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Author Topic: MPFL Reconstruction and Lateral Release  (Read 1816 times)

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Offline esm87

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MPFL Reconstruction and Lateral Release
« on: February 08, 2014, 05:49:18 PM »
Hi Everyone

I have had recurrent dislocations on my left knee since I was 11 (I'm now 26) and in August last year my right knee dislocated for the first time. Due to the fact my left knee has dislocated so frequently I'd become almost used to it! It obviously causes me a lot of pain and discomfort (and swelling) but it really was nothing compared to when I dislocated my right knee. I had turned to pick up a bag off the floor and it dislocated.

To cut a long story short.. I had been to hospital many times for my left knee and been to see several different specialists who all told me that this is something I would grow out of. Due to the severity of the dislocation on my right knee I had x-rays and an MRI scan which revealed that the only way to stop this from happening was to have a MPFL reconstruction and lateral release on both knees. I've to get this surgery one knee at a time.

I have been frantically googling (as I'm sure most people do, or maybe it's just me! haha) this surgery and recovery times etc and came across this forum. It's been amazing reading everyone's stories and post-op diaries and it's given me a pretty good insight in to some of the things I can expect.

I live in the UK and from what I've read I think there are some variations in recovery etc from those based in the US. I've been told my surgery is day surgery and I have a friend who has had similar surgery (albeit a few years ago) so she has filled me in on how painful it can be. I've sort of reached the stage where this doesn't phase me much as I just really want to be able to have some stability in my knees and be able to do normal activities without worrying if I'm going to suffer from a dislocation/pain.

So basically I was just wondering if there's anything I should do to prepare for this surgery? I have read that it's really difficult to get the strength back in your quad muscles so should I be doing strengthening exercises on these just now to try and help this? Or will this not make much difference? I've also read that hamstring stretches are useful.

I've also read that setting regular alarms for pain medication is essential in the first few days after the surgery (my friend also told me to do this). I was also wondering if you have a brace on your knee after the surgery and I've not been told about that?

I'm definitely not an expert so any tips on how to get through this would be much appreciated!

Thanks, Emma.

Offline rob2278

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Re: MPFL Reconstruction and Lateral Release
« Reply #1 on: February 14, 2014, 03:33:54 AM »
Hi Emma..

I'm a 35 year old guy from NYC who's had issues with my left knee dislocating/subluxing since I was 12. After a few dislocations,  I had a lateral release/medial reefing back when I was 14/15, which kept my knee limited to subluxing until last April when I had a dislocation while jogging.

Anyway, I just had an MPFL reconstruction on January 31st and am just about two weeks post op (you can find my diary in the 0-50 diary message board).  I chose to have the surgery because like you, I was tired of my knee issues from limiting my activities. I had always been fairly active, but after my last dislocation I never even got back to jogging.

Leading up the surgery, I'd recommend keeping your knee/leg in the best shape that you're able to. For me, that meant keeping up with squats/leg press/hamstring curls/etc.. Your quads will shut down after surgery no matter what you do, but it should be a quicker recovery the better shape they're in. I asked my OS about this and he claimed that it 'couldn't hurt'.. but I also know that athletes who have the procedure are able to bounce back quicker than the rest of us.. So it's worth a try.

I also stretched my quads and hamstrings. The hamstrings are key since your leg will be locked in a brace, and bending your leg for a few weeks will be tough. You quickly find out how flexible you are when you need to take off a shoe or sock and no one else is around.

During surgery request a nerve block. This will make your first 24 hours SO much easier pain wise. In fact, you might fool yourself into thinking it won't be that bad! (Don't worry, within 24 hours the pain will start creeping in) If you're able to get a nerve block, start taking your pain meds anyway. The worst thing you can do is wait until you're in pain - then it's too late.

I would imagine you'll be in some kind of brace post op. I'm in a hinged brace in which the angle can be adjusted. My OS protocol is 2 weeks locked, 3rd week 30 degrees, 4th week 60 degrees..  I spent a week+ on crutches, but now can slowly walk in my locked brace.

I'm not sure what your OS plan is post-op, but I've found that it's CRUCIAL to start bending your knee asap after the surgery. One of the surprising things for a lot of people is who stiff your knee is post op- and how painful it is to get back your ROM.  Ideally, you'd receive a continuous passive motion machine. If you cannot get one, I'd go on Amazon or online and buy some of the multicolored resistance bands for heel slides.

