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Author Topic: Questions on MPFL surgery??!! help me understand please!  (Read 20557 times)

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Offline Kiska

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Questions on MPFL surgery??!! help me understand please!
« on: July 29, 2010, 06:07:36 AM »


Hi I am wondering about the surgery I am about to get.... its called MPFL.. I am wondering how many cuts will have to be made?(guessitamate is fine).. how long does it take to recover.. typically....
and also the doctor told me hes going to be taking some tissue from my thigh...so wondering how does that work?? this is my 3rd knee surgery.. this OS is my newest 1... my other retired.... any information would be appreciated.. Thanks :)

Offline skiergirl

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #1 on: July 31, 2010, 06:33:27 AM »
Slow down!
First thing, you need to make sure you ask your doctor EVERYTHING you want to know, BEFORE surgery.
But I am 4 months post-op from an MPFL reconstruction and lateral release. So I can help a little. Here's what I got from my doc about the procedure:
I'm assuming you have had either subluxations or dislocations (twisting) or a kneecap that slides too far out. This could be because of a high Q-angle (knees bend in) or shallow trochlea. (groove at the end of your femur where your kneecap sits) Either one of these can commonly cause pain or dislocations.
Basically there are structures on the inside and the outside of your knee that hold your kneecap to both sides of your femur. One is the MPFL (Medial Patellofemoral Ligament), and the other is LPFL (Lateral Patellofemoral Ligament) These are essentially the strings that keep your kneecap centered. So if the MPFL (inside strings) get stretched out, this can cause any number of problems. So your doctor will essentially take a piece of your muscle and put a screw in your femur, attatch one end there and drill 1 (sometimes 2) holes through your patella and tie it off on the other side. This centers your kneecap.

So...

My scars... Right over the top of my knee i have  a 3-4in. incision, then one little <1in. scar on the inside with four dots around it. Like: :l: Depending on how your doctor does it, yours could look different.

The first three days after the surgery you should have someone with you. Theses days will be the toughest. You will have regrets, fear, and hopelessness.
*KEEP A SCHEDULE FOR YOUR PAIN MEDS*
I went as I needed them, and found myself waking up in excruciating pain a few times.
Just remember in these days that you can do it. And you will make it.
I chose to have a femoral block, (I'd suggest it to ANYONE) which completely cut off feeling in my leg for the first 24 hours. This helped alot with pain. So after the first few days, you will ease off the heavy meds onto lighter stuff. (I went vicodin to percocet) The coming week you will begin toe touching with crutches. I was on crutches with my brace for about 5 weeks, and then began walking with the brace, which I kept for about another month. At my six week post-op appointment, my doctor remover the sutures. Then the PT began to get intense. They are going to try like crazy to get your quad working, which will be aggrivating because it's the first to go and last to come back. For 6+ weeks, you wont be able to lift your leg with the brace off. Don't worry, it's all normal. From then on, you will do alot of leg lifts.
I guess it depends on the person, but I've always heard horror stories about range of motion exercises. They're not really that painful. When you get off the brace they'll have you at +10-15 degrees per week. It will be about 5.5 months until you can start contact activities like running, but it's well worth it.

I have had six dislocations on my left leg, five on my right, and I'm having the same procedure on my right one this month, and I'm only 13. (I have chronically shallow trochlear grooves) So If there's any advice I can give you just keep a positive outlook. The first week may seem like it isn't worth the pain, but in the last three years of my life, four months is the longest I've gone without a dislocation. So I consider the surgery a success, enough to do it for my right knee as well.

Good luck, and keep your head up. 
-Caroline

Offline Kiska

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #2 on: July 31, 2010, 03:26:49 PM »
Thanks for responding..... There's alot I didn't put in my post.... Like l
my knee has dislocated like 10 times....the doc said my knee cap moves at 90% he said
I'm curious to how he'll get tissue from my thigh? That he's going to be using .....I'll be sure to ask him everything before surgery...I'm still waiting on our insurance to authorize my MRI ... I hate the waiting game...
So there will be screw in my knee? I don't think I like the sound of that :(      ....   

Offline naturegirl

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #3 on: July 31, 2010, 03:32:22 PM »
Hello!

