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Author Topic: Yasir's MPFLr + LPFLr  (Read 2631 times)

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Offline aaa

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Yasir's MPFLr + LPFLr
« on: February 01, 2012, 02:04:37 PM »
Day  48: Almost 7 weeks.  Things are starting to pick up somewhat,  I have been getting into the pool.

Walking in the pool has been unexpectedly difficult.  The entire left side of my body was working to stabilize and walk through a normal gait pattern from the deep abdominal muscles through the hips all the way down.  The local pool has a lot of people, so the movement of other people I guess make the walking more challenging.   I'm able to do more SLR's, range is about 3 inches from full flexion, continuing hip work.

Still using the cane, and the crutches at times.  I *hate* the crutches, they are clumsy and awkward to use for so long.  Hoping more pool work will finally allow me to toss them out and not look back.

Day  40: Almost 6 weeks.  Leg muscles are coming back, my legs are beginning to look equal and the swelling is mostly gone.  I can work pretty much everything - hips, glutes, hamstrings, calfs, etc. ... but the not the quads so much!

I'm still markedly limited in walking, its coming slow.  Finally did SLR's today, only 5 but not much pain and with good control ... patella felt locked in solid!  \o/.  I am still relying on the cane, and sometimes use the crutches, I'm a little embarrased of that but I know my body and I don't want to be foolish.  The limb control simply isn't there yet, so there is apprehension.  Spoke with OS's office, they want me completely off crutches at 2 months.  Finally getting into the pool, I'm set for tomorrow and will be there probably a few days a week for the next few weeks.

Day 26: Still on the crutches, sometimes.  I'm using a cane as well, depending how I feel, and can sometimes (rarely) take some steps without anything.   I'll push it a bit harder one day, and the next day I don't feel like moving much.  The following day is better, and there is an improvement from the days before.  So I'm happy to see there is a noticeable improvement happening.  The kneecap itself I'm pretty sure feels stable.  Around the rest of the knee, its still feeling a little wobbly, there was a fair amount of drilling done, so I'm not surprised.  ROM is getting there, hoping to get near full flexion before week 6.  I'm working the ROM for longer periods of time than before, and not really keeping track of time like I was earlier on, and not feeling so much of an ache from working on it.   The reconstructions are starting to feel normal, I very rarely have a sensation like I am wearing a brace like I did before.

I think I tend to be quite a bit more cautious than most people would, I have been at home and not moving a whole lot.  Fortunate to have a great employer allowing me to work from home as well.

Day 15: 1st Post-op visit today, in Canada.  Turns out under the steri-strips were just ends sticking out for dissolvable sutures.  Snipped the ends and that was about it, lol.  I have the option to have further post-op work done in Canada, but probably will go to MI, USA if there is a need next time.  Probably won't update the diary for a while, unless there is a setback.  Next 4 weeks should be weaning of crutches and getting full ROM. Jump to pictures.

Day 12: Swelling is coming down, and pain is going up a bit ... read more

Day 9: Pain post-surgery has been tolerable, so I have been taking two norco's for pain only before bed, I am allowed 2 every 4-6 hours. When I tried increasing walking, I didn't have a ton of pain but my knee felt as if it was stiffening up.  I thought perhaps it is a pain response although pain was bearable.  Have upped the pain meds and taking more regularly, on track to take 6 total today, and the knee is responding quite a bit better.  Lesson learned, I won't be skimping on the pain meds as long as I can stomach them, my movement is significantly better today.  Still using the crutches.  Anticipating getting the steri-strips removed and stitches out this Friday.  An OS in Canada will take care of things going forward, unless I feel I need to see my OS in MI, USA.  Posted some pictures of the knee.

Day 6: ROM is progressing, at about 90, pain so far isn't too bad.  I contacted OS and he suggested I could start trying to walk with a normal gait pattern, although pain might limit initially, and once I get there try to get away from the crutches.  Also, it will be safer to increase activities once I get full flexion and extension.  I'm hoping to get of the crutches over the next 10 days.  I should be able to do stairs as well, but going to try and get close to full ROM and walking before I push it further.

Kneecap definitely feels tight.  Its as if I'm wearing a brace but I'm not, this new tension will take some getting used to. 

Day 2: Made it back to Mississauga.  Drive back wasn't too bad at all.  Next couple of weeks should be just some light PT, bike but not too full extension, and rest .. also will try to get to swimming pool when things settle down a bit.  People at the hospital where phenomenal, very organized and effiicent. 

