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Author Topic: Bilateral MPFL Reconstruction-7/25  (Read 18371 times)

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Offline Teacher2Many

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Bilateral MPFL Reconstruction-7/25
« on: June 27, 2012, 04:25:27 AM »
Hi all...I have had far too many orthpedic surgeries on the hips/knees over the last 5 years [if interested, see my thread entitled "Derotational Femoral and Tibial Osteotomy (Right: 7/8/10 and Left: 6/16/11)].  I am undergoing bilateral MPFL reconstruction via hamstring allograft at the end of July. Was wondering if anyone has undergone this procedure previously and can share some info regarding pain, rehab, limitations, etc.?  I have read a bit about what others have experienced with this procedure but am interested in particularly hearing the perspective from someone who's had it done bilaterally (both knees at the same time) but any advice, input, etc. would be helpful!

Thanks in advance!!!!!
« Last Edit: July 30, 2012, 03:03:56 AM by Teacher2Many »
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline lisa424

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Re: MPFL Reconstruction-advice, info, etc.
« Reply #1 on: June 27, 2012, 05:06:05 AM »
I had both of my legs done (not together) with hamstring allografts. In my experience the mpfl hurt more than my TTTs and lpflr.  Not sure why. But I have a high pain tolerance and only needed painkillers for a week. I was full weight bearing, no brace, and had full range of motion in 6 weeks. I started pt at 6 weeks as well.

Offline oohheykate

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Re: MPFL Reconstruction-advice, info, etc.
« Reply #2 on: June 28, 2012, 02:11:40 AM »
I've only had one of my knees done but I agree with Lisa, it definitely hurt. My OS uses screws and I think that's what was causing the most pain and why I couldn't get off crutches for five weeks. I was WBAT from the start and was supposed to be in a brace for six weeks but it ended up being three months because of weakness and not being able to bend my knee. PT (started at 3 weeks) is crucial for this surgery. Bend your knee whenever you can because I ended up with an MUA.

Good news is, over a year later, my knee feels wonderful!
-18 years old-
Left knee;
11.07.08- Scope
07.02.09- Lateral Release/Meniscus Repair
11.11.09- diagnosis of Patellar Instability/Patellar Tracking Disorder
12.10.09- Medial Reefing/Lateral Release
01.11- Synvisc
04.14.11- MPFL Reconstruction
06.21.11- LOA & MUA

Offline Teacher2Many

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Re: MPFL Reconstruction-advice, info, etc.
« Reply #3 on: June 28, 2012, 05:06:01 AM »
Thanks for the info!  I know I will be full weight bearing without crutches but wearing bilateral braces for about 6 weeks-locked in extension for the first two weeks 24/7 including when sleeping, then unlocked to about 30 degrees for weeks 3 and 4 and not needed when sleeping and then unlocked to 45 degrees for weeks 5 and 6.  Pain is not a stranger to me due to all my previous surgeries but was more concerned with limitations, etc. especially due to my job, which I will be back to around week 4.5.  PT will end the day before surgery and will begin again at 10 days post-op.  Any other info, advice, helpful tips, etc. would be greatly appreciated!
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline Teacher2Many

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #4 on: July 30, 2012, 02:56:13 AM »
On 7/25, I underwent bilateral MPFL reconstruction using donor tissue as a way of finally settling the issue with the subluxing/dislocating.  My surgeon was (and always has been and always will be) awesome and was understood that he was to fix anything else he found wrong, particularly the cartilage defects from the ACI procedure done in 6/2009.  Surgery was short, maybe 1.5 hrs. total and also consisted of the hip doc coming in and doing the cortisone injection via flouroscopy while under anesthesia.  Waking up in recovery was horrible-the pain was immense, emotions were high, and breathing was a bit difficult.  But this has been the course for me as each surgery seems a bit harder to come out of.  However, when my surgeon came in when I was fairly coherent and free of pain (compliments of a femoral nerve block on the left leg), his comment was that the patellas were extremely hypermobile (which was reassuring to hear that my thoughts were accurate) and he did some trim work on the ACI site but that everything else looked good.  I am in bilateral knee braces/immobilizers for 6 weeks with the first two being locked in extension and then slowly opened.  I am set to return to work in 3 weeks to prepare my classroom with a start date in 4 weeks so hoping things progress so that I can get back to my kiddies.  I've heard/read of many people to have a MUA done after this procedure as ROM is hard to get back due to swelling and tightness but since my joints are typically hypermobile, I'm hoping this isn't an issue for me.  It's only been 96 hrs. post-op and I am off pain meds, unless I need one at night to ensure a pain free, good-night sleep and am finding the greatest pain relief with the use of the cooling/compression machine.  Walking is awkward, which surprises me as I was in the same protocol with knee braces, etc. after the bilateral ACI was done and am wondering if it's because my bones are now straight, making it harder to ambulate (before, they were so excessively rotated, my legs were already at that awkward angle to swing them out and around when walking-not so much anymore).  Swelling is still intense, making my previous surgical scars look more hideous than they already do and the bruising is pretty nasty as well.  But no signs of infection or of blood clots, which is great news.