Like Caroline said, be sure to call your OS and ask all your questions.  Each surgeon is different, and they have different protocols.  He/She will be able to tell you exactly what he plans to do and why/what it will look like afterwards.  You don't want to be sitting post-op, wondering what just happened.   ;)

I also had an MPFL reconstruction, 3 months ago yesterday!  Along with it, my OS did a Fulkerson TTT, which helped with the alignment in my knee.  Because I had 2 surgeries in one, my scar is considerably longer (7 inches).  However, from what I gather on these boards, 3ish inches is a good estimate.  Since your doctor is taking tissue from your tight to repair the ligament, you'll have a small incision there too.  I had a donor graft, so I don't have that.

As Caroline mentioned, keep up with the pain meds!  Set a schedule, and be sure to set an alarm or have someone to wake you up at night.  It's worth it.  My Mom didn't want to wake me up for meds, and when I did wake, it was torture to wait for the meds to kick in.  I had a lot of pain from the MPFL site after my femoral block wore off.  I don't say that to discourage you, just to let you know. I did not realize how painful it would be (21 years old/first knee surgery) and was unhappily surprised!  It did get better considerably after 2-3 days though.

I was non-weight bearing on crutches for 5 weeks, mainly due to the Fulkerson, which involves cutting the tibia bone.  You probably won't be required to be on crutches that long, but you ought to ask your OS.  Gaining back ROM is hard, and usually the crappy part of PT.  However, I have gained back 135 (out of 148 for me...which apparently is a lot of motion) degrees in 3 months.  Some people have a lot of trouble gaining it back, but I was lucky and haven't suffered to much with my ROM.  

Your quads will be extremely weak post op, and like Caroline said, you won't be able to lift your leg independently for awhile.  I managed to do it at 3 weeks, but again, everyone is different and it may be longer.   You have to be diligent with your exercises.  My OS cleared me earlier this week to do whatever activities I want: running, biking, swimming, etc.  I've been biking and swimming for awhile, but running is very hard.  My knee isn't quite strong enough to do it yet.  Your doctor will have a specific protocol, so again, talking to your OS about when you can do your activities again is a good idea.   :)  I didn't ask enough questions previous to my operation (again...first surgery ignorance) and I was surprised by the limitations.  

At 3 months post op, my life is relatively normal.  I'm still in PT to gain back strength, but I can walk fine, up and down stairs.  I have pretty good ROM and my OS and PT are happy with my healing.  There were times, especially that first week, when I regretted the surgery.  But that was simply pain driven frustration.  I am VERY happy with my decision and my knee is so much more stable.  I do have a post-op diary that you can check out in the Post-Op Diaries<100 Posts section of these boards.  Just look for my name.  There are also a lot of other diaries on this surgery that may help you out!

-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 DaTexanBoy

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #4 on: July 31, 2010, 05:49:33 PM »
I'm new on here and would like to ask a question. I'm 32 and have had 7 knee surgeries (all from 18-25), 5 on left 2 on right. My last one on my left was the Fulkerson, which helped for about 5-6 years for keeping my patella in place. Now like before the Fulkerson the patella is not staying in place. It's loose enough that I can dislocate it at will if I chose too. Of course I dont cause it hurts too much.

Do yall think a MPFL would be a good alternative to another Fulkerson which is what I am looking at getting again here in the next couple of months? I have to deal with the VA since I'm a disabled veteran as well. Would it be a good idea to bring this procedure up to my doctor?

Thanks,

DaTexanBoy

Offline naturegirl

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #5 on: July 31, 2010, 05:55:17 PM »
Hello DaTexanBoy,

Has your doctor said the Fulkerson is no longer effective, or is that your observation?    My OS chose to do the MPFL reconstruction because my ligament wasn't holding my patella into place (alignment issues aside).  The Fulkerson fixed the alignment, and the MPFL made sure my kneecap stayed in place.  It could be that you are experiencing the same problem, and an MPFL reconstruction could work.  Only your doctor (and probably an MRI) can tell you.  It wouldn't hurt to discuss all your options with your doctor, and to get updated x-ray/MRI work done. 

-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 DaTexanBoy

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #6 on: July 31, 2010, 06:26:46 PM »
Jen,

Most of it is from my own observation. Kind of the old saying that "this isnt my first rodeo" if you know what I mean. My patella slides all over the place. Side to side and up and down (way out of normal range). I had an x-ray on the first which showed bone fragments all over the place, very low (almost none) fluid in the knee joint, and moderate deteriation all over the joint in general along with arthritis and bone spurs. Hopefully, if I bring this surgery up it will give him another option to fix my knee if the alignment is there. Of course from the sound of my OS nurse yesterday, there is a lot of issues going on in there as seen on the x-ray.