Day 1: (Update) Nausea subsided , at least for now.  Pain not too bad, did a bit of very slow walking w/ crutches, just WBAT, kind of dragging the leg.  Leaving about 6pm, will have drive back, drive is @4 hrs.  Have a sheet of PT exercise to do home, very light stuff mostly ROM

Day 1: Slept half-decent.  Epidural out, nausea been holding me back from trying to walk/ weight bare.

Day 0: Update (Thanks Tom!) - surgery done, it was indeed both grafts needed and my kneecap dislocated medially  under stress radiograph! Surgery took about 4 hours.  Have me on CPM doing 60 - 80 degrees, I think they started it few hrs after surgery and will run all night.  No pain right now, but lots of meds!  Will see OS in the AM, probably head back tomorrow

Day 0: Made it in about 8:30, blood drawn and IV line in.  Just waiting now for epidural, surgery should be about 11, saw Anaesthesiologist, will see OS before surgery

------------------

Hi All,

I'm having an MPFLr and LPFLr using allografts, performed on my left knee Feb 2nd 2012.  Driving out today from Mississauga, Ontario, Canada to Taylor, MI.

Its been a long road of misdiagnosis and sham surgeries for 10+ years, including a failed lateral release.

No TTT being performed, patella alta was ruled out and TT-TG was normal.

I do have increased femoral anteversion of about 30 on the left leg, but my OS does not think it needs correction.  My initial dislocation was from a direct blow to a kneecap and I had no knee pain or instability prior to it.

Will be keeping a diary here, hope it all works out!
« Last Edit: March 22, 2012, 02:13:46 AM by yb »

Offline TOMMAX

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Re: Yasir's MPFLr + LPFLr
« Reply #1 on: February 02, 2012, 08:53:51 PM »
Hey Yasir,

Hoping everything went well today and am really nervous for you. Said a little prayer for you this morning and look forward to hearing your updates when you get the chance.

Best of luck.
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline lisa424

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Re: Yasir's MPFLr + LPFLr
« Reply #2 on: February 04, 2012, 06:08:14 PM »
Glad to hear everything went well.

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #3 on: February 11, 2012, 04:01:54 PM »
Has anyone had irritation from steri-strips?  I've got 20+ of them on my knee and they haven't peeled at all, they are glued on pretty solid.  Its been 9 days from surgery.

Offline lisa424

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Re: Yasir's MPFLr + LPFLr
« Reply #4 on: February 11, 2012, 08:36:46 PM »
Generally you're not supposed to take them off until they fall off on their own. Showers will loosen them. Some of the medical grade type can stay on a pretty long time on their own.
Just curious, how many incisions do you have and how long are they?

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #5 on: February 11, 2012, 08:46:52 PM »
Update day 9.

Thanks Lisa! I've got 3 incisions , one across the center of the patella probably 3 inches, and 2 others on sides of the knee, probably 2 inches.

I'll just bear with them for now, I haven't really gotten them too wet, probably that is why they are stuck on so well.  I'll see an OS in Canada to take a look Friday.

Edit: adding some pics, took a couple so can see both the lateral and medial incisions


« Last Edit: February 11, 2012, 11:34:53 PM by yb »

Offline TOMMAX

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Re: Yasir's MPFLr + LPFLr
« Reply #6 on: February 13, 2012, 04:05:08 AM »
Hey your knee is looking pretty good Yasir. Maybe you can post some updated pics after you get the sterri strips off?
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #7 on: February 14, 2012, 06:10:07 PM »
Day 12:  Sure Tom, I will post some pics, the stitches should be coming out Friday and will get some new pics uploaded.

Swelling has been coming down, but I feel the pain has been going up a bit.  I think as the swelling decreases the muscles start to fire and maybe I don't know what I'm talking about but I think the contact between the patella and the articular cartilage gets more pressure since the kneecap isn't floating around in all that swelling?

Anyway, I have increased lateral patella pressure and the feeling of a mild strain along the medial patella plica, I think.  Slightly concerned and hoping the reconstruction hasn't pulled my patella over too tight / far laterally but its too early to really think about that too much.

What seems more reasonable is  the lateral release left the lateral cartilage without much load for so long that the new position of the patella is causing the sensation of increased pressure and I think it will feel normal over time.  With the swelling I think some straining of the VMO is bound to happen as the quads are inhibited somewhat.  Also, my hip muscle are seriously wasted, my right thigh / hip is looking unproportionately larger than the left

At this point, I'm thinking the knee isn't just going to work itself out magically though, I've got to do my part.  With my knee bent 90 degrees things feel pretty safe.  I'm starting to do some abductor work and putting some load on the knee (squatting) with my knees bent safely.  Trying to do some leg lift / crunches with knees bent and a bit of lower back work.  Working the glutes doesn't really feel safe yet, I tried lying on front and lifting the leg with knee bent, but there is an uneasy feeling, so will wait on that.

