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Author Topic: Surgery Diary: Lateral Patellotibial Ligament Reconstruction  (Read 2684 times)

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Offline noradaexplora

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Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« on: March 20, 2013, 05:36:07 PM »
I thought that since there are so many people on this board with failed lateral releases that I would share my experience with the reconstruction I had yesterday in Vail.

I had a lateral release in 2002 on my right knee and it deteriorated gradually ever since.  If I was a more sedentary/non-athletic person my knee would be more of an annoyance than anything else, but I have big athletic goals and my knee has become too painful to train properly.  I saw Dr. LaPrade at the Steadman Clinic in December, and he recommended trying reverse McConnell taping for 2 months to see how that went.  I found that PTs struggled to do this taping right--they would often put way too much compression on the knee cap, or pull it way too far laterally.
After discussing this further over the phone with Dr. LaPrade's assistant, we decided to schedule the surgery anyway.

Luckily I live close-by (in Boulder, Colorado).  I came to Vail on Monday for all the pre-op appointments, and arrived at the hospital at 6am Tuesday morning.  They prepped me very quickly and I was out of surgery by 8:15!
The doctor used segments of the patellar tendon and the IT band and stitched them together.  He said my kneecap could just be picked up and dislocated with ease, but now it is being held with just as much stability as my left knee.  Hooray!  My knee never actually dislocated, but it tracked medially which led to much pain and inflammation.
Originally I had been told I would spend the night at the hospital, but they discharged me back to my hotel around 12pm.  I have an immobilizer on and a GameReady ice machine to use many times per day.  I will stay in Vail for a week and receive an hour of PT two times per day.  Right now I have a nerve block in, but when that wears off the pain will probably increase quite a bit.

The rehab protocol for this surgery involves no weight-bearing for 6 weeks, followed by walking with crutches for another 3-4 weeks.  I can start bending the knee to 90 degrees and do very small quad contractions. 
Full recovery is expected to be 5-7 months.

I know that others on here have wondered about the surgery, so let me know if you have any questions!

-Nora

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #1 on: March 28, 2013, 05:19:02 PM »
An update:
The nerve block wore off on day 3, but the pain didn't increase substantially.  Going to PT for 2 hours a day is such an amazing luxury; the therapists there are really wonderful and it is motivating to see and feel progress each day. 
I achieved 84 degrees flexion on day 5, but then regressed a bit when the pain became worse for the next few days.  I have been struggling with taking my pain meds because they just make me feel so nauseous and awful, and unfortunately that means not being able to rehabilitate quite as aggressively.
I am on day 9 now and can do straight leg raises because I have the strength to keep my leg completely straight.
Learning to get around on crutches (especially with a 7 month old puppy at home) is quite the challenge, and I can't seem to find a comfortable sleeping position, but otherwise the recovery is actually going better than I expected.
Days 4-7 were probably the roughest.

The incision is pretty gnarly looking, but I've been assured that the actual scar will not be too bad--just a thin line, about 4 inches long on the lateral side. 

The Steadman Clinic gave out a very detailed and helpful set of instructions with a timeline on beginning specific exercises:  the highlight for me being biking outside in 16-20 weeks. 

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #2 on: April 05, 2013, 04:38:24 PM »
So now I'm about 16 days post-op.  I have had much less pain than I anticipated, the only pain is when I attempt flexion really.  I've gotten fairly comfortably to 90 degrees flexion and am now allowed to attempt to go further.  There is just an incredible tightness behind my knee and in the IT band lower down (which makes sense given what was done to the IT band!).
Quad strength is really the main goal now, but I will be limited in what I can do with that until 6 weeks post-op when I can begin weight-bearing.
The stitches and steristrips came off yesterday and the incision looks really great, so much better than I expected!

If anyone is thinking about this operation, please feel free to contact me for more detailed info!  So far I'm feeling quite good about it.

Offline allyd

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #3 on: April 05, 2013, 04:44:05 PM »
Great to hear everything is going well. I hope you keep seeing good results/progress.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #4 on: April 09, 2013, 04:37:34 PM »
Here are some photos, they might be helpful. First, fresh incisions (day 3 or 4 I believe)

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #5 on: April 09, 2013, 04:38:30 PM »
Incision at 14 days, looking muuuch better!

