone is a patella specialist versus a knee specialist doesn't mean they will be able to help you anymore. He needs someone to figure out WHY his kneecaps are tilted and the cause of his problems. My patella tendon was connect on a slant toward the outside of my leg, and that was why my knee was tilted. It took my entire life to find someone who even saw that that was what was wrong with my knee. I'm not pretending to know anything about his problem (I'm not a doctor!), I'm just telling him what worked for my similar problem and hoping that by providing him with the information I learned I am able to help him. I didn't know anything about the Fulkerson until I found this doctor and I wish I had found out information on it sooner.

Katie

Offline KW

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Re: Hypermobility and tilted kneecap: is a lateral release a good choice?
« Reply #14 on: June 29, 2010, 12:43:19 AM »
I was not trying to put down your Dr...I only trying to clarify a common misconception and maybe pass on a little info. Unfortunately,  there are a lot of people who use the terms interchangeably. Most of the time when someone thinks they have a patella specialist they do not.  There are a lot of really good knee specialists out there (i have a great one)...but very few patella specialists (i only kind of have one in Philly).   I have read time and time again about patella specialist saving someone from having the wrong surgery.  This can be a really long learning process...I wish this site had been what it is today when I had the first of my 11 surgeries.   

Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed