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Offline Sam451

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Update on Sam451
« on: May 20, 2013, 01:03:40 AM »
Well here we go again. I just had another procedure. I will be moving my future posts to the diaries section for the full post op diary. I need to move as I no longer have an articular cartiledge issue, but a mechanical issue. For those who have followed my journey for the past 3 1/2 years, you know I had a scope done in January. It was at this point that it was decided that the pain that rears its ugly head post surgery every time, was actually coming from my first surgeon screwing up the mechanics of my knee(of course my OS would never say that but we all know it's the truth).  My current OS had fixed the articular cartiledge issues and the grafts were looking great.  I no longer had issues with my articular cartiledge.  My current OS had fixed nearly everything the former OS had screwed up.  The last piece was that my pattela was no longer gliding through the groove with ease but was instead, popping out of the groove and destroying the back of the patella. By the time my OS went in to fix this I had also developed tendinitis through the pattelar tendon. This was due to the strain it was going through trying to keep the kneecap in place. I also had a nice lump of scar tissue forming on top of my knee cap. I named it George lol :).

On May 14th I had a TTO(Fulkerson). For those not familiar, it is where the OS breaks your tibia where the patellar tendon attaches to the tibia. He is careful not to cut the tendon. The piece of tibia is moved to the desired position and fastened in place using two screws. In my case he also used a bone graft paste under the piece of tibia to raise it a little so as to take even more strain off of the tendon.  By repositioning the attachment of the pattelar tendon the kneecap should now sit in the groove and move without popping out of the groove.

I was told at my pre-op appointment that this would be the worst pain of all 6 knee surgeries I have had done. That surprised me as the MCL reconstruction along with the osteochondral allograft that was preformed in Nov 2011 was the worst pain I have ever been in in my life. Let me tell you, recovery from that hurt more than childbirth with both of my kids. Well folks, the OS wasn't lying lol.  This recovery has been far worse than I imagined.  It is excruciating to stand. I knew it was going to be like this almost as soon as I woke up in recovery. The reason I knew was because I could feel the pain through the block. Believe me, the block was working.  My leg was good and numb.  The pain was under control, but I could feel the pain through the block.  I have never had that before.  The block actually lasted aprox 52 hours. I almost called surgeon because feeling wasn't coming back. But at the same time I was happy to not be feeling the full effects of the surgery. This block was different than ones I have had in the past. It gradually wore off. Others I have had I went from 2 on a pain scale to 10++++++++ in minutes. This time the transition went slow which really helped. I did not have to up my dosage on pain meds.

If I keep my leg propped up with the ice machine running 30 on 30 off, it helps keep the knee calm to some extent. It is the standing that really kills me.  I try to get up slowly  but it doesn't matter. The blood rushes to the knee and it has a heartbeat of its own :o. The skin is stretched out so much from the swelling that it looks shinny. The scars I have from previous surgeries are normally indented a bit. Due to the swelling they actually are puffy now. I have bruising all down my shin as well as around the back of my knee.

I do not get to start PT until I am three weeks out from surgery. Non-weight bearing as well for the first three weeks. My brace is locked in full extension until this point as well. I can however, open brace while laying down but must fasten it when I get up or sleep. I can only remove it for showering.

One thing I don't get is how I see so many people being told to walk as tolorated right after this procedure. I know every OS has their own protocol but I would think that the bone should be given time to heal prior to bearing weight. If you break your leg you are not supposed to walk right away. They dont give you a boot for 3-4 weeks. Isn't it the same?  Oh well, just glad I'm not being told to walk. 

I am going to attempt to post pictures. If you want to continue to follow my journey come find me at the post op diaries.
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline Sam451

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Re: Update on Sam451
« Reply #1 on: May 23, 2013, 01:15:32 AM »
I had my post-op today. OS said everything went very well. He said that he did not have to redo any of the previous things he had done while he had it opened up.  It seems like every other surgery he was fixing something that the original surgeon had messed up. All the pieces are finally starting to be put back together.

