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Author Topic: MPFL reconstruction possible TTT  (Read 2654 times)

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Offline Tiggs1986

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MPFL reconstruction possible TTT
« on: March 30, 2012, 06:00:42 PM »
Hi everyone,
  I am 25 years old and have NEVER had any problems with my knees (with the exception of being Pigeon toed). Feb 3 I was snowboarding on my favorite hill and was going to attempt an Ollie (here's a good vid re: what i was goin to try to do http://www.youtube.com/watch?v=gzXKGlJfYYc) I've been boarding for two years and felt confident in trying some terrain park features instead of just "swerving the jumps" I had just lowered my center of gravity and started to lean back when I felt (and I believe heard) a pop to the left then back to the right in my back leg. I fell and was unable to stand. The pain was so bad I was shaking. By the time I left the Ski Patrol lodge I could place enough weight on my leg to limp around. The next morning my leg had swollen to twice it's normal size and was very painful, so I went to urgent care where a doctor told me I had torn my meniscus, gave me a Medrol pack and told me I could be out boarding again in two weeks and be able to continue with my nursing duties (ha!). I decided to use an ace wrap for support and swelling control for work.  About a week after the incident I was seen by an NP, recieved a sleeve, had an MRI,  PT and ORTHO consults ordered, and work restrictions . I was told  the MRI came back only showing some bruising and the Ortho consult was canceled. A couple of weeks later I saw another MD I was told the bone was bruised, not the soft tissue and I had a MCL sprain. PT was started 2wks after the fall and was doing US therapy and have given me some simple knee exercises. One of which was a side-lying straight leg raise that was incredibly difficult to do and extremely painful (it felt like a rubber band was about to snap on the medial side of my knee)-this was obviously canceled at my next appt. A week later I recieved a buttress brace. All the while my leg had been "giving out" on me if I walked too fast or too far. Then at work about 5wks after original injury I had, had a very busy shift and at the end of it my knee collapsed and I almost fell. The next day I was shopping and did it again but this time I had to grab a chair next to me, it felt like the buttress and the patella had collided and felt so bad I got a little nauseaous. That weekend I was unable to stay within my prescribed restrictions at work and ended up calling in sick on Sunday. A couple days later I was so painful and could hardly walk, I felt like I had gone backwards a month (if not worse than ever).  I saw my MD again who gave me a complete immobilizer (with the idea that I would only need it for a couple days) and set up an Ortho consult. I saw an Ortho PA that Friday who about had a fit that I hadn't been seen earlier. Said I had dislocated my knee and had probably done it twice more since initial injury. That by now I had a less than 50% chance of good recovery (still with high risk of future dislocations) with conservative treatment. I was told that not all of the ligaments in the MRI had been addressed and upon inspection was told my MPFL had lost it's elasticity and that he could dislocate the patella easily if he wanted to. I was given a different immobilizer and was set up with an OS. I had discovered that if I walk too fast or take too large of steps I can feel a lateral "click". After the OS had inspected my knee he stated that we could do a MPFL reconstruction (and possible TTT) or try to fix it again with PT (but it would more than likely continue to redislocate). Due to my lifestyle, I chose the surgery and am having it this Wednesday April 4th. I had imagining tests done and was told that the chance of a TTT is 20% but won't know for sure until he is in there. In the meantime I continue to wear the immobilizer and PT had instructed me in taping, maintanence excercises, and ROM. I will continue to update my status post-op. Hoping that everything goes well and am worried about embarrassing myself around my friends/coworkers since the hospital I will be going to (and staying overnight at) is the same hospital/floor I work on). Sorry this post has been so long but I wanted all the history out there!
« Last Edit: April 02, 2012, 10:08:45 PM by Tiggs1986 »

Offline 2cutekiddos

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Re: MPFL reconstruction possible TTT
« Reply #1 on: March 30, 2012, 06:33:23 PM »
Your second sentence says a lot to me. The reference to the fact you have pigeoned feet could be a sign of rotational issues. Has your othro looked into if you have any rotational deformities? If they do find excessive rotation then a differernt osteotomy might be needed. Usually a TTT is warrented if your TT:TG (Tibal Tublical to Trochlear Grove) ratio is greater than 20. Have they gone over that with you?

I am pretty sure I need the Fulkerson TTT instead of a derotional osteotomy because I do have slight femoral anteversion but it is not excessive but my TT:TG is way over 20.

Good luck and I hope you find/get what you need to get you back on the slopes!