I return to my doc on Thursday to have stitches removed, Rx for PT given, and hopefully less bulky braces but that's yet to be determined. 

Only 1 more surgery on the horizon, which would be the hip one and only if the cortisone shots don't cut it, so keeping my fingers crossed I am done frequenting the OR multiple times each year, after just having had my 24th and 25th surgical procedures!

Happy summer,

Beth
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline oohheykate

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #5 on: July 31, 2012, 02:23:14 AM »
Glad your surgery went well! I can't believe you're already off pain meds but you've had so many surgeries your pain tolerance has been built up. I hope you continue to be pain free. Definitely bend your knees as much as you can tolerate once you're allowed to because I'm extremely hypermobile (which is why I had the MPFLr) and still ended up with an MUA.

If you end up having hip surgery and it's a scope, it is nothing compared to any knee surgery I've had. It's the easiest surgery I've ever had!
-18 years old-
Left knee;
11.07.08- Scope
07.02.09- Lateral Release/Meniscus Repair
11.11.09- diagnosis of Patellar Instability/Patellar Tracking Disorder
12.10.09- Medial Reefing/Lateral Release
01.11- Synvisc
04.14.11- MPFL Reconstruction
06.21.11- LOA & MUA

Offline emm10161301

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #6 on: July 31, 2012, 09:35:31 AM »
Hey :) I had both my knees done mpfl at the same time 1 month 5 days before you its under mpfl and lr on boths knees 20thjune2012. Found out yesterday my rehab is going better than expected so if you are stuck or need to vent some frustration I'm sure I've been there! :) good luck with your recovery!!
2002-2012 regular dislocations of both knees, tried everything from braces and casts to physio.
June 2012 MPFL surgery on both knees

Offline Teacher2Many

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #7 on: July 31, 2012, 11:29:48 PM »
Oohheykate:  I was quite surprised about being off pain meds so soon but surprisingly, it doesn't hurt!  I firmly believe that the ice/compression machine helps drastically with the pain and is my saving grace!

I've been bending my knee since the first day post-op and am sure once I start PT on Friday, the bending will hopefully increase (& am sure the pain will increase then as well).  Just wondering what the parameters were in regards to deciding to do the MUA?  Are there guidelines that you had in regards to flexion at a given time frame (ie by 2 weeks, x degrees of flexion)?  The swelling seems to definitely be impacting my ability to bend it and it isn't going down much; did you have that same issue as well?

What type of hip surgery did you have?  I believe if this is done it'll be done via a scope bit than is just as bad-3 weeks on crutches with a brace for 3-6 weeks and rehab for 3-6 months!  But can't imagine it'd be worse than the hip ones I've already had.

emm10161301:  I've read your posts; sounds like rehab is going well for you.  Am I remembering correctly that you did not have any braces post-op?  Haven't come across those who've had this done bilaterally so it was nice to find at least one person who has.