 :'( I have been having EXTREAM shin pain after this surgery. To the point I get sick from the pain when I stand up. It's not at the site if the break but down by the ankle on the medial side of the shin. When I asked the OS about it today he said that the pain is from the fluids that are trapped between the bone and the skin. Once the swelling goes down the shin pain should go away.  The leg a wonderful combination of purple green and yellow.

One of the screws is 2 inches. The other is a bit smaller. It's crazy.

I am trying to spread out the time between pain meds. I was taking two every 4 hours. I have been able to go 5-6 hours between sometimes.

I was told today that I could start putting weight on my leg. I have to have my brace on and locked in extension to do so but hey it's a step.

I also found out that the OS did a lateral release at the same time. That explains the additional pain on the outside part of my leg.

 :D Please feel free to ask any questions. I love helping people by sharing all I have dealt with.

Nov 2009 Initial Injury-Torn MCL, Torn Articular Cartiledge, Torn Lateral Meniscus, Boxers fracture left hand, and Slap tear/rotator cuff tear right shoulder
April 2010 Micrifracture Failed/menisectomy Right Leg
Dec 2010 Autograft Failed Right Leg
Sept 2011 Scope  and Chondroplasty Right Leg
Nov 2011 Fresh Allograft MCL Reconstruction
July 2012 SLAP Tear, Blanckart Tear, and keyhole Rotator Cuff Repair Right Shoulder
Jan 2013 Chondroplasty, Lateral Release Right Leg
May 2013 TTO Fulkerson & Lateral Release
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #2 on: June 08, 2013, 04:54:44 PM »
You definitely have had a lot of surgeries. Hopefully this last one will be the last. My 16 year old daughter had a microfracture and lateral release done 11/12 and she is still having problems. She saw a Dr. in Ca and he now says she needs an allograft. When you originally had your allograft did the Dr. Know you had tracking problems?

Offline Sam451

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Re: Update on Sam451
« Reply #3 on: June 09, 2013, 01:09:55 PM »
The original dr that preformed the autograft caused the maltracking.  It was not talked about when I went to the dr I am with currently no, not at the time the allograft was preformed.  Neither I nor my current Dr realized how bad the tracking was because the autograft was failing so badly. The plugs had not been placed properly. He may have suspected but did not say. I say this because as I was healing and continued to improve in some areas and not in others he talked about the possibility of this surgery he just preformed. He has basically pieced my knee back together from the other guys mistakes though he would never say that. However, one of his colleagues had no problem telling me lol.

At the time of the allograft I also had an MCL reconstruction. I had so much lateral movement because no scar tissue had formed to repair the original tear of that. This could be part of the reason we did not discus tracking as well. That portion had to be repaired in order to see how much movement was do to the laxity of the ligaments also.

I would think at the time your daughter had the lateral release they would have seen the tears in her articular cartiledge. Why didn't they recommend this immediately following her lateral release?  Also if the lateral release failed then they should be talking about doing something to fix the tracking issue along with fixing the cartiledge.  One thing I recommend is to find out your drs results with allografts. Looking back I realize the first surgeon should have never been doing my autograft. (I was new to the knee surgery scene and didn't know better). I have since done a ton of research. My current dr is amazing. He is the dr for our local major league soccer team and I trust everything he says. When I first saw him I was at the point of giving up any hope of walking without pain. I now can see a light at the end of this dark tunel and look forward to returning to my active lifestyle. Obviously the activities will have to change but even the thought of walking pain free is exciting.

As always feel free to ask me any questions. I love sharing my story and being a support for others who may be dealing with similar issues. I know this board has helped me so much.