Andrea

 
1981 First Subluxation/Dislocation Rt knee - 7yrs old
1981 to the Present: Countless Subluxation/Dislocations of Rt & Lt knees
1993- Rt Knee LR & Medial Reefing (failed)
1996- Lt Knee LR & Medial Reefing (failed)
2012- Lt Knee Fulkerson TTT & MPFLr
2014 -RT Knee Fulkerson TTT & MPFLr: scheduled 6/18

Offline TOMMAX

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Re: MPFL reconstruction possible TTT
« Reply #2 on: March 30, 2012, 06:44:46 PM »
20% chance of the TTT working? That sounds scary. I personally would be weary of a doc that told me that. Id find a doc to do all the proper measurements and scans before commiting to surgery and really rest and give PT a good shot.
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 allyd

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Re: MPFL reconstruction possible TTT
« Reply #3 on: March 30, 2012, 06:49:15 PM »
I believe the OP said/meant 20% chance of having the TTT done at the time of surgery. Not success.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Tiggs1986

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Re: MPFL reconstruction possible TTT
« Reply #4 on: March 31, 2012, 10:05:06 PM »
yeah sorry if it wasn't clear. there's a 20% chance of me needing the TTT. My OS did do full leg standing x-rays as well as some bent laying ones and CT scan. Then just looking and manipulating my legs after telling him I was pigeon toed, he didn't seem to think it'd be a problem.

Offline Tiggs1986

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Re: MPFL reconstruction possible TTT
« Reply #5 on: April 02, 2012, 03:07:47 AM »
Well tomorrow is my pre-op physical. Seeing the MD that sent me to ORTHO (his reasoning was because he was goin on vacation). Will be interesting to see if he suspected I'd need surgery or if he is just as blown away as I was.

Offline Tiggs1986

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Re: MPFL reconstruction possible TTT
« Reply #6 on: April 02, 2012, 09:50:45 PM »
well MD didn't seem suprised at all that he was seeing me for Pre-op, though he did say he thought he was gonna get yelled at by ortho for the immobilizer. Also my fortune cookie today said "soon, you will recieve pleasant news". Got home discovered a letter from my surgeon and guess what? I CAN GO SNOWBOARDING! it is ortho's goal to get me back on the slopes (though he did say there were risks and i may not be at the same level as b4 but I'LL TAKE IT! i can live with doing only the features the 6year old girls do!). It's my choice for spinal or general (which is AWESOME since I was freaking out about the whole Gen anesthesia thing). AND found out I'll be in brace for 4 wks and crutches about the same amount time, MEANING I will hopefully be out/off of both in time for my brother's high school graduation!  ;D

Offline allyd

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Re: MPFL reconstruction possible TTT
« Reply #7 on: April 02, 2012, 10:32:43 PM »
Definitely not surprised that your doc intends to get you back on the slopes. I also eventually elected for surgery simply because of lifestyle Ė I could make it through my daily life fine with little effect from my knee, but I couldnít do the things I wanted without it either dislocating, subluxing or the simple fear of instability. So surgery it was. Iím about 6 months out - itís a long rehab, but my knee is stable, and with a little more strengthening, I expect to get back into some things slowly this summer Ė some golf, a little volleyball maybeÖ probably more mental conditioning this year than anything. By next summer, Iím hoping my knee is better than normal and Iíll have lost any apprehension.

Good luck on your goals!
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline kneepaincure

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Re: MPFL reconstruction possible TTT
« Reply #8 on: April 03, 2012, 02:38:07 AM »
Hope you are on your way to getting fixed, but just curious to know why you're not going the PT route (at least to try it)?
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline Tiggs1986

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Re: MPFL reconstruction possible TTT
« Reply #9 on: April 03, 2012, 03:02:49 PM »
because it hadn't really helped earlier (though it wasn't aggressive), and each dislocation within that 5wk period should have never happened with what I was doing. I've been told it's not a muscular issue (my quads and such have been tested). My OS and PA are doubtful PT will work on it's own at this point (as is my PT, MD, and every other therapist I've talked to at work-when I was working).† Also I want to snowboard with confidence that it won't randomly do it to me again (and I not be able to land as nicely as I did before and seriously injure myself), I want to participate in obstacle course races (which WAS my plan for this summer as well as learning to wakeboard but that's now off til at least next year) or (most importantly)I don't want to be afraid it will buckle when I'm walking a patient and I end up taking both of us down.
« Last Edit: April 03, 2012, 06:13:55 PM by Tiggs1986 »

Offline Tiggs1986

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Re: MPFL reconstruction possible TTT
« Reply #10 on: April 06, 2012, 01:35:39 AM »
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=59196.0
here's the link to my post-op diary! everything went well. We only had to do the MPFLr. ;D  :)
be warned the 1st post is very long and detail about the OR day and my hospital stay.