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Author Topic: Chronic Patellar Instability -- Surgery  (Read 1723 times)

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Offline beachymama

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Chronic Patellar Instability -- Surgery
« on: September 25, 2012, 09:40:13 PM »
Hey everyone!

I had no idea there were forums just for knees out there! Glad to have found it. Forgive my lack of technical wording. I'm just so happy to have some people who understand what I'm going through.

A bit about me -- I'm a 33 year old female who has suffered from patellar instability pretty much my entire life. When I was young (10-12 years old) both of my knees would routinely and painfully dislocate. This could be as simple as me falling on my face (such a joy at school!) or bad enough that I'd end up on cruches for a few weeks afterwards.

My orthopedic doctor at the time told my parents I had a shallow groove where the kneecap sits (in both knees) and I had over the course of two summers, surgery on both knees to tighten the muscles and keep my kneecaps in place. Originally there had been talk of putting pins in my knees, but at the time I was too young and hadn't finished growing yet.

Fast forward any number of years, my left kneecap still wiggled but didn't cause too many problems. My right kneecap was a lot looser, but only fully dislocated once in a great while. I got married, had kids, didn't have a whole lot of time to bother seeing an ortho for a problem that only cropped up occasionally. Of course, when it DID dislocate it would go with a bang.

Now, recently my right knee has been swollen, tight, painful. I finally gave in to my mother's prodding and went to see her doctor. After being told I have arthritis from my knee continously diclocating (my kneecap pops back and forth every time I take a step, it's not painful, I just figured that's what I was stuck with) I had some Xrays and an MRI.

I was told I need surgery on my problem knee -- specifically: right knee medial reefing and medial patellofemoral ligament repair and A/Lateral release. I was told I will be in a complete leg immobilizer for six weeks after surgery. I'm not sure why, I remember coming home from my previous surgeries with an ace bandage and some crutches... but again, I was young and maybe I'm not remembering clearly.

Anyway, sorry to be so verbose! I understand that he wants to tighten the ligament to make my knee stop bopping around, but it just sounds really scary. What is the recovery like for this? Being in an immobilizer for SIX weeks? Ack. I have three kids (6-12) and I'm a stay at home mom, so I'm just trying to figure out what kind of insanity I'm bringing upon the family!

Thanks so much, again sorry to babble.  ;D
Beachymama
1992: (R) Medial reefing & lateral release
1993: (L) Medial reefing & lateral release
11/12: (R) Medial reefing, MPFL repair, lateral release

Offline allyd

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Re: Chronic Patellar Instability -- Surgery
« Reply #1 on: September 25, 2012, 11:19:55 PM »
Hi There - you are definitely not a lone in your issues on this board.

Treatment plan seems to be in keeping similarly with those of us with shallow grooves and no other issues. Having done a lot of research, i will say a mpfl reconstruction has shown better results than a repair... so that may be a good question for you to ask... I'd also suggest you read around the patellafemoral section to learn what some of the "other issues" are that can cause dislocations. You may or may not want to ask about them as well.

Some other rambling things to ask/research on your part:
Also would ask why they are suggesting the LR - it gets a bad rap mostly because it is often overperformed when it's not indicated. what is their intent to help with the cartilage damage? Or is it not severe enough to address, or will stabalizing the knee address?

Time in a brace, etc. - first thing you will learn is that every doctor has their own protocal. Best advice is there is to follow their instructions. if they say six weeks, it will probably be six weeks. Clarify mobility and weightbearing during this time. I for example was in an immobilizer type brace, but it was hinged and slowly unlocked, and i was walking w/out crutches by the time they removed it. I do think most doctors will tell you return to functional normal is about 12 weeks for this type of surgery.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline beachymama

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Re: Chronic Patellar Instability -- Surgery
« Reply #2 on: October 11, 2012, 02:15:53 AM »
Sorry it took so long to get back here -- things are always crazy at our house.. lol. I feel like I'm trying to cram so much stuff into the time before my surgery.

I'm scheduled for surgery November 5. I did talk to the doctor and brought up some of the stuff you said, and he really feels (without me getting all long and explanatory) that this is the way to go. He has done knee replacements and repairs on my family members, so I'll just trust him on this one.

I did clarify about the immobilizer because I thought I heard wrong... but nope, it will be six weeks in a locked at 0 brace. No PT during that time, no bending it, nothing. Thankfully I'll be able to bear weight even when I come home the first day or I'd never be able to make it up the stairs to my bedroom. I completely forgot to ask how I'm going to manage to shower or anything afterwards.

Anywho, that's what's up with me! :)
1992: (R) Medial reefing & lateral release
1993: (L) Medial reefing & lateral release
11/12: (R) Medial reefing, MPFL repair, lateral release

Offline ArtByCassie

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Re: Chronic Patellar Instability -- Surgery
« Reply #3 on: October 12, 2012, 04:57:54 PM »
First off GOOD LUCK with your surgery!! 

I am confused also by the 6 weeks in a straight leg brace. I have had Patella realignment, lateral release and inner reefing done on both knees. I was in straight leg brace only until my check up.. But was also told to bend it at home as I was able but when up and about I needed it locked in place. With one knee (my frist done, right knee) I had so much trouble after. In the brace for 4 months!! no stability in the knee, massive swelling to this day I have issues and have had 3 more surgeries and will be going in for another since they did not fix the REAL problem all those other times (I have over 30* rotation in my tibia causing my alighnement to be completely off). With the other one I was up walking in no time. I was out of my brance by 10 days and was feeling awesome but I have no rotation in my tibia on this leg and think that had a huge effect on everything. I also returned to work too early on the first surgery and on my second on I was at home and took it nice and easy. The lateral release for me was needed since I my knee would guide to far to one side. So they did the lateral release then tacked it over with the inner reefing..   I wish you the best of luck and quick healing!!!

