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Author Topic: Grey's LPFLr, MPFLr, TTT  (Read 29591 times)

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Offline Dave258

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #45 on: December 16, 2011, 04:44:57 AM »
It sounds like things have went very well for you!  Great job.

drmark

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #46 on: December 16, 2011, 01:59:11 PM »
Here I am breaking my arm patting myself on the back again.

Fat head showed pictures of his surgery.  The surgery I did on Grey, looks about the same.  While only the surgeon knows how tight the screws went in (you can't appreciate that from a two diminsional pic), the recovery, both in the near term (who long until you return to normal life) and the far term (how many arthrofibrotic knees are created) all amounts to the rehab philosophy of the guy or girl who holds the knife. 

For my patients and I, that leads to immediate weight bearing, immediate full ROM, and no brace to help the knee freeze in its locked position.  To do this requres good screw tightening, usually the use of a third, insurance, screw, for the TTT or tibial/femoral osteotomy  and sound fixation of the  LPFLr MPFLr, with multiple sutures, all tied in 30 degrees of flexion to avoid overtightening.  That idea, which has worked great for me goes back to the mind of Dr. Jack Andrish.
But in the end, the doctor needs to have the courage of his/her convictions, or these threads will certainly go into the +300 pages.

Offline Fathead D

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #47 on: December 16, 2011, 02:24:59 PM »
Fully agree with Dr Mark.  My surgeon wanted to use 3 screws to fixate my tubercle but he said that it was anatomically too small.  I guess I am a genetic freak.  Big guy on the outside with small tubercles. 
11/29/2010 Lateral Release left knee
1/2011 Cortizone injection left knee
4/1/2011 Lateral Release right knee
5-6/2011 Supartz injection series (5)
12/12/2011 TTT and Lateral Release repair left knee

Offline bassetlover

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #48 on: December 16, 2011, 10:05:21 PM »
I think we are exactly the in our post-op recovery. It's so cool to read how well you are doing. Keep up the good work. My surgeon is very aggressive post-op also. Keep up the good work.
3/12/11- Dislocated Patella
3/25/11- Medial Retinaculum Repaired
9/13/11- Subluxed Patella
11/21/11- TTT with LR

Offline greyliston

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #49 on: December 21, 2011, 12:27:59 AM »
Of course, I have the staples out now. This was at week 2.
2010 - Failed LR
2011 - Failed LR lengthening
2011 - TTT, LPFLr, MPFLr

Offline Fathead D

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #50 on: December 21, 2011, 01:10:09 PM »
Wow thats a huge scar.  I had a TTT and LPFLr as well and my scar is about half that size.
11/29/2010 Lateral Release left knee
1/2011 Cortizone injection left knee
4/1/2011 Lateral Release right knee
5-6/2011 Supartz injection series (5)
12/12/2011 TTT and Lateral Release repair left knee

Offline Dave258

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #51 on: December 21, 2011, 03:08:49 PM »
That is one nice scar!  Mine is much smaller also, I think I only have 15 staples in mine that should be coming out tomorrow if I am lucky!

drmark

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #52 on: December 21, 2011, 03:23:23 PM »
The Saphaneous nerve runs on the medial side of the knee.  I frequently gets cut in the first part of the incision.  Its accidental section is a potent cause of Chronic Regional Pain Syndrome, a life changing doctor-caused disease.  For that reason, I make my knee incisions on the lateral side of the leg, and have complete confidence that the nerve is safe.  My view is that the skin heals in two weeks, CRPS from a saphaneous nerve injury last forever. Commonly it will lead to an unemployable, uninsured, divorced, drug addicted person who's life just isn't worth living.  If you doubt this, go the the forum on CRPS or Reflex Distrophy.  Here is the link:  http://www.kneeguru.co.uk/KNEEtalk/index.php?board=44.0
« Last Edit: December 21, 2011, 03:26:03 PM by drmark »

Offline Dave258

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #53 on: December 21, 2011, 03:46:33 PM »
Dr. Mark, would you believe I was diagnosed with RSD/CRPS after my second knee scope before the real problem was found.  I am still pretty pissed of at the Doctor that just threw out that diagnosis willynilly!

Offline greyliston

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #54 on: December 21, 2011, 04:12:09 PM »
Yea I could care less about what kind of scar I have as long as the knee works properly and I don't have nerve damage.
2010 - Failed LR
2011 - Failed LR lengthening
2011 - TTT, LPFLr, MPFLr

drmark

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #55 on: December 21, 2011, 04:42:38 PM »
Minimally invasive surgery?

Do we measure it by length of incision, or by time with crutches, braces, or casts, or time off work with no money coming in, or by incidence of serious complications requiring serious medicines or revison surgery?

For example, I alway make a longer incision over the tibia, so I can osteotomize at least 6 cms of tibial tubericle and attached anterior tibial cortex.  This way, I can always fix the osteotomy with three strong screws and a tension band.  This way the person can start immediate braceless, and shortly thereafter crutchless weightbearing.  The cost of this is at least another two inches of incision.

I know what I think about this stuff,  but opinions are like butt holes, everyone has one.
« Last Edit: December 21, 2011, 04:47:26 PM by drmark »

Offline Driden

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #56 on: December 21, 2011, 06:16:30 PM »
Dave, I can top your story. I traveled a long way from my home to the cleveland clinic, thinking that a team of doctors at a top institution could figure out why my post-LRR knee and quad were in such poor shape despite many months of physical therapy, oral drugs, injections, personal trainer, etc. The OS was worried about RSD due to osteopenic bone and sent me to a neurologist specializing in RSD. The neurologist concluded that i did not have RSD but, instead, had some unidentified sympathetic response to pain, causing muscle inhibition, that had "not yet been published" in the medical literature. He advised that I ride an exercise bike with my eyes closed every day, for only 5 minutes, and take an unspecified muscle relaxer. The OS, who attended this appointment with the neurologist, nodded in agreement--this was the course we should take and not surgery to reverse the lateral release. So, I flew back home, $1,000 poorer, wondering what the heck happened and if I am on planet Earth or someplace else. The neurologist never wrote down his clinic notes--so I have no proof of this incident--but he charged my insurance $700 for it. 

Offline greyliston

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #57 on: December 21, 2011, 09:29:10 PM »
Yes there are some serious idiots out there. Like the doctor here in Oregon that knew that I had already had 2 LRRs and yet he wanted to do another one.
2010 - Failed LR
2011 - Failed LR lengthening
2011 - TTT, LPFLr, MPFLr

Offline Driden

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #58 on: December 21, 2011, 09:48:15 PM »
One of the biggest idiots I have ever known recently got admitted to medical school at age 34. He tried 4 or 5 times over the years, and they finally took him. With that kind of brains and tenacity, if he goes into orthopedics, I anticipate that he will be the type of doc who does a repeat release for a failed release. Scary stuff.

Offline Fathead D

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Re: Grey's LPFLr, MPFLr, TTT
« Reply #59 on: December 21, 2011, 09:54:14 PM »
My Fiance' is a Med Mal attorney.  You would be suprised at the stories I can tell you. 
11/29/2010 Lateral Release left knee
1/2011 Cortizone injection left knee
4/1/2011 Lateral Release right knee
5-6/2011 Supartz injection series (5)
12/12/2011 TTT and Lateral Release repair left knee