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Author Topic: Regaining confidence after TTT  (Read 3334 times)

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Offline Hooligan

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Regaining confidence after TTT
« on: July 09, 2011, 11:53:39 PM »
Hi all,

I had a TTT almost one year ago to the date. After years of subluxations, it was time to get it fixed once and for all. I've made some real progress in the past year - I can jump, lunge, squat and have great ROM.

However, I still find walking with confidence a challenge. I had to wait about 16 months for the surgery - and during that time I developed a weird little hip limp to compensate for my unstable kneecap. Putting my leg through extension (the heel strike phase) while walking was my biggest trigger for instability. Just last week though I took my first few completely normal steps - and it feels so weird that it actually scares me. Plus there are a lot of tiny muscles that haven't been used properly so they fatigue very quickly, so I am back on the cane.

After spending most of my life protecting me knee, I can't tell anymore if I still actually have a slightly unstable kneecap, or if my mind is playing tricks on me! I know there are weak muscles that I'm still working on (like my glute medius and damn VMO) that will help me continue to feel better over time.

I want to be brave on my knee, but am finding it so hard. Has anyone else had this problem? How can I work to overcome it?

Hooligan
May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)

Offline sarah123

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Re: Regaining confidence after TTT
« Reply #1 on: July 30, 2011, 11:35:22 AM »
Hi ..have just seen this and so know what you mean. I have had recurrent dislocations all my life...know what you mean about a life protecting your knee. I am 10 weeks post op ..trochlepolasty on right knee...very shallow grooves both knees. That learning to walk again is so hard ..heeltoe action....I was hyperextending all the time and it felt do odd. My physio says I am walking correctly now and i practice in the park doing laps and timing myself to get the 'feel' of waking normally. But i cant let go of crutches...have actually posted on the site this morning for help. It like i've lost my balance and confidence.I double dislocated on March 14th this year and decided enough was enough. OS said 8-10 week pre op physio to get quads srtrong before op....i was off crutches for 2 weeks before the op. If felt great .....knowing I would be back on them after th op. I did not realize the recovery and rehab would be so long.  Why am I on them still, should I be?...it feels like a psycological block...i freeze with panic when I cant see them.  Is the only answer excerise, build quad strength and 'it will come'. Sorry , this may not have helped but I fell reassured I am  not alone in this loss of confidence. Hope someone maybe able to shed some light. Thank you, sarah

Offline Hooligan

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Re: Regaining confidence after TTT
« Reply #2 on: July 31, 2011, 02:15:26 AM »
You are going through a lot! But just by virtue of the fact that you go to the park with your crutches to practice walking, shows that you have determination! My brain was frazzled by the time I got my surgery and at 10 weeks post-op I was still on crutches. I didn't get rid of the cane FOREVER (or so it felt).

I will give you the advice I give myself daily.

Firstly, be patient. You're in a process...and it's a bit like a roller coaster ride. There are ups and downs - and it's not all just going to come together suddenly. Talk positively to yourself and dwell in the GOOD moments and GOOD progress (not matter how small), not the bad ones. It's cheesy, but positivity goes a long way! Secondly, I like visualizing myself walking full of confidence or even running. Visualization is important, I find anyway. As soon as I think of myself falling or something bad happening, my leg gets jittery. Sometimes I repeat in my head (as I'm walking), "I'm so over this! I'm so over this!" Then I just suck it up and go for it! I am always surprised by how incredibly well this works for me!

Lastly, don't underestimate how important your quad/ham/glute strength are. As they get stronger so will you, and your confidence will build. Trust me on that. They take a while to build up though. Plus they have to learn new motor control patterns. Once you can get on a treadmill and repeat the pattern of normal walking (while holding on to the rails), I think you'll find your legs will respond well! Also, once your physio gets you doing proprioception (balance) activities, that will help a lot.

Remember...it's a process and you're doing great!