6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline emm10161301

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #8 on: August 01, 2012, 09:48:29 AM »
Hey yea, ice and hot water bottles worked better for me, I found that my muscles got cramped so hotwater bottle relaxes it :) and yup no brace I was given a sort of brace for one leg, but I didn't used it as such, maybe if I walked far I'd shove it on my left leg but I mainly went without it. Flexation rates surgeons have different expectations, usually if u can get to 90o by 6 or so weeks that's grand. My surgeon was pleased as I had managed to do all my bending with full ROM on right and 90-100isj on the left in well I'm 6 weeks post op today :) he told me I'm miles ahead and expected me to be a madhouse case as its such a painful op, in all honesty the pains I have they're sore I don't deny that, but I get pain free spells and I'm ok :) sitting on somewhere like a high bed and sliding forward is fantastic to get the knees to bend. My habit I need to break is the whole lifting my legs with my hands because the right doesn't have that problem I can lie on my back and lift it into the air nearly onto my head and tuck my knee into my chest. I think it progressed quickly as I didn't wear the brace on it and that held my left knee back. But everyone heals differently, I proved it as nothing in your body is symetrical. I read a diary that a girl recovered in 2 weeks with one leg done. I couldn't ever I am too forgetful and maybe should remember to do my knee exercises as often as advised and I'd be further (I manage maybe the full amount of 1 in a day) but sure I managed to make the physio think I'd done more with my progress lol. Happy healing everyone and teacher to many you'll be fine you can do this its doable!! :)
2002-2012 regular dislocations of both knees, tried everything from braces and casts to physio.
June 2012 MPFL surgery on both knees

Offline Teacher2Many

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #9 on: August 02, 2012, 04:33:13 PM »
Stitches came out today and the awful braces that went from my thighs to my ankles are gone-now I simply have bilateral Hely Weber braces that help keep the patella from shifting laterally.  I am to wear them whenever up and about but no longer need them from sleeping (insert smile here)!  Swelling and bruising still there but hopefully once PT starts tomorrow and motion starts improving, the swelling will decrease.  Maybe returning to work in 3.5 weeks will actually be doable!
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline oohheykate

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #10 on: August 03, 2012, 01:10:23 AM »
Ice is amazing! I used my ice machine religiously for about six months after my surgery. As for the MUA, after nine weeks, I had about 80 degrees flexions. I was supposed have full ROM by six weeks post-op. My knee was definitely swollen but I could feel tightness and just a general stuck feeling in my joint when I tried to bend it and when my PTs bent it. I had a scope along with the MUA to clear out scar tissue.

I had a labral repair via scope on July 6th. I was NWB for 12 days and I'm 50% weight bearing now and I have a brace that stops my flexion at 75 degrees. I don't even need crutches, pain wise, but everything needs to heal.
-18 years old-
Left knee;
11.07.08- Scope
07.02.09- Lateral Release/Meniscus Repair
11.11.09- diagnosis of Patellar Instability/Patellar Tracking Disorder
12.10.09- Medial Reefing/Lateral Release
01.11- Synvisc
04.14.11- MPFL Reconstruction
06.21.11- LOA & MUA

Offline Teacher2Many

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #11 on: August 03, 2012, 09:40:07 PM »
First PT visit today, well okay it was the PT eval with treatment starting on Monday.  Right passive flexion measured at 65 degrees and left passive flexion measured at 45 degrees.  Right knee is bending nicely when walking but left just isn't quite there yet.  Hopefully by the end of next week, after 3 good PT sessions, that will be different.

I did sit in the front seat today of the car today (had previosly been long sitting across the back seat) and man, good thing there wasn't some type of emergency that I had to get in/out quickly.  Was hoping to be able to drive by Monday but not sure that's possible unless the bending improves a lot over the weekend but if not this Monday, for sure by the 13th.  Getting into the driver seat will be easier than the passenger seat as I'd be leading with my right leg which is cooperating more than the left.  We'll see how things progress!

Back to work to set up the classroom in 2 weeks and then to start the school year in 3...here's hoping I can keep up with my kiddos!
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline YogaGirl

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #12 on: August 14, 2012, 07:02:16 PM »
Hows it going now? Driving, teaching, PT, how are you holding up? Good I hope!
www.peaceloveknees.com <---- check out my MPFLr blog
www.brightskyyoga.com

Offline Teacher2Many

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #13 on: August 14, 2012, 07:32:31 PM »
2 weeks and 6 days post-op...

