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Author Topic: Gonna have MPFL recon with allograft or autograft, any opinions on my injury?  (Read 1227 times)

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Offline RacinNasonFan

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Hello all.....I am new to the site and have just registered because it looked like from what i've been reading on here, there is lots and lots of information here.....So here is my story.....

I am a 41 year old male and had a fall one month ago...i had slipped and fell on some ice outside at my work and twisted my leg/knee pretty good.....Well after one month now of seeing a couple of different doctors, having some blood/fluid drained from my knee area, deciding on which doctor i wanted to see for sure and having x-rays and then MRI's done, this has been the conclusion.....The MRI was read to me last week from the doctor i have choose to go with...(She is a very well known orthopedic doctor in my area/State and also did a knee replacement on my mom's knee in 2002 and along with my mom and other people is very highly talked about as an excellent surgeon)...and she has said that first of all my patella had dislocated and it completely tore the inner retinacula so it is not there.....She said that usually the retinacula will have a tear, but mine was so bad that it tore it completely and was not visible on the MRI.....So she explained to me that chances are i will either have to have an allograft or an autograft done to replace the inner retinacula.....And actually she had wrote on top of a page that she had given me that shows how the knee is constructed, she called it a "Medial Retinacular patellofemoral ligament"...which from what i have been seeing on here that people have been abbreviating must be the MPFL'r?.....The OS has stated that if for some reason if she see's that my own ligament is still there and can be saved, that is what she will try and do...but she is worried that with the combination of not seeing it at all, she thinks even if she were to find it that it would be an example of where you could sew it and it would not hold...sew it and it would not hold...sew it and it would not hold...so this is why she is leaning towards the allograft or autograft surgery.....Now according to the OS from the last visit last week, she said that it is totally up to me on what i want to do...and if i were to choose the autograft, she would use a hamstring.....But she has also said that the allograft's now, between how much safer they are now...(And she did mention that the company they use for the allograft's, its a very solid and trustworthy company with an extremely low percentage of issue's) that she would tend to lean towards having the allograft done vs. having the autograft done...and obviously the more there is to the autograft and another place to heal and so on.....Right now at the moment, im probably leaning towards having the allograft done, although i have not fully committed to that yet since i still have a month before surgery.....Not something i'm looking forward to at all, but on the other hand i guess i dont have much of an option either.....Also as i speak, right now she has me in a long leg brace and using crutches...i can walk around on the bad leg with a little weight with the aid of crutches...and she also mentioned for me to do seated leg raises so that makes me constrict the thigh muscle and to get it as strong as possible before surgery.....But i guess im just looking to see what some people have for there thoughts and opinions.....As i mentioned, i have read quite alot of stuff on here before registering and alot of the MPFL'r that i have read, some did not mention an allograft or autograft...which perhaps could mean there ligament was usuable?.....I also know i had come across a message that Dr. Mark had wrote on one of the past pages where he said something like that they did not have to have holes drilled in the patella for a MPFL'r...it would only give more of a chance of a patella fracture in the future...(Sorry, i had written it down word for word, but the paper is at my gf's house)...so i hope i have that info somewhat correct.....My OS had told me that there would have to be "Anchors"used, so thats why i am mention this comment from Dr. Mark...perhaps he could mention something more about this.....But i will be going in for an appintment a few days before the surgery date to talk things over one last time and to decide what exactly im gonna have done...providing my ligament is not gonna be able to be used...which as i mentioned she does not think it will be.....I am trying to stay optimistic about things, but on the other hand some of the things i have read, it sounds like a pretty big surgery.....It also seems to be some comparison's as well...as far as the dizzyness, nausea/sickness...the pain obviously and the long road to recovery.....Im just hoping that whatever is needed to be done, that it goes well and is successful.....Also if anyone needs to know my activities, i live in the U.S. in Vermont, so we dont have real long summer's....I do golf during the summer time, but only recreational...i try to go once a week but it doesnt always work out that way.....I am a bowler during the winter months and bowl in a league once a week with an occasional tournament here and there, so this is also another reason why if i choose the allograft, that it will be the correct choice...again, my OS seems to lean that way, but still says as we all know that its my choice.....I will end this for now and will be looking forward to hopefully reading some messages and it would be hugely appreciated with any comments you all may have.....Thank-you for reading.
« Last Edit: March 01, 2013, 09:00:00 PM by RacinNasonFan »

Offline LindaM

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Re: Gonna be having surgery in one month
« Reply #1 on: March 01, 2013, 08:19:08 PM »
Wow, that's a lot to deal with!  I think you will find that more people will answer you if you put in a subject that is more specific.  There are so many different surgeries out there that people sometimes look for just the questions that they are knowledgeable about to even read.

Good luck on finding the answers and support you need.

Linda :)
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline RacinNasonFan

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Thank-you for the advice LindaM...i will try that.

Offline allyd

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Racin, Yes – it sounds like your doctor is referring to what we abbreviate as the MPFL. Depending on the doctor’s train of thought (or even their technique for repair/reconstruction), anatomically it can be referred to differently. MPFL stands for Medial patella femoral ligament. The medial retinaculum I’ve been told to think of as the ‘shrink wrap’ around the knee. The ‘MPFL’ is intertwined in this retinaculum anchored at the patella and the femur. So… sort of all the same thing. Sort of. Most of the MPFLr’s reports you read here are likely reconstructions.

As for the repair vs reconstruction. Studies have shown that repairs tend to stretch out again over time. So the advice of your OS to lean towards the reconstruction sounds pretty legit. Allograft vs. Autograft… personal choice really.

Regarding drilling, anchors, etc – the more research you do, the more you will realize there are various techniques in play for the MPFL reconstruction. Best advice I have always heard is – don’t get too caught up on technique and ask your surgeon to do it one way or the other because of this possible complication or another. The surgeon uses a certain technique because they have success with it. If you ask them to do something they don’t normally do, it may not have as good of a chance for success.

It is a long recovery – it usually takes about 12 weeks to regain some normalcy for strength – and I would say if everything goes right, You’d be on the golf course at some point this summer. Maybe not feeling 100% - but you could get out there. Bowling by winter definitely. I’d definitely discuss these goals with your doctor and discuss the reality of them, and hopefully you’ll be able to put a rehab plan together to reach them. Try not to scare yourself to much with the possible complications and recovery. The bad often outweighs the good on these boards as happy patients are out busy living their lives.

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

Offline Horselover

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i second everything allyd said.  as far as allograft or autograft - my surgeon said if it needed to go inside the knee capsule, he insists on using your hamstring.  if not, your choice.  since the recovery was gonna be hard enough, i chose allograft!!

i FREAKED out for the month prior to this surgery.  but, you will be ok.  i wish i'd had it years earlier instead of dislocation after dislocation!  i had my reconstruction on nov. 8th.  i ended up needing a second surgery on feb 1is because i had too much scar tissue and pulled an anchor loose.  the second surgery was a snap and i've been improving like mad since!!!!!  i am so thankful my surgeon was proactive and listened to me when i told him something didn't feel right.

good luck!!!!















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