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Author Topic: Have a question/looking for advice  (Read 1153 times)

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Offline DaTexanBoy

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Have a question/looking for advice
« on: October 23, 2013, 10:41:19 PM »
It's been awhile since I've been on here but I have a question.

A little background on me. I'm a 36yo male, prior military service, dislocated both knees at age 18. Since then, I've had 9 knee surgeries (7 on left, 2 on right). Well, my left knee is back at it again last surgery I had on it was back in 2010 when I had a lateral release and VMO advancement. I've had about everything you can think of done to my left knee to keep my patella in place. Well my patella is back to where it's sliding all over the place and dislocating at all times. Even while sleeping. UGH!

Well the VA won't replace it yet because I'm not 60, no really I have to be 60 at the Veterans Admin hospital to get it replaced.

Is there anyone out there that has had these issues with your patella, and finally had something that worked? If it wasn't for my skin, my patella would just slip right off. It's painfully annoying. The VA surgeon said next time I come back, he's gonna fuse my leg, I said not at 36 you're not.

Offline tstubbs66

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Re: Have a question/looking for advice
« Reply #1 on: October 24, 2013, 02:41:21 AM »
 ??? Hello I just had bone scan done 2 days ago my results came back as c.r.p.s. I would like too know if prp injections or renexx injections would help with c.r.p.s. ? Thank you

Offline Lottiefox

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Re: Have a question/looking for advice
« Reply #2 on: October 24, 2013, 09:25:39 AM »
tubbs, I notice you've posted a couple of questions onto other peoples' original questions....it might be worth you starting your own thread as you're not going to get answers to your issues if you just post under someone else's different situation. In a quick reply crps = complex regional pain syndrome - is this what you have been told you have?

Texan - there are folks on here who can help better than me but you may need to explore reconstruction of the ligaments around the kneecap - search here for MPFL reconstruction and if your patella is dislocating laterally too then other structures may be compromised. allyd is a member here with lots of experience and advice on patella issues. Have a look through for her posts too.

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline DaTexanBoy

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Re: Have a question/looking for advice
« Reply #3 on: October 24, 2013, 12:19:41 PM »
Tubbs, for me, the PRP injections did not work on my left knee at all. For most people, they do work. I believe my left knee is too far out of whack for them to work though. So, YMMV.

Lottie, I actually read about the MPFL surgery in here, prior to my last big surgery, but the VA doctor didn't want to even contemplate doing it. I've watched videos on it, and have read about it, and I think it could work. Of course, anything and everything seems doubtful to work except a replacement.

Offline allyd

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Re: Have a question/looking for advice
« Reply #4 on: October 24, 2013, 04:29:28 PM »
Texan, is your issue just stability Ė or do you have cartilage/arthritic defects on your patella as well? Either way, it sounds like the stability needs to be addressed Ė and Iím not sure a TKR would solve that problem; and a knee fusion seems a bit drastic, and unnecessary Ė but I donít know the whole history. At this point, It may serve you well to find a second opinion with someone who has experience with patella femoral problems, If for no other reason than a fresh set of eyes on your knee.  Ė Although, Iím not sure what your options in the VA system are, nor how to navigate it.

An MPFL reconstruction is a real possibility Ė Iím not sure when your last big surgery was where the doc shot it down Ė but use, research and results on the procedure have really seemed to pick up in the last 4-5 years and it is becoming more common as good results are being reported. But, Overall, anyone around here will tell you that you need to find the reason for the instabilityÖ surprisingly itís not always the same. Ask about measurements for Patella Alta, TT-TG (Tibial Tuburcle to Trochlear Groove distance), Trochlear dysplasia, etc. Ė There is the also more rare rotational deformities that can cause these problems as well.

For me, my instability was caused by the trochlear Dysplasia and lateral tilt for the most part and the MPFL + a lateral lengthening (similar to Lateral release) did the trick. Some people need to correct more than just the MPFL and need a TTT as well. For repeat dislocaters, they seem to be finding most of us need that MPFL reconstructed as it gets shredded w/ the dislocations. But if you donít correct the cause, youíll just end up shredding the new MPFL too. Basically, it comes down to finding the right combination of procedures for the individual.