Thanks for the reply,

Jeremy

Offline naturegirl

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #7 on: July 31, 2010, 07:03:07 PM »
Jeremy,

It definitely sounds like something isn't right! And you know your knee better than anyone, and know what it's doing.  I hope your surgeon can find a good solution to it, one that will last.  You make me worried though that I might be in your shoes several years from now!   :-\  I'm going to hope not though!

You've got a lot going on that needs fixed, and I hope you can get it done soon.  Being able to dislocate your own knee manually is not a good skill to have.

-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 DaTexanBoy

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #8 on: July 31, 2010, 07:12:22 PM »
Jen,

Thanks for the encouragement. I really didnt want to be in this situation either but I just have to deal with it now.

I hope you dont end up with knees like mine. It has definitely been a struggle.

Thanks,

Jeremy

Offline skiergirl

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #9 on: August 02, 2010, 03:38:26 AM »
Kiska-
The screw is really no big deal. It probably won't set off the metal detectors at the air ports, you won't see any difference (except the little scar), and my doctor actually used a bio-absorbable screw, which gets broken down by your body pretty quickly.

And my doctor let me choose between muscle from my adductor magnus, my hamstring, or a tissue donor. Because of my age, he said there is a low chance of donor rejection. So the fact that he's choosing your thigh means that you will have 1 (*Maybe 2) incisions in your thigh, likely arthroscopic. This ends up being tiny holes you can barely see once they heal.
One more thing. Your OS will be taking some of your muscle out, so it is definitely a good idea to talk to him about pre-operation physical therapy. This is because the atrophy of your thigh (quad especially) will be tremendous, and as long as you aren't in pain there is alot of strengthening that you can do now to avoid doing later.

This atrophy will be morse significant if your OS uses part of your muscle. So I hate to "prescribe" something but I was in alot of pain before my surgery, having had a dislocation a week before, and I couldn't run or swim, so i had an exercise where i extend my leg as much as possible, tightening my quad and holding ten second, ten times an hour. This definitely helped decreasing the amount of necessary rehab post-op.

I hope it all works out for you,
Caroline

Offline crankerchick

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #10 on: August 02, 2010, 02:42:23 PM »
Jeremy,

MPFLr in my opinion is not really an "alternative" to a Fulkerson. It's more like an addition.

Knee caps dislocate for a reason (or reasons) and a stretched or torn MPFL is the consequence of a dislocation, not the reason, if you will. It's certainly something to bring up with the doctor but all I'm getting at is the root reason for the unstable kneecap needs to also be addressed, otherwise that newly reconstructed MPFL is still under the same stresses that caused the knee to dislocate the first time (and subsequently tear the MPFL to start).

The MPFL and LPFL aren't the only structures responsible for keeping the kneecap in place, and in fact aren't the primary mechanisms either, at least not as reported in the literature I've read if memory serves me.

Its worth asking the VA doctors though. I would just be weary of doing that as the ONLY procedure. Need to get the kneecap in the right place first and then deal with keeping it there.
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 gerine9903

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Re: Questions on MPFL surgery??!! help me understand please!
« Reply #11 on: August 13, 2010, 05:48:36 AM »
Kiska,
Ask your OS all the possible questions you have.  Make a list.  I had a MPFL in May on my left knee.  I had a lateral release on my right 12 years ago.  Supposedly, the MPFL is highly effective.  I was told a 3-6 month recovery.  I am at the 3 month mark and I still have a ways to go.  I had a donor graft, biodegradable screws, and 2 incisions, and 2 arthoscope holes to clean up my cartilage.  The first week is rough so definately have someone.  With the femoral block, you will not be able to wiggle your toes so you will need someone around to help you to the bathroom because you will have no feeling at all and when it wears off you will need help.  Like everyone else said, stay on schedule with your meds.  As soon as I got home, my mom started giving them to me.  I was out of it for awhile, but you do not want to chase the pain.  Honestly, this is a difficult surgery.  Although I asked questions, I was not mentally prepared for it.  I was expecting it to be similar to my LR but its rough and PT is going to be difficult.  The most important thing with the MPFL reconstruction is range of motion afterwards.  Your knee is not going to want to bend; it feels like there is a rock in there.  You must get range of motion or you will develop scar tissue and will be asking for another surgery.  Be very honest with your physical therapist and ask PT and OS as many questions as possible, so you can be prepared.