Jenni
 

Nov 2009 Initial Injury-Torn MCL, Torn Articular Cartiledge, Torn Lateral Meniscus, Boxers fracture left hand, and Slap tear/rotator cuff tear right shoulder
April 2010 Microfracture (Failed)/menisectomy Right Leg
Dec 2010 Autograft (Failed) Right Leg
April 2011 New Surgeon
Sept 2011 Scope  and Chondroplasty Right Leg
Nov 2011 Fresh Allograft & MCL Reconstruction
July 2012 SLAP Tear, Blanckart Tear, and keyhole Rotator Cuff Repair Right Shoulder
Jan 2013 Chondroplasty, Lateral Release Right Leg
May 2013 TTO Fulkerson & Lateral Release
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #4 on: June 09, 2013, 07:04:37 PM »
Well to make a long story short. My daughter went in for surgery to have a supposed meniscus tear repaired by her pediatric OS, she came out of surgery with no meniscus tear, but a grade 4 defect on her trochlear groove. He did microfracture it and lateral release. He also took piece out for a possible ACI if needed. We are in process of finding a new OS who specializes in cartilage.
The last Dr. We saw said her defect is subchondral and ACI would'nt really repair it. It seems as though she has more problems since first surgery. Maybe it's just because she was running track and xc on it.

Offline Sam451

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Re: Update on Sam451
« Reply #5 on: June 09, 2013, 07:44:52 PM »
She absolutely should not be running with a defect. It will make it worse. Even after repair it will break it down faster if you run. Yes many people do if fact run after however, i certainly wouldn't want a knee replacement in my 20's or 30's. I don't understand why he did a lateral release if she was not having tracking problems to begin with.

Please understand I was training for marathons when I was injured so I am not one to say not to be active, however running after these type of procedures is not a good idea. Your daughter should find a new form of activity. I'm thinking of mt biking.
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #6 on: June 09, 2013, 11:27:11 PM »
Lol. We really don't know why he did a lateral release either. I think he told us it was to protect microfracture while it heeled. Now she has IT band issues and patellar tilt which the Dr. Never talked about before.  The Dr. cleared her to run, knowing she was running miles and never warned of future problems.
How do they test for maltracking?  If she gets just an allograft like the new Dr. Recommends, I'm concerned she may need another surgery to correct previous lateral release.

Offline Sam451

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Re: Update on Sam451
« Reply #7 on: June 10, 2013, 01:50:29 AM »
For myself the maltracking was obvious with each step. I would get sharp pain as the kneecap was sliding in and out of the groove. I would get a sharp pain that would cause the quad to shut off and the knee would give away. He did a few tests of movement in his office as well. He sent me to another dr to confirm as well.

The dr may have allowed her to run because the defect was in the groove rather than a weight bearing area. She may be allowed to run again once all is healed. I know weight bearing is allowed sooner after an allograft in the groove. Mine were on the condyles of the femur. Just be sure to research this thoroughly and be sure there is healing before pushing it. The key is finding out why there is a defect in the groove. Was it an injury or is the patella off track causing this issue. The former dr may have done the lateral release for that very reason and it just didn't  work. From everything I have read they are hit and miss. It seems they are something simple they can do while in the knee already to see if it works.   I'm just guessing at what may have occurred.   

I get the feeling of my knee being worse after surgery. It is frustrating. I believe that the original surgeon set me back years in healing. I am thankful for the OS I currently have. Once you find that surgeon you need to trust him. Beale to question the reasons he wants to do things but trust him. If you can't than he isn't the OS for you. I question the causes of the different pains I have.  I question why he wants to do certain things. When he gives me an answer though I believe him. I even trust when he says give it time. I get frustrated but rough the frustration allow time to pass because I know that after the said time frame it will either have improved or he will take the next step.   My first dr made me feel like I was crazy. I wasn't even trusting myself with him.

Your daughter is young and it sounds like she is an athletic kid. With the right surgeon she should have great success with an allograft.  My grafts have healed well over the last year and show no sign of breaking down at this point.

Please keep me posted on what you decide to do and how it goes. It's a tough surgery but I would do it again in a heartbeat. Just be sure that the issue of why it broke down in the first place gets taken cre of so that if she does have the allograft she won't break it down because the original cause never was fixed. I hope I am making sense with that.

