Advertisement - Hide this advert





Author Topic: Patella Alta corrections and post op recovery  (Read 3792 times)

0 Members and 1 Guest are viewing this topic.

Offline Davism

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 0
Patella Alta corrections and post op recovery
« on: December 11, 2010, 01:34:33 AM »
Hello there!  I am new to this forum and am just learning how to navigate so my apologies if I am posting in a wrong spot.  I have been diagnosed with Patella Alta, and was recently informed I have no cartilage on the lateral undersides of my patellas.  I just had the TTTG CT Scan and go to see the doc Jan 4th.  I have been an avid runner for 20 years, I snowboard, and am very much into yoga.  I have learned to rely a bit more on swimming, biking, and the elliptical, although I would rather be running.  I was just wondering if anyone can offer me any insights into potential surgeries and post op recovery.  I understand every knee is different and that not all people have the same recovery successes, but any input that anyone has to offer would be wonderful and greatly appreciated.  I am 35 and still pretty active, although certain poses in yoga (mainly squatting, such as warrior) are beginning to become a bit uncomfortable.  I am also a recovering anorexic and running has been the one exercise that has worked best at helping me maintain my weight and not become obsessed about every morsel I put in my mouth.  If anyone has had corrective surgery for this condition and has been able to resume running I would love to hear your stories.

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Patella Alta corrections and post op recovery
« Reply #1 on: December 11, 2010, 11:56:11 AM »
Hi and welcome

I too have no lateral cartilage on my patella. Plus some healthy missing chunks on the medial side. My TTTG offset is OK, but I have mild rotational issues on my underlying bones and a tilted kneecap. There are surgeries that can offload the patella, such as the tibial tubercle transfer where the attachment of the patella tendon is shifted (the tubercle bump) and the patella can be kind of lifted outwards or downwards or however the scans indicate would be best. I should stress that such surgeries should only be contemplated in the hands of a specialist patella femoral orthopod, someone who understands the dynamics of YOUR knee and what the effect will be. You should have full CT scans of the patella tracking at various degrees of flexion too, with quads tensed and relaxed to look at tilt and shift. Ideally X-rays of the bones in your legs too should be undertaken to rule out any rotational issues. This is a highly complex field.

If the surgery is right for you and you recover well, then people do return to active lives. There is someone on here who has returned to triathlons after TTTs on both of her knees but I forget her name. Perhaps someone else can help my poor memory! I think one of your decisions will be whether you undergo relatively major re-alignment surgery or else modify what you do, and try and strengthen what you do have. Running unfortunately does place a big stress on the knees, and if you've got some form of malalignment then that cartilage just gets wiped out. I don't run any more. i was never big into running but found it a useful addition to other training, and as you say, its a great one for burning those calories. I find spinning, boxing, high interval work now replaces that running burn but it takes more planning etc.

Do you trust your surgeon? Where in the world are you?

good luck and I hope things work out,

Lottie x
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Patella Alta corrections and post op recovery
« Reply #2 on: December 11, 2010, 08:01:52 PM »
The person Lottie is referring to is fraud_ninja. For each leg, she had correction of a previous failed TTT along with MPFL reconstrunction. Her first (failed TTTs) were Fulkerson TTT which don't particularly address patella alta, which was part of her problem. Her revised TTTs were to restore the tibial tubercle medially and instead advance them to bring the patella down and correct the patella alta. The MPFL reconstruction was to restore the ligament that had been torn due to the dislocations. Here's a link to her latest diary.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=40953

How was the patella alta diagnosed?

Being that your surgeon has done CT to assess the TT-TG, it sounds like they are checking to see if you are a candidate for a TTT and if so, in what directions imaging suggests it needs to move. The wearing of the cartilage behind the patella should also play a role in the surgical decision, as moving the tibial tubercle can increase the pressure behind the patella and aggravate defects also. I would be sure to ask your doctor, whatever the surgical recommendations are, about how the loss of cartilage will be taken into account.

I had a TTT to correct patella alta in my left leg over a year ago. I also had osteotomy of both the femur and tibia to correct rotational deformities. I am able to run and sprint, although I've never been a long distance runner and really don't desire to, so I can't really weigh in on that side of it. I can say that for me, the TTT was a breeze compared to the other 2 osteotomies. But anyway, my point is to just piggy back on what Lottifox already said, which is to say that it is very important that your whole leg is fully evaluated and checked for alignment, which includes the patella alta you've already been told you have, but also for rotational deformities (femoral anteversion, tibial torsion), knock-knees, and bowed legs. Patella alta can contribute to malalignment and instability but need not be the sole reason for the problems, so it's important to be thoroughly evaluated.
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 Davism

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 0
Re: Patella Alta corrections and post op recovery
« Reply #3 on: December 12, 2010, 05:15:04 AM »
Thank you both Lottie and Crankerchic for your replies!  I am located in Bethlehem Pa.  My doc is Dr. Palumbo with Orthopedic Associates of Allentown.  I don't go for my CT results until Jan. 4th, so I am hoping that I can get some good news then.  I had the TTTG CT Scan done as well as a slew of Xrays and an MRI.  I know he had mentioned about looking at rotational issues, so I guess I will have to wait and see what the test shows.  My biggest concern is that I just want to be active.  If the surgery will give me a better quality of life then I would definitely consider it.  Fingers crossed, just have to wait and see now!

Offline crankerchick

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1861
  • Liked: 24
  • How 'bout them Cowboys!
    • Derotation osteotomy & TTT Post-op diary
Re: Patella Alta corrections and post op recovery
« Reply #4 on: December 12, 2010, 01:50:27 PM »
[in reply to your other post]
Having youth and fitness on your side is definitely a good thing for sure. Surgery should most definitely be a last resort, but it's a very personal decision and what one person can tolerate can be way different from what another can tolerate before they hit that point where they want something done.

In your case, because you are athletically inclined, I would make sure you talk through your running concerns with your doctor and get a good idea of how he rehabs his patients after surgery. Different doctors have different approaches to what they allow their patients to do in those first weeks after surgery. The variation in rehab protocols is pretty large. As you can imagine, this has a big effect on how long it takes a person to get back to their activities (and sometimes even IF they get back to their activities). There's nothing wrong with getting second opinions (in fact it is highly encouraged) and using the doctor who's surgical recommendations and rehab protocols are in line with what you want.
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 Davism

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 0
Re: Patella Alta corrections and post op recovery
« Reply #5 on: December 12, 2010, 11:38:39 PM »
Thank you so much crankerchick!  I am definitely working on a list of questions and also a list of goals for post op activities.  My 2 biggest goals would be to resume running and snowboarding post op.  I am already trying to mentally prepare myself for the possibility that I may not get back to either.  It is just so much to think about and there are so many things to consider!  I really appreciate all your feedback. I emailed the triathlon girl to see if she could give me some pointers regarding both preparation and post op.  It just sucks because I am pretty active right now, but certain things that did not bother me are now becoming difficult.  I am just afraid that if I wait too long my quality of life will go down and my muscles will start to atrophy which will make the rehab much harder.  But then on the other side of the coin if I have corrective surgery and it doesn't go well, then I may be worse off then I am now!  Just a lot to think about and very difficult because no 2 knees are the same and as you pointed out everyone recovers differently!















support