Likewise, you need to start working on your quads days after surgery. I found that using my good leg as support, I started retraining my quad to do leg lifts. It took a few days before I could lift the leg on it's own, but now I can, and the quads are once again firing for me. Another option is to buy a TIMS/EMS machine online. If you've never used one, they might look intimidating, but the machine helps your quads to fire again, and are used by a lot of PT's in the USA. I found one on overstock for about $80 USD.

I guess my biggest advice is to really understand what you're going to be putting yourself through - it is a painful procedure, and the recovery takes time. If you haven't had a major knee surgery yet, you might be surprised a bit, and some people get frustrated. Remind yourself that it's all about the end goal of a stable knee cap, stay positive, and remember how well and quick you recover is largely correlated with the effort you're willing to put in.. GOOD LUCK!
« Last Edit: February 14, 2014, 03:37:57 AM by rob2278 »
Knee History:

01/1990 - R Knee - removal of bone chips
05/1990 - L Knee - dislocation
Fall 1991- L Knee - 2 dislocations
12/1991 - L Knee - LR/MR
1992-2013 L Knee subluxations
04/2008 - R knee reconstruction (torn patellar/quad tendons)
04/2013 - L knee - dislocation
01/31/2014 -MFPL reconstruction

Offline esm87

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Re: MPFL Reconstruction and Lateral Release
« Reply #2 on: February 16, 2014, 12:11:05 PM »
Hi Emma..

I'm a 35 year old guy from NYC who's had issues with my left knee dislocating/subluxing since I was 12. After a few dislocations,  I had a lateral release/medial reefing back when I was 14/15, which kept my knee limited to subluxing until last April when I had a dislocation while jogging.

Anyway, I just had an MPFL reconstruction on January 31st and am just about two weeks post op (you can find my diary in the 0-50 diary message board).  I chose to have the surgery because like you, I was tired of my knee issues from limiting my activities. I had always been fairly active, but after my last dislocation I never even got back to jogging.

Leading up the surgery, I'd recommend keeping your knee/leg in the best shape that you're able to. For me, that meant keeping up with squats/leg press/hamstring curls/etc.. Your quads will shut down after surgery no matter what you do, but it should be a quicker recovery the better shape they're in. I asked my OS about this and he claimed that it 'couldn't hurt'.. but I also know that athletes who have the procedure are able to bounce back quicker than the rest of us.. So it's worth a try.

I also stretched my quads and hamstrings. The hamstrings are key since your leg will be locked in a brace, and bending your leg for a few weeks will be tough. You quickly find out how flexible you are when you need to take off a shoe or sock and no one else is around.

During surgery request a nerve block. This will make your first 24 hours SO much easier pain wise. In fact, you might fool yourself into thinking it won't be that bad! (Don't worry, within 24 hours the pain will start creeping in) If you're able to get a nerve block, start taking your pain meds anyway. The worst thing you can do is wait until you're in pain - then it's too late.

I would imagine you'll be in some kind of brace post op. I'm in a hinged brace in which the angle can be adjusted. My OS protocol is 2 weeks locked, 3rd week 30 degrees, 4th week 60 degrees..  I spent a week+ on crutches, but now can slowly walk in my locked brace.

I'm not sure what your OS plan is post-op, but I've found that it's CRUCIAL to start bending your knee asap after the surgery. One of the surprising things for a lot of people is who stiff your knee is post op- and how painful it is to get back your ROM.  Ideally, you'd receive a continuous passive motion machine. If you cannot get one, I'd go on Amazon or online and buy some of the multicolored resistance bands for heel slides.

Likewise, you need to start working on your quads days after surgery. I found that using my good leg as support, I started retraining my quad to do leg lifts. It took a few days before I could lift the leg on it's own, but now I can, and the quads are once again firing for me. Another option is to buy a TIMS/EMS machine online. If you've never used one, they might look intimidating, but the machine helps your quads to fire again, and are used by a lot of PT's in the USA. I found one on overstock for about $80 USD.

I guess my biggest advice is to really understand what you're going to be putting yourself through - it is a painful procedure, and the recovery takes time. If you haven't had a major knee surgery yet, you might be surprised a bit, and some people get frustrated. Remind yourself that it's all about the end goal of a stable knee cap, stay positive, and remember how well and quick you recover is largely correlated with the effort you're willing to put in.. GOOD LUCK!

Hi Rob

Thanks so much for your reply. It's really helpful to hear from someone who's currently going through the same thing.

As you said I haven't had a major knee surgery yet so I just wanted to hear from people who have had this procedure so I can get an idea of what to expect, even if this isn't always the good stuff, ie the pain, difficulty in getting your quads firing again, movement of the knee etc.

Thanks for your advice - I'll be sure to continue with my exercises because even if it helps me ever so slightly it's got to be better than nothing.