I am officially driving!    ;D  I like having my freedom and although I have no intention of going anywhere but PT for right now (mostly because walking causes swelling/pain and hate to be stuck at a store because I can't bend the knee enough to get it into the car to come home) , it's nice to not be fully dependent upon people (I HATE being dependent)!  Not the easiest getting in/out of the car but easier to get in the driver's seat than the passenger seat as the left knee is the one refusing to bend and when getting in on the passenger side, it has to bend more because the space is smaller.  I can drive for maybe 1/2 hr. tops-the knee starts to get really painful from being bent after about 30 minutes and it would then become a safety issue.  But 1/2 hr. is more than enough time in the car to get me to/from therapy, to/from work, and to/from any stores to run errands.  Going out to see my sisters and nieces/nephews would be an issue as they live an hr. away so mom or dad would have to drive for that one.

I am heading back to work next week to start working in my classroom and getting everything set up.  Mom is coming with me as she has since I started teaching in 2006 and with surgery every summer starting in 2007, it's become a tradition.  I don't foresee it being too much of an issue unless I have a ton of new stuff that got ordered that I need to unbox, assemble, and find a place to store.  Teaching preschoolers with moderate-severe disabilities is so rewarding but also requires so much STUFF in my classroom!  Our 'official' first day at work is 8/27 and I am keeping every joint I can crossed that I can manage to get through each day.  My bigggest worry is stairs-none to get into my buildling but when we have meetings those first few days, sometimes they are on an upper or lower level in one of the schools so we'll see how that goes!  And of course, there's the worries pertaining to being with my students-getting them to/from the bus, playing with them, chasing them around the room, etc.

PT is rough to say the least.  I have been through h*ll and back with all of these surgeries and have to admit, this is the hardest and most painful rehab.  Didn't think that would be possible after surgery last year (both hips, both knees, 2 blood clots, peroneal nerve damage, and foot drop).  Granted I read a lot about MPFL and how hard it is but really didn't think it could be worse than last year-guess what, I was so wrong!  The R knee is coming along nicely with approximately 80 degrees of passive and active ROM at 1 day shy of 3 weeks post-op and with small gains each PT session.  However, the L knee is stubborn beyond belief.  Only 60 degrees of active and passive ROM and this has stayed the same for the last week or so.  I see my surgeon next week Thursday and this is going to be a huge question, as no specific guidelines were provided as to what ROM at what week post-op.  He did specify no forced flexion so we'll see if that changes next week although honestly, forced or not, I don't think it's going to go anywhere.  We'll see how PT goes tomorrow and if it's no better at all, I might just send him an e-mail to let him know what's going on.  Really makes me worried about returning to work, unless there are huge gains in the next two weeks. 

But I have been free of crutches since 3 days post-op, in small braces since 8 days post-op (more like patella supports than actual braces), and even do a bit of walking around the house w/no braces (only small bits, like if I'm going from my bedroom to the bathroom, which we share a wall so it's really not a huge distance).  The braces will start to be weaned at the 4 week post-op mark (so figured I'd start a little weaning now) and probably gone completely at 5 weeks.

Pain is intense with flexion but manageable otherwise-no pain meds since 4 days post-op except for the occasional one at bedtime (maybe once/week).  Sleeping is horrible due to the hip issues, foot drop, and knee pain but doable.  My cooling/compression machine is a godsend for pain control and sometimes works better than the actual pain meds.  But I also have a fairly high pain tolerance due to so many previous surgeries and tend to just ignore the pain and continue with what I was doing or what I plan to do.  I am a big believer in the 'no pain no gain' philosophy and refuse to let pain control my life; it just requires some modifications!

Until next time (with hopefully increased ROM on both knees instead of just the R)...
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline Xeplasma

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Re: Bilateral MPFL Reconstruction-7/25
« Reply #14 on: August 15, 2012, 02:05:33 AM »
Yay to driving! I can't wait to regain that freedom! I feel like I could but still a bit nervous since it is my right leg which has to do most of the work, maybe in a week or two.
I have to say my goodness you've been through so much! You have a great attitude which will definitely impact rehab in a good way and from ehat you're saying it is showing already. Your results are already amazing at just 3 weeks post op.
Keep up the good work!















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