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Author Topic: Shattered Patella Reconstruction after 24 years  (Read 678 times)

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Offline SkiR Girl

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Shattered Patella Reconstruction after 24 years
« on: April 18, 2012, 07:14:59 PM »
Hello – I’m new here and have some questions.  Long story, but hopefully someone has been in my situation!

24 years ago to the day (1988), I was in an automobile accident whereby the steering column collapsed onto my right leg shattering my patella in over 20 pieces in addition to spiraling my femur, chipping both tib and fib and severing muscles, tendons, etc.  Before surgery I overheard that they want to amputate, but I awoke to see my toes and a cast from my hip down to my ankle. 

The surgeon removed all pieces of patella except for the three biggest ones and I had 3 pins put in place.  They mentioned “you will never walk again”, but being a competitive skier, all I really wanted to do was get back to the slopes.  This was in 1988; PT was never mentioned, I just tried my best to strengthen my quad as best as I could by myself.  After 8 weeks in the cast, my leg looked like a fawn leg, about the size of my forearm.  A year and a half later, I had the pins removed and did ski for the first time that same year.  I ended up moving to Colorado after a full recovery and ended up competing in moguls again.  I really never gave my knee much thought except for the awful scar, but it really gave me no problems whatsoever for a very long time.  However, I knew that I would eventually be a candidate for a TKR judging from the severity of my injury.

In 2009 after moving back to Pennsylvania, I skied at our local ski area over 100 times.  That’s when things started to go a little haywire.  Extreme swelling, a lot of pain, etc., which has really never improved.  I went to a local Orthopod who mentioned TKR, then on to Penn for a second opinion.  Apparently, my patella grew back in an abnormal fashion (sort of like a kidney) and is 2x the length it should be.  The patellar tendon and the quad tendon are both shortened because of the length of the patella.  There is severe post-traumatic arthritis.  A TKR would not work because the components will in all probability re-shatter my patella.  Pictures attached.

Move on to December 2010.  I was walking up a set of stairs and lost my balance, tripped and fell right on the right patella.  Never went to a doctor, skied the whole season (bad idea – I had problems even putting my boot on, couldn’t push my foot into my binding or even sit on the lift with my leg hanging without horrible pain) and in March 2011, had a scope to see what was going on.  Same stuff, quad and patellar tendonosis (overuse!), severe arthritis, torn meniscus, thoughts on patellofemoral replacement, but again the components could possibly re-shatter patella, plus the medial side is bad as well.  Never healed from the fall in 2010 or the scope in 2011, lots of pain underneath patella, aching/deep pain, maltracking.  Skied only 10 times 2011/2012 season (mostly due to lack of snow, but the pain kept me away as well).

Sought out another opinion in Philadelphia and I feel like I’m on the right path with this doc.  He specializes in patella reconstruction.  Here’s what he said he’s going to do; shave patella on both top and bottom to make it more of a normal size, tendon grafts on both quad and patellar, skin graft (with amount of trauma, there is hardly any tissue left to work with), pin/screw everything together, 12 weeks of immobilization with full weight bearing after the first couple of days.  This is the first step to allow my patella, tibia and femur to be able to tolerate the TKR components.  TKR most likely next year, 2013.

Has anyone out there had this type of injury and eventual disfigurement of the patella?  Did the reconstruction work to the end result of a TKR?  I’m planning my reconstruction surgery for the first week in June.    

Thank you in advance for reading my long-winded story!