If you have cartilage defects you may want to take a look at the cartilage repair section of these boards for some ideas. OATS, ACI, etc. Although Ė Iím guessing the VA docs/hospitals arenít going to be too crazy about looking into these procedures.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline DaTexanBoy

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Re: Have a question/looking for advice
« Reply #5 on: October 24, 2013, 11:28:24 PM »
Allyd,

It's feels very unstable. Always giving out on me. Of course my kneecap is pretty much just free floating except for the fact that my top and bottom ligaments are still attached. Hardly have any cartilage left in my left knee. Bones spurs. Arthritis. All kinds of scar tissue. List goes on. It's just really painfully annoying that after 7 procedures (1996x2, 1997, 1998, 2003, 2010, 2013) on my left knee, that my patella is back to the point that it's sliding all over the place.

Of course now, due to having to use a cane all the time and shift of weight distribution, it's affected my back, and ankles and my back is even more jacked up now (recently told I have degenerative disc disease, along with bulging disc and arthritis in my back).

Which the major cause is my left knee. There's been a few times I've asked them just to cut it off, so maybe just maybe, I won't have these issues any more.

Sorry, I know more than you bargained for, but being 36 and having dealt with this since 18, literally half my life, I'm more than a little frustrated with my left knee right now.

Offline allyd

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Re: Have a question/looking for advice
« Reply #6 on: October 25, 2013, 01:23:10 AM »
I don't know that much about solutions for the arthritis/defects. I know repair options for that are dependent on location, size, etc. All that was undoubtedly caused by the instability. And any repair would fail if you don't also stabalize the patella.

You are sorta between a rock and a hard place. If you find the right combo platter of stabalizing procedures... you may still be in pain from Your lack of cartilage.

The frustration is understandable.  But the best we all can do is keep looking for the right answer when we have problems.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline DaTexanBoy

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Re: Have a question/looking for advice
« Reply #7 on: October 25, 2013, 02:03:16 AM »
Yeah. That's why I'm thinking that my only option out there is total knee replacement or to do a previous procedure again. I did have one back in 2003 or 2002 that did last about 7 or 8 years. That one has lasted the longest. I'd even be happy with them making it so tight that I only have 90 degree bend, as long as it meant my patella didn't dislocate anymore.

Offline allyd

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Re: Have a question/looking for advice
« Reply #8 on: October 25, 2013, 02:24:46 AM »
That's not necessarily where you want the tightness.  With the Biomechanics of the knee, patella Dislocations generally happen at about 20-30degrees. The point ri ght before the kneecap engages in the trochlear groove of the femur. This is the importance of the MPFL... it is at its tightest when the knee is flexed at about 20-30degrees.  When we repeatedly dislocate,  it is stretched out or torn, and no longer is engaging as a check rein for the patella.

I'd really just encourage you to read up on the various causes of instability . You can't learn to much... then ask the doctors a  lot of questions. Its all about getting the RIGHT procedure combo.
« Last Edit: October 25, 2013, 02:28:56 AM by allyd »
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline DaTexanBoy

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Re: Have a question/looking for advice
« Reply #9 on: October 25, 2013, 03:26:43 AM »
I actually brought up a MPFL before my last surgery in 2010, and the doctor wouldn't even budge. I personally feel like he's stuck in his old ways and won't think about other procedures, or maybe he didn't feel comfortable since he hasn't done any or many.

He is one of the top surgeons in Arkansas as far as knees go, bad thing is, he said working on my knee is like working on Gumby. I might have to get out of the VA system and see a civilian doctor.

Offline allyd

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Re: Have a question/looking for advice
« Reply #10 on: October 25, 2013, 04:59:12 AM »
A fresh set of eyes may be good... I'm sure he is a great doctor, but like you say he may not have the most experience with the latest patellafemoral procedures. many have passed through these boards having had surgeons perform outdated or non indicated surgeries. If they aren't keeping up with the research/indications for pf pain/instability... you may not see the best results as it seems to be an ever improving area of ortho surgery

 I believe there are a lot of good surg eons out there that can get the job done... and it doesn't have to be a 'big' name. My advice is always just ask a lot of questions.  If a doctor doesn't want to do an mpfl... ask why. There may be a reason. Find out what it is. As someone that doesn't always understand the science of it all... i always ask the question whether i care about the actual answer or not. Because how they answer and field questions tells me alot about whether TH EY understand it.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening















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