I decided to go through with the surgery because I figured that it's got to be better going through a difficult few months after the surgery than having to deal with my knees the way they are at the moment. I can't do any physical exercise and even every day activities hurt my knees and I'm really tired of how this is holding me back (which i'm sure you can relate to)

I'll ask about the nerve block, hopefully this is something they can offer me when I'm getting the surgery if it helps as well in the first 24hours as you say. I've also been told by a couple of people to keep ahead on the pain medication and not to leave it until I'm in pain so I'll be sure to do this too.

I'll also look into the resistance bands, I have used these in the past for my knees. I'll also look into the other stuff you mentioned too.

How do you find normal activities such as showering, sleeping etc after your surgery?

I read through your post-op diary and I am really determined to put the effort in to push ahead with my recovery (as it seems like you have been doing) I know it's not going to be easy but I'm staying positive that it's got to be better than the way my knees are just now.

I hope your recovery continues to progress well and that you manage to get back to the activities you used to be able to do. I'll also keep an eye on your post-op diary as this will be really useful for me to read.

Thanks, Emma.

Offline rob2278

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Re: MPFL Reconstruction and Lateral Release
« Reply #3 on: February 20, 2014, 08:09:28 PM »
Hey.. thanks for reading my long reply to your post. I realize I spewed out a lot of information! I'm glad to see you're moving forward with the surgery.

Each OS has their own post-op protocol on what's 'allowed'- just by reading the board you can see the whole spectrum from people who were able to start therapy 3 days after surgery to people locked in straight braces for 2 months.  I've found, at least in my own recovery, that again - the sooner you can begin passive movement of your knee, and the quicker you can get your quads to start firing, the better off you'll be.

Since you've never had major knee surgery before - you're going to be surprised by how quickly your quad shut down and your leg becomes 'dead'. Your knee will be the size of a grapefruit! Also expect a lot of bruising and lower leg swelling- put dont worry, it's normal. The first week is the worst.. but once you get past day 4 or 5 or so, each day you'll start noticing improvements. One one hand, I'm about 3 weeks post op and have made great strides since my surgery.. but on the other hand I still have a long way to go.

As for your questions - showering is usually allowed once you see your OS a few days post op. The first few times are a bit rough. I've heard shower chairs are a help, but I've never used one. What I did was keep my brace on so I could get my injured leg over the bathtub edge, and then took it off while in the shower. (and then put it back on before I got out of the shower) The first time in the shower without my brace, I was afraid to move an inch.. but each time it gets easier, and now I'm taking showers without being affected by the knee..

Sleeping is a challenge - mostly because your knee will stiffen up overnight. If you're taking pain meds, you might not notice it at first, but as you ween yourself off the meds, nights become rougher. I found that keeping my leg elevated and taking my brace off at night helps, but I'm still sleeping on my back and wake up a few times a night. Mornings are usually the worst time of the day - i wake up with a stiff, sore knee, and it actually feels good to get up and move around.

The toughest thing for me right now is regaining ROM - it's PAINFUL.. and there's no way around it. You have to push yourself and understand that you have to go through a lot of discomfort to make gains.

When is your surgery? Keep me posted with how things are going for you..

Knee History:

01/1990 - R Knee - removal of bone chips
05/1990 - L Knee - dislocation
Fall 1991- L Knee - 2 dislocations
12/1991 - L Knee - LR/MR
1992-2013 L Knee subluxations
04/2008 - R knee reconstruction (torn patellar/quad tendons)
04/2013 - L knee - dislocation
01/31/2014 -MFPL reconstruction

Offline esm87

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Re: MPFL Reconstruction and Lateral Release
« Reply #4 on: February 26, 2014, 12:11:42 PM »
Hi Rob

Thanks for your reply - it's really useful hearing from someone who's going through the recovery process at the moment.

I'm not sure when my surgery is yet - I'm in the UK and they have told me it could take up to 12 weeks but could be any time before that (which is frustrating - I just want it over with!)

That was about 5 weeks ago and I've yet to hear anything. Fingers crossed it's soon because I've got a couple of things coming up in April/May that I really don't want to miss.

Your advice on sleeping/showering was good - I keep thinking of things that probably seem trivial but I just want to be as prepared as possible so i'm not worrying how i'm going to manage these simple tasks.

As i've been reading about this surgery it seems that gaining back your ROM is the hardest part. I'm trying to stay positive about this (easy before you've had the surgery) so I can try and be ready for the frustration and pain involved in this.

I'll keep you updated when I finally receive a date - fingers crossed it's soon!

Thanks,
Emma















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