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #6 on: April 09, 2013, 04:40:19 PM »
Here is a (silly looking) picture from about 3 years ago, where you can see the big difference in my quadricep size.  Riding my bike 15-20 hours a week with my atrophied right quad was not doing my poor knee any favors. Hopefully now my right side can catch up to my left!

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #7 on: April 09, 2013, 04:42:41 PM »
And finally, here is an outline of the rehab protocol that the Steadman Clinic provided. Very helpful.  As you can see, there's not a whole lot to do until the 6-7 week mark.  If anyone is considering this surgery, please let me know if you have any questions.


Allyd, thanks for the nice words! :)
« Last Edit: April 09, 2013, 04:47:03 PM by noradaexplora »

Offline Mistyd

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #8 on: April 10, 2013, 04:19:07 PM »
Nice battle scar Nora!  Glad you are on the mend :)  I bet you are anxious to get into the really good rehab stuff so you can get back to your bike.  Waiting for things to heal can be so annoying sometimes, lol ;D

Keep up the good work and keep us all posted on how you are doing  :)


God Bless,

Misty
Living for the Audience of ONE: Jesus Christ

'95 -knee injury
5-'04 -knee scope cleaned up grade III tears
12-'12-knee scope cleaned up tears
2-'13-harvested cartilage for upcoming ACI
...awaiting ACI

Offline noradaexplora

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #9 on: July 06, 2013, 05:18:09 PM »
So I thought I'd give a little update now that I am nearly 16 weeks post-op.  I began weight-bearing at 6 weeks and weaned completely off the crutches by 8 weeks.  My ROM has been pretty much 100% for a while now, and my gait is pretty much normal--only a slight limp or abnormal stride sometimes.
At 6 weeks I was allowed to start riding the stationary bike with very little resistance, and I slowly worked my way up from there with longer sessions and higher resistance.  The main objective now is just regaining quad strength and control, which is going slower than I would like but my PT has assured me that I am exactly where I should be at this stage.
Getting the eccentric control/strength back is very hard.  Therefore, going down stairs is still not "normal" i.e. I have to hip hike to step down with my right leg, and I don't yet have the eccentric control to run normally.
You are allowed to bike outside at 16 weeks but I decided to try it about 2 weeks early and it went well.  I rode for an hour and 10 minutes a few days ago and it was okay.  Definitely some slight swelling and pain after, but better than I expected.
The scar looks GREAT.  For anyone who wants to minimize scarring I would recommend the following.  I used silicon strips on the scar basically 24 hours a day for the first 6-8 weeks.  You can use them longer, but I have sensitive skin and developed a slight allergic reaction to it eventually.  This really smooths down the scar and minimizes the discoloration.  Also, massage massage massage!  I massaged it several times a day for the first 10 weeks, and now I do it just a little but it feels very smooth and "normal" underneath.  Thirdly, keep it out of the sun!  Now that I am outside in dresses/shorts I keep strips of kinesio tape (Spidertech specifically) over the scar at all times.  I've developed a nice little tan line from the tape so I know it is working to keep the scar from darkening!

I go back to see Dr. LaPrade in a week for the final post-op check-up.  All in all, I am getting back to normal but definitely the knee is still far from fully recovered.  I can tell when I am cycling that my knee is no longer tracking medially the way it was before, so that is exciting!

Offline katieee

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #10 on: April 24, 2014, 08:52:35 PM »
Hi Nora,

how are you doing now?  can i ask you some questions offline?

thanks.
roger

Offline janemarie33

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Re: Surgery Diary: Lateral Patellotibial Ligament Reconstruction
« Reply #11 on: July 09, 2019, 12:40:40 AM »
Hi Nora,

I read your story and it really encouraged me. I had a lateral release surgery 2 years ago and have not been able to fully get back to doing the activities I love because of the pain under my knee cap. I'm an otherwise healthy, active 27 year old. I saw Dr. Laprade last week and he told me I need the Lateral Patellotibial Ligament Reconstruction surgery. I'm trying out the reverse mcconnell taping for the next few weeks before seeing him back. Could I ask you about your experience with it and how you're doing now? I would really, really appreciate any insight or advice you are willing to share with me.

Thanks!
Jane
« Last Edit: July 09, 2019, 12:42:21 AM by janemarie33 »















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