Hope I'm not overdoing anything, but OS said with knees bent things are pretty safe as the grafts aren't going to get much stress in those positions.  Going to keep at it and play it by ear, hoping I'll be able to walk without the crutches soon.  But, at this point, I'm walking pretty short distances every so often, and feels like getting away from the crutches might take a while.  OS was anticipating 2-3 weeks, it feels like it might take a bit longer, time will tell.
« Last Edit: February 14, 2012, 08:52:31 PM by yb »

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #8 on: February 17, 2012, 10:55:23 PM »
Day 15 pics.  Incisions are pretty clean, although I guess still looks kinda gross at the moment, some scabs came up with tape, should fade with time and doubt scars will be visible.

« Last Edit: February 18, 2012, 12:02:02 AM by yb »

Offline TOMMAX

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Re: Yasir's MPFLr + LPFLr
« Reply #9 on: February 18, 2012, 01:50:23 PM »
Yasir, your scars look awesome! I cant believe how fast they are healing. Seems like excellent progress for only a couple of weeks post op. Look forward to your next update and hopefully you will have an easy time regaining the ROM and leg strength. Are you doing any kinds of strengthening exercises yet or just working on ROM? What kinds of strength exercises are you doing? Thanks for the update!
March 2005: LK Plant & twist injury (full lateral patellar dislocation)
April 2010: LK scope (LRR, posteriolateral meniscus, medial plica)
Current: Medial instability
May 24, 2012: LPFL + MPFL recon scheduled

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #10 on: February 18, 2012, 03:28:28 PM »
Thanks Tom!  For exercises, Dr. T encouraged me to set ROM - full flexion and extension - as the first goal, so this has been my main concern.  Once motion is safe, he said using more muscle is safe, and more normal activity is safe.  I have a bike, and I find it is excellent for ROM.  I can very slowly move my knee by using the opposite leg, and so the left leg is being moved passively.  I have a Schwinn Airdyne, which has arm-handles to also work as a rowing machine ... i can use my arms as well to control the pedal rotation, so it gives very fine grained control.  I seem to have reach full ROM with passive extension, early on there was a point where things felt tight, but that has passed.

The reconstructions feel like they tied the kneecap down pretty good, and there has been some pain behind the kneecap with ROM exercises (feeling of pressure, and mostly a dull ache following afterwards) which seems to be settling down a bit now.  I am increasing how much ROM work I am doing as my knee feel like it is tolerating it better.

Last night, I was able to bend my leg well past 90 degrees, probably 120, but that was at the end of session working on ROM.  The trick to ROM, for me at least, seems to be going very slowly and stopping short of the point where pain and tightness starts to set it, backing away and trying again, often i take a few seconds rest between.  I also time how long I am working ROM, as too much time leaves me with too much of an ache behind the kneecap.  I spend about 7 minutes on the bike.  When I start I usually cannot do a full revolution, it takes a few minutes to get there, and my leg is probably only moving a few inches per second.  After the bike, I have been doing a couple of more minutes sitting and doing something like a heel slide.  I am definitely making improvements each day.

Thinking back to PT's I have worked with ... it makes me a little angry how aggressive most of them are.  They are always pushing the patient to do too much too soon.  I have to accept for now that my knee simply isn't ready to do certain things, and have patience to let things progress.  During the course of the day, I will get a some little pinching like pains or things feel a little funny ... and PT often tell you to try and push through that too ... not smart IMHO, I just accept those pains are going to happen and not try to force anything, if i get enough pain or fatigue, i'll just stop.

Also, normal gait for me is safe, although again the ROM is the first goal.  I am too get normal gait with crutches, and then try to get away from them.

I have been working hips a little bit, with my knees bent .. I think this helps as my leg doesn't feel so weak.

For now, ROM and walking in a straight line without crutches is what I'm hoping for.

I'll need to check back with OS, as I have been hesitant to put twisting / turning motions at all on the knee.  I'm using the crutches to carefully navigate any corners or stairs.  Maybe I'm being a little too cautious.  If I do achieve normal gait and ROM I will likely follow up with OS on how I can safely progress further.


Offline lisa424

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Re: Yasir's MPFLr + LPFLr
« Reply #11 on: February 18, 2012, 09:15:48 PM »
Sounds like you're doing well. The scars look great. You're lucky- I scar terribly.

Offline aaa

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Re: Yasir's MPFLr + LPFLr
« Reply #12 on: March 22, 2012, 02:14:03 AM »
day 48 update at top