Offline beachymama

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Re: Chronic Patellar Instability -- Surgery
« Reply #4 on: October 12, 2012, 07:45:13 PM »
I know he said he wants to be very cautious with the surgery. Maybe because this isn't the first time my leg has been cut? I don't know. I was so young for my previous surgeries, but I don't remember even HAVING a brace.

See, I don't know what other people experience as far as their kneecaps jiggling. Is mine normal? Is it extreme? Basically (I'm trying to think of a good way to explain this) if you are looking at a clock.. and your kneecap is supposed to be at 3 o'clock normally... every step I take, my kneecap pops over to 9 o'clock. That's how loose it is. Is that "normal" for those of us who have instability problems?  :-\ 

I'm just hoping and praying this works out.

And I worry about the stupidest things.. like, what am I supposed to wear on my bottom half post surgery? Skirts every day in the winter? Will I get tangled up in maxi skirts? How am I going to shower? How am I going to sleep on my BACK (ugh)? I'm a mess right now thinking of all these seemingly stupid side issues.  ::)
1992: (R) Medial reefing & lateral release
1993: (L) Medial reefing & lateral release
11/12: (R) Medial reefing, MPFL repair, lateral release

Offline allyd

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Re: Chronic Patellar Instability -- Surgery
« Reply #5 on: October 12, 2012, 09:30:59 PM »
Good luck on your scheduled surgery! I’m glad you trust your OS, that’s really all that matters.

Everything is relative in terms of ‘how extreme’ your instability is, and what is and isn’t normal. If it is negatively impacting your life, well than don’t think twice about pursuing a fix. I guess, I’ve learned it’s best not to try and define normal.  As for the 6-wk brace, while it may not be the same experience as some others, it is YOUR doctor’s protocol, and following it will give you the best chance at success. Each doctor has a reason for why they do things, sometimes based on the individual/procedure and other times just their standard practice. Doesn’t sound like a fun 6 weeks, but it will come and go before you know it!

Your side issues are not stupid, very smart to think ahead and have things ready. You don’t want to ‘figure’ this stuff out AFTER surgery! (and if you need more post surgery ‘how-to’ advice, this is the place to ask – probably one of the biggest benefits I found on this board)

Shower – they’ll likely tell you how soon you can get the incisions wet… Invest in a shower chair of some sorts. I’m cheap, so I just went to Target and bought a plastic folding chair. Worked like a charm for the first month or so. The strategy of this often depends on how your shower/bathroom is set up. Think it through. 

I wore gym shorts at home as it made the brace less vulnerable to gravity, and when I’d go out, it easily fit over sweat pants, jeans, dress pants, etc. - most immobilizers do this easily, but you’ll learn the brace will slip down easier on some materials. Or yeah – rock a skirt out! Haha.

Sleeping on your back??? Good luck? I had the hardest time with this as it’s not natural for me. I think I slept on the couch for the first month as in my mind it made it easier. I had a fear of subconsciously rolling over in my sleep in bed!
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline ArtByCassie

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Re: Chronic Patellar Instability -- Surgery
« Reply #6 on: October 13, 2012, 04:07:02 AM »
Very good questions really. I went and bought work out capri shirts and nicer black work out pants. The brace can come off long enough to put on indicted pants and put the brace on over it.  When it came to sleeping, I have a terrible low back so as soon as my surgeries are done I put a heat patch on ky low back or it will spasm on my from having one leg up.. I also would roll up a small blanket and put that under my low back. It made it more comfortable for me. I hate laying on my back so something to try is put two pillows in between your knees. So your leg is raised, padded and you can lay on your side. The big body pillows are nice for this. I've had 6 surgeies so far so I've finally figured put what works for me. It will take you some playing around to get it. Also make sure you stay on top of the pain with the less they give you. I set my alarm so I would not sleep through needing meds. It's so hard to get back on track if you let one time pass you.

Offline JTB

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Re: Chronic Patellar Instability -- Surgery
« Reply #7 on: October 13, 2012, 06:25:21 PM »
Thanks for your kind words on my back-pain post. You're right, when one system goes down others tend to struggle: bad knee changes to other knee going off then to bad back. It's pretty amazing how well it all works when we have our health.

Was reading your posts and good luck to you with your upcoming procedure, sounds intense. And I don't think your stupid for thinking about the details. It's those silly, easy to do things pre-surgery that'll make you crazy with regret when you're not able to do them while rehabbing. Preperation for surgery is good and I didn't seem to do enough myself...
Bike racer electing sport-med scope Jan 2011 for patella catch: shave patella, MFC and trochlea (with sneaky lateral release) Grade 3 findings. @ 1 year, CRPS, pain inhibition, muscle atrophy, osteopenia, sudden bilateral chondromalacia. in free-fall 2 1/2 years.
Today on Strava riding well.

Offline krunzer

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Re: Chronic Patellar Instability -- Surgery
« Reply #8 on: October 15, 2012, 07:56:53 PM »
Sounds like you are having pretty much the same surgery as I had.  I was also in an immobilizer brace for 6 weeks with absolutely NO bending. I was told it would undo what I had had done.  It really wasn't too bad.  I spent a lot of time in a chair haning out with my dogs and watching TV.  It can get a little boring so make sure you have lots to keep your mind occupied.  The not being able to drive is probably the worst.  As I live on an acreage it got pretty boring staying at home all the time!  But you will be ok, you'll be in quite a bit of pain for the first 3-4 days and sleeping with an immobilizer is not fun, but necessary!  I was off of crutches 3 days after surgery, but make sure to listen to your doc.  You should be able to find my post-op diary and read what happened and see some pictures.  I believe it is under Lateral Release and Patella Stabilization.  Good luck with your surgery!















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