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Author Topic: LPFL Reconstruction  (Read 5610 times)

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Offline Samsy

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LPFL Reconstruction
« on: July 04, 2013, 07:27:29 PM »
First post, here goes...

I'm an active 21 year-old who got a lateral release done on my left knee about 13 months ago after experiencing lots of pain and grinding.  Ever since the surgery I've been getting pain in my knee when putting weight on it while it's bent.  I've poked around on the forums and found that this is a pretty common thing for people who get this operation.  There is a set of home exercises I've been doing that keeps my quad beefed up to the point where the pain is pretty minimal, but if I skip these exercises for even a day or two the pain begins to make a swift comeback. 

I've seen two specialists about this problem: a surgeon and a sports medicine doctor.  The surgeon recommended I get an LPFL reconstruction, while the doctor said I should just continue with the therapy.  I've done research into the reconstruction, but there aren't a whole lot of resources available as it is evidently a pretty new surgery.  As I said before, I'm an active guy who cycles at least 8 miles a day and loves backpacking, so the prospect of not being able to comfortably do either of those for the rest of my life is not a very happy one. 

So I was wondering what you guys had to say about it.  There aren't many threads on this site about the reconstruction, so I didn't have a whole lot to go on.  If I do decide to go through with it I would be happy to contribute my own post-op diary to add to the well of info.  So throw everything you know at me.  Recommendations, information on the surgery, anything that might be relevant.  I'm just trying to gather as much knowledge as possible about what I should do.

drmark

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Re: LPFL Reconstruction
« Reply #1 on: July 04, 2013, 10:32:56 PM »
The surgery is anyting but new.  It was first described by Dr. Hughston, one of the Fathers of American Orthopaedic Sports Medicine in 1982.  Its a pretty simple procedure, reconstucting the LPFL with a strip of the iliotibial band.  I have done nearly 100 of these.  Coupled with intelligent functional use of the limb after the procedure it is well tolerated and almost always sucessful. 

The big issue is, that the ill fated LR was done for a reason.  That reason is probably still obscure.  This needs to be identified and resloved synchronously with the LPFL reconstruction. or the procedure will certainly fail.
« Last Edit: July 04, 2013, 10:41:46 PM by drmark »

Offline katieee

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Re: LPFL Reconstruction
« Reply #2 on: July 05, 2013, 10:34:15 AM »
Hi Samsy,

May I know which surgeon recommended you for LPFL reconstruction?  What was his approach?

Thank you.
Kate

Offline Samsy

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Re: LPFL Reconstruction
« Reply #3 on: July 05, 2013, 02:19:53 PM »
The surgeon that recommended the surgery was Dr. Shneider in East Lansing, MI.  As for the reasoning behind the LR, I was one of the people who actually needed the operation done - my OS (not Dr. Shneider) identified lateral subluxation through x-rays and a physical examination.  When he showed me the scope pictures from my operation, it was very clear that my patella was subluxated and there is even a small scratch on its underside where it was grinding up against the bone. 

My main concern now is whether or not reconstructing that ligament would cause the subluxation to happen again.  I assume the new ligament is attached carefully to allow easy gliding of the patella, but I don't want to take any chances of ending up in a worse spot than I am now.  Thanks for the responses, guys!

drmark

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Re: LPFL Reconstruction
« Reply #4 on: July 05, 2013, 04:37:18 PM »
The lateral retinaculum prevents lateral subluxation because it runs from front to back, rather than from side to side.  Doing the LR, further loosened the patella.  So from that evidence, then the first operation should have been at least an MPFL reconstruction.  So, the MPFL and the LPFL would need to be reconstructed in this case.  You havent' said anyithing about the trochlea groove-tibial tubericle offset, patella height (alta or baja), trochear depth, or rotational alignment, or malalignment.   These questions need to be answered.

Offline claus6778

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Re: LPFL Reconstruction
« Reply #5 on: July 05, 2013, 09:14:40 PM »
Thanks for sharing Samsy. Did Dr. Schneider say you only need LPFL reconstruction without other procedures?
« Last Edit: July 05, 2013, 10:42:18 PM by claus6778 »

Offline Samsy

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Re: LPFL Reconstruction
« Reply #6 on: July 07, 2013, 05:37:53 PM »
That was his assessment after a physical examination, yeah.  I've yet to have an MRI done on it.  I've heard some very good things about Dr. Teitge in Detroit, which luckily is only an hour drive away.  I scheduled an appointment with him, so hopefully we can get the issues all ironed out.  Thanks for the responses, they've been a great help.

Offline claus6778

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Re: LPFL Reconstruction
« Reply #7 on: July 08, 2013, 04:38:06 PM »
Dr. Marks,

I am wondering if I can ask a technical question. What is the difference between using a thin strip of IT band versus a wider flap of IT band to reconstruct the LPFL?

thank you.

drmark

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Re: LPFL Reconstruction
« Reply #8 on: July 08, 2013, 08:46:34 PM »
It depends on what you consider thin.  I typically use 1.5 centimeters of ITB in width, and use a length that is necessary to cover the defect.  Usually its bigger than you expect.

Offline claus6778

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Re: LPFL Reconstruction
« Reply #9 on: July 09, 2013, 02:32:07 AM »
Thank you Dr. Sanders. I just have one more question. Dr. Hughston's paper described a method of using a strip of patellar tendon along with IT band to reconstruct the LPFL.  Is there any added benefit of using a strip of patellar tendon in the reconstruction? 


drmark

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Re: LPFL Reconstruction
« Reply #10 on: July 09, 2013, 12:17:35 PM »
The patella tendon isn't long enough, and is much stronger than the native ligament.  The IT band is a perfect match for the LPFL.

Offline claus6778

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Re: LPFL Reconstruction
« Reply #11 on: July 10, 2013, 01:08:58 AM »
Hi Samsy,

Can you please describe Dr. Shneider's approach to reconstruct the LPFL?

thank you.


Offline Samsy

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Re: LPFL Reconstruction
« Reply #12 on: July 11, 2013, 12:39:19 PM »
He described to me a process in which he would use a strip of quadriceps tendon instead of IT band (much like in this essay, though warning there is some gore: http://traumatologiapenta.com.ar/docs/lateral_patellofemoral_ligament_reconstruction.pdf). 

At the time I didn't know anything about the procedure so I didn't ask him the difference between using this or a section of IT band.  Knowing what I know now though, it would be interesting to find out how the tissue from this part of the leg might affect the surgery differently.  Drmark?  Care to step in?
« Last Edit: July 11, 2013, 12:46:51 PM by Samsy »

drmark

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Re: LPFL Reconstruction
« Reply #13 on: July 11, 2013, 01:14:40 PM »
In my view, the IT band usage carries much less pain and requires far less post op restrictions than taking the quad tendon, which is somthing I have done many times for ACL and other reconstructions.  While I am certain that the quad tendon procedure will work, in my view, its like taking an elephant gun to hunt pheasants.

Offline claus6778

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Re: LPFL Reconstruction
« Reply #14 on: July 15, 2013, 08:43:08 AM »
Dr. Sanders,

Sorry I am wondering if you can help with another question.  There seem to be two methods of harvesting the iliotibial band graft for the reconstruction. One method has the graft remained attached to Gerdy's tubercle and has the free end in the thigh area that can be mobilized towards the patella. The other method has the graft detached from the Gerdy's tubercle and the other end remained attached to the thigh.

I have seen illustrations of both methods and the orientation of the graft are opposite.

I am wondering what is advantage/disadvantage of each method?