By the way where are you located. I am in OR. Well I'm from WA but dr is in OR. I have heard som good names thrown out on the west coast.
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #8 on: June 10, 2013, 09:03:54 PM »
I can only imagine how frustrating it is. I'm sure you like my daughter just want to be pain free and move forward. My daughters knee gives out too but Dr. Said it is from defect.
We live in Nevada. We saw a cartilage specialist is so. Ca last week and she has another appt. next month out there.  It's hard making such a hard decision that will affect the rest of her life.

Offline Sam451

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Re: Update on Sam451
« Reply #9 on: June 10, 2013, 11:41:34 PM »
I feel for your daughter. It is a very difficult decision. I too had issues with leg giving away because of the defect. I think that was part of the reason it took until the the defects were fixed to realize the mechanics were so bad. There is a Dr I have heard people talk about named Bugbee in CA. They rave about him. If you are willing to travel to OR dr Greeleaf is my Dr. I have sent five friends to him and all have been extreamly satisfied. Portland is a great place to visit as well!  I love him because he isn't a surgery happy dr. If you need it he tells you. If there are other options he lets you decide. Both of my kids have seen him for shoulders. One he point blank said we need to fix this. He said it was up to us but told us the reasons it was important. (his was a crushed clavicle). The other one was a SLAP tear. With him he suggested therapy first. After some time and little improvement we asked for options and he gave us several. We ended up choosing surgery because he's headed off to college in the fall to play football and needed it to be solid. I love that he is open to us and our feelings and concerns.

Have any of the Drs told you what they believe caused the defect? 
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #10 on: June 11, 2013, 03:04:54 AM »
Thanks for the Dr. Referrals.  I will check into them. It's great that you can trust your OS.
We don't really know how she hurt her knee. Mri report leans toward patella dislocation or something like that. She says she doesn't remember doing anything to it. She used to play a lot of soccer before giving it up to focus on running. She could have been kicked in knee or fallen on it. She aid when running sometimes it would feel loose but don't know if that was just from a really hard practice or long run. Maybe from the defect.

Offline NickCat11

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Re: Update on Sam451
« Reply #11 on: June 11, 2013, 03:24:47 AM »
Xclaxmom,

Why not look into a non-invasive stem cell procedure for your daughter. It's worth a shot before going down the long road of surgeries. She's very young, if her defect isn't gigantic, I bet she would respond well.

Offline xclaxmom

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Re: Update on Sam451
« Reply #12 on: June 11, 2013, 03:22:15 PM »
Thanks, I really haven't heard too much about stem cell treatment. She may have some bone loss so not sure if it will work with that. Not to be cheap, but does insurance recognize this as a treatment for cartilage loss?

Offline NickCat11

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Re: Update on Sam451
« Reply #13 on: June 11, 2013, 11:41:08 PM »
Unfortunately that's the one downfall, insurance doesn't cover it yet. There are studies showing that stem cells can heal bone loss as well. I believe a blog on Joseph Purita's web site showed a before and after. I'll hunt down the links and post them later tonight or tomorrow.

Offline Sam451

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Re: Update on Sam451
« Reply #14 on: June 13, 2013, 01:11:17 AM »
Had my 1 month appointment today. Everything looks good. It wasn't a great visit in that I guess I wanted him to say it looked excellent and I could take brace off and go for a run lol. Obviously an exaggeration but you get my drift. I guess no bad news is good news. The bone is just taking such a long time to heal *sigh* ::)
I do get to open the brace 10 degrees every few days until I get to 90. I also get to start physical therapy. So I am progressing just slowly. Hanging on by a thread :)


As always please feel free to ask any questions. I love helping people by sharing all I have dealt with.