Hooligan
May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)

Offline sarah123

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Re: Regaining confidence after TTT
« Reply #3 on: July 31, 2011, 07:49:06 AM »
hi you're a star..thanks. So good to hear it from someone who has gone through this tunnel....I know there is light at the the other side and you have put it into perspective that it is a journey, a process.I am quite impatient and I have got to be kinder to myself. I agree with you that strength is not quite there and the quads and other muscles are not quite there yet which make me feel a bit unstable...so am going to continue working everyday and on my core.  I like the fact you say positive affirmations to yourself....i did that pre surgery and I think I have got lost in all this...my.. negativity. So this is a new day. I am going to look at my affirmations again..put them on the fridge so the kids can see them too. I have got to get it right this time as i will neeed to have the left knee operated on next year. I have to learn from this experience.
Can i ask what a TTT procedure is.in simple terms..have  googled it...and how different is it to a triochleplasty. It looks like it is a stabilization surgery...am  I on the right track? Have you had both knees done?
Thanks again. And good luck with your confidence too.
Sarah

Offline hinata42691

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Re: Regaining confidence after TTT
« Reply #4 on: July 31, 2011, 01:43:19 PM »
TTT is what I'm currently recovering from (almost 6 weeks post-op now). There are several types that all do basically the same thing. I had a Fulkerson procedure. There is a tendon that goes over your knee/kneecap and attaches to the bone above and below the knee. Sometimes when the knee is chronically unstable it means that that tendon is too loose. The doctor carefully picks up the piece of bone that it attaches to below the knee, moves it over and down a bit, and pins it back into place (and fills the small gap left behind). This way you only have to heal bone rather than muscle (unless you're like me and also needed ligament repair (MCL, LCL) while he was in there). Pain levels and recovery times vary from person to person.
For me, it wasn't nearly as painful as I expected (except at times when things moved and weren't supposed to yet...). It was also my first surgery so I think I kinda expected the worst and came out well. The surgeon I had was amazing. The procedure lasted a bit less than 2 hours for a the TTT and MCL/LCL repairs. He also did a really good job with the stitches - the stiches themselves aren't visible, it just looks like I have a really big, clean cut on my leg. What's been hardest for me about the surgery has been having to be on crutches yet again and not be able to use my leg or bend it when I'm using the crutches. That and regaining my range of motion. According to my PT I'm getting it back pretty quickly but I feel like it's going so slowly and that no matter how hard I try I can't seem to get it to go. It is getting better though. I got it unlocked 2 weeks ago tomorrow and managed to get it to 73* in PT on Thursday. I know it will come when it's ready but I'm starting to worry that it won't be recovered enough for my study abroad this fall (I leave 8/29). I could technically have waited for the surgery until next summer after I came home but my knee wasn't letting me get through my job at the library without trying to dislocate at least 5 times a day. There was no way it could last through the next year (it had already been six months since I'd shredded my MCL and started PT). I just have to keep telling myself that my knee will be okay (it'll be weak, but more stable - I hope). Good luck to both of you!

Offline sarah123

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Re: Regaining confidence after TTT
« Reply #5 on: July 31, 2011, 03:03:42 PM »
Hi ..thanks for this. The advice in this forum has been really positive and I am so gratef ul for the time people have spent in logging their advice, thought etc. Its hard when we become 'kneecentric' and bore the pants off our friends and family with our ups and downs and small progress. In fact I think I have had an small eureka moment....no not off crutches ...but thanks to comments over the last 2 days have realised that it is a journey and my muscles need to be strong to enable the leg, walking function to be back to normal. If i am really honest I dont think my quads were strong enough before surgery hence the wobbles/weakness now. So I am going to bust a gut and work really hard knowing that each exercise session is getting me closer to strong legs and that leads me to walking. Love the idea of the shopping trolley...will try that tomorrow as part of my PT!!!! Thanks to Susie for that.

So thats my advice to you...everything we do is part of the healing journey..your focus is your trip...get a strong as you can for then....my os said keep pulling that knee in for beter flexion...I held it in and pulled a little more each day ...my flexion is great, my strength not so good so thats my area to focus on. I also want to go into the playground in  september without crutches....not sure if that is too big a goal for me but I can promise myself I will have exercised as hard as could to build strength because thats where the confidence will come from. Also recurrent dislocations are so debilitating you could not have gone on like that. So good for you. Just keep gpoing. Hope I feel as positive as this tomorrow. sarah

Offline Hooligan

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Re: Regaining confidence after TTT
« Reply #6 on: July 31, 2011, 05:03:56 PM »
My TTT involved moving my patellar tendon down my leg 2cm and then screwing it in to place. I also had medial reefing and a quadriplasty (I've googled it but don't even know what that is! I just saw it on the surgical report). My kneecap sat too high, so they basically had to move it down so it sat better in the trochlear groove. My groove is also shallow, but the surgeon thought it would be deep enough to stabilize my kneecap, along with all the other procedures and as long as I got the muscles going again.

My recovery has been annoying because of fear I think. Sure I had a lot of muscle atrophy, but I've gained A LOT of strength. It's frustrating to be able to jump, squat, cycle etc....but then not be able to walk with confidence. My leg turns in to a wet noodle as soon as I let fear get the best of me. I basically hate any activity that involves activating my quad with my leg in extension, because that was formerly a dislocation trigger. Standing on my surgery leg balancing (like yoga tree pose) or shifting my full weight on to it makes my heart skip a beat! It's so annoying.

I'm going to follow your lead and just practice walking today. I've been off all walking aids for a while but generally avoid walking :( (something I used to LOVE doing). I'm going to go a track and walk around it today. Like you Sarah, I've got to get this working for me because I'd like to have the other knee done next year. I've never injured it but it feels wonky and I'd like to deal with it proactively...and then close this chapter of my life.

We're all going to kick this fear in the butt aren't we! ;)

Hooligan
May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)

Offline Hooligan

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Re: Regaining confidence after TTT
« Reply #7 on: July 31, 2011, 09:13:31 PM »
I posted this on another thread, but I think it should go here too:

I want to report that just now I successfully walked around a track one and a half times (about 600m) with no cane or limp or pain. I've been out walking and doing lots and lots of things (concerts, dancing, errands, taking public transit, etc) in the past many months, but it's never felt "normal" - I would do little weird movements with my hip and lower back to protect my knee, which caused serious, debilitating back spasms. After three years of this junk, and now one year post surgery, my gait has finally normalized. Now I have to work on endurance and confidence (I was so nervous!). I'm just going to have to walk this track every single day until I can charge around it 10 times. That's my goal. My hip flexors/psoas are in a shortened, overused position so they fatigue really fast. This is exciting progress though. Now on to the exercises I've been able to do for ages....my squats, jumping, leg press routine.

Happy days!

Hooligan
May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)

Offline sarah123

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Re: Regaining confidence after TTT
« Reply #8 on: August 01, 2011, 07:05:12 AM »
Thats fabulous news...well done you. You will notice you will get faster and faster ( i put my ipod on and time it and write the laps i do to chart the progrss...practice, practice, practice) and my physio has told me that this will increase the fluidity of the walking motion and make it feel more normal. So I have been doing it with crutches, and then with one in 'stick mode' some days more successful than others but am still doing it....this morning I can report I walked unaided to the sink and to the lounge to get my pc to post here. I was holding my crutch but it was as a balance rather than putting on floor, and it was slow but i was not hyperextending. So need to practice this at home and get used to the feeling and gettin g my balance back.....my nervousness comes when im  in the highstreet...kids on scooters, bus noise, people running......how do you fight the fear that these people are doing their own thing and the fact you are not remotely of any interset to them....yet because being 'kneecentric' panic mode sets in!!! Any how its a new day and im going to to achieve new things.
Keep going ,...enjoy that lovely feeling...I so want to be at this stage...but small steps slowly.... and thanks for posting. It is inspiring.
Sarah

Offline emmi

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Re: Regaining confidence after TTT
« Reply #9 on: August 04, 2011, 12:55:50 PM »
I'm sorry I can't offer much in the way of advice here but I thought I should say how helpful all of your comments are for someone approaching a TTT.  I nearly had a lateral release but thanks to this board I asked a lot of questions, which I think have irritated one of the consultants, but the result is that I will be having a CT scan today to make sure that I am having the correct procedure, and I have been referred to two other specialists.

I am going off the subject a little bit, but my main point was to say thank you because your comments have given me a good idea of what to expect.  I know exactly how it feels to live in fear of putting a foot wrong incase your knee dislocates and I would love to be able to become involved in different forms of sport/exercise.

I have been trying to build up my quads as much as possible at the moment whilst everything is on hold so that they are as strong as possible.  From your messages I feel reassured that I am doing the right thing.

Good luck to you with your post op journey. 

Emmi

Offline mochadoo

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Re: Regaining confidence after TTT
« Reply #10 on: March 18, 2012, 06:15:12 PM »
Can anyone tell me what is quadriplasty? what is done? What does it help? What is the physical therapy protocol? Thanks in advance!

Offline Hooligan

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Re: Regaining confidence after TTT
« Reply #11 on: April 17, 2012, 05:39:52 PM »
Sorry - I don't know! I saw on my surgery report that I had one - but have no clue what it is. If I had to guess, I think it might be loosening the lateral structures of the quad so the kneecap can track properly with the TTT. But that's a total guess!

May 1998 - LK scope, loose body and scar tissue removal
March 2008 - LK scope, plica removal, partial lateral release
July 2010 - LK  TTT (tibial tubercle transfer to correct patella alta)