Jenni

Nov 2009 Initial Injury-Torn MCL, Torn Articular Cartiledge, Torn Lateral Meniscus, Boxers fracture left hand, and Slap tear/rotator cuff tear right shoulder
April 2010 Micrifracture Failed/menisectomy Right Leg
Dec 2010 Autograft Failed Right Leg
Sept 2011 Scope  and Chondroplasty Right Leg
Nov 2011 Fresh Allograft MCL Reconstruction
July 2012 SLAP Tear, Blanckart Tear, and keyhole Rotator Cuff Repair Right Shoulder
Jan 2013 Chondroplasty, Lateral Release Right Leg
May 2013 TTO Fulkerson & Lateral Release
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #15 on: June 13, 2013, 05:00:16 PM »
It sounds like you are healing, so that is good. Opening the brace will make things more comfortable too.

Offline Sam451

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Re: Update on Sam451
« Reply #16 on: June 19, 2013, 07:38:40 AM »
So the latest and greatest.......I now have stitch abscesses that are also infected. OS took several stitches out of the open wounds on Friday and put me on an antibiotic. Chills and cold sweats continued through the weekend and had to go to ER Sunday. Happy fathers day to my hubby  :'( not. IV antibiotic and still dealing with sweats and chills. What is going on. I go back to OS tomorrow. My body is fighting against these stitches big time. Half my incision is scared over and the other half is wide open. Five weeks post op with open incision. This is ridiculous. Oh well, this too will pass right? :P

I also have been opening my brace 10 degrees every couple days. It's now open to 30 degrees.

As always please feel free to ask any questions. I love helping people by sharing all I have dealt with.

Jenni

Nov 2009 Initial Injury-Torn MCL, Torn Articular Cartiledge, Torn Lateral Meniscus, Boxers fracture left hand, and Slap tear/rotator cuff tear right shoulder
April 2010 Microfracture Failed/menisectomy Right Leg
Dec 2010 Autograft Failed Right Leg
Sept 2011 Scope and Chondroplasty Right Leg
Nov 2011 Fresh Allograft MCL Reconstruction
July 2012 SLAP Tear, Blanckart Tear, and keyhole Rotator Cuff Repair Right Shoulder
Jan 2013 Chondroplasty, Lateral Release Right Leg
May 2013 TTO Fulkerson & Lateral Release
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline xclaxmom

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Re: Update on Sam451
« Reply #17 on: July 14, 2013, 04:33:12 PM »
Hi. I really hope you're fealling better by now. How's the knee?

Offline Sam451

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Re: Update on Sam451
« Reply #18 on: July 15, 2013, 03:56:40 AM »
So intersting that you ask how things are going. I was just thinking I needed to post an update. So far I have dealt with just about everything lol. 1/2 of my incision decided not to heal. My body rejected the internal stitches. I spit up several stitches and then had to be on two rounds of antibiotic for infection. That has finally almost healed. The screws are very annoying as well. They are painful to touch or bump.  The bones were not fusing at the last x-ray. I hope that the next X-Ray shows calcium being laid or I don't know what wil happen.  I go back in on Wed so we will see. I have ulnar nerve impingement in both elbows but worse in the left. My ring and pinky fingers fall asleep all the time. This is from using the crutches. I have to see if my surgeon will refer me to the hand/elbow specialist for this :(.  My kneecap dislocated Thursday night while I was sleeping. I fell asleep on couch with my brace off and rolled over on stomach. Not a great idea :P. It seems everything that can go wrong has. Probably because this is supposed to be the final surgery :). I'm trying to keep a positive attitude and just do the things I can do. I trust my OS so we will see what he has to say on Wed. I will update with what he says after the appointment.

Jenni


Nov 2009 Initial Injury-Torn MCL, Torn Articular Cartiledge, Torn Lateral Meniscus, Boxers fracture left hand, and Slap tear/rotator cuff tear right shoulder
April 2010 Microfracture Failed/menisectomy Right Leg
Dec 2010 Autograft Failed Right Leg
Sept 2011 Scope and Chondroplasty Right Leg
Nov 2011 Fresh Allograft MCL Reconstruction
July 2012 SLAP Tear, Blanckart Tear, and keyhole Rotator Cuff Repair Right Shoulder
Jan 2013 Chondroplasty, Lateral Release Right Leg
May 2013 TTO Fulkerson & Lateral Release
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum