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Author Topic: Comminuted patelar fracture and MUA. The story so far.  (Read 4265 times)

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Offline mjeffrey

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Comminuted patelar fracture and MUA. The story so far.
« on: July 06, 2014, 08:38:07 PM »
Injury
I was a pretty active 53 year old male. I was doing 120km per week on the mountain bike and new personal bests at the gym. Then came the bike accident on 19 Feb 2014 here in Brussels which ended all that. The kneecap broke in multiple pieces - a comminuted fracture. On the 21st Feb it was operated and 4 Kirschner wires, a figure of eight and a cerclage were inserted (see photos  https://www.dropbox.com/sc/wgabzfu3ri6o1b2/AACgGUPTBJWlMUAVQ5bna6Mba).

The next day in hospital I already had PT and they worked on the flexion and taught me how to use crutches. More PT on Sunday and I left hospital on Monday.

First few days at home.
Wearing a fixed brace, everything is difficult. The PT at the hospital had given me training on climbing and descending stairs (our house is over 4 floors) and so I was mobile but it was painful and slow getting around.
Luckily my wife was there to help and she organized everything and made my life easier. She organized a nurse to come to change the dressing twice a week (for 2 weeks until the staples came out) and a PT to come to the house for regular torture sessions.
I was instructed to only have partial weight bearing on the injured leg and so I got around with 2 crutches most of the time.

Showering was difficult, I felt pretty unstable out of the brace and I needed to protect the dressing from getting wet. Getting dressed was difficult, putting on shoes on my own was impossible. On top of this my energy levels were low and so I spent most of the day on the sofa, and doing my exercises twice a day. I was given a prescription for paracetamol (1000mg tablets). I skipped the other opiate based painkiller which I had in hospital as it made me a bit nauseous and so I only used the paracetamol. I also needed to take heparin by injection in the abdomen for 3 weeks to prevent DVT, I didn't look forward to this each day.
Pain was bearable but pretty constant except when doing exercises or moving when it was much worse. I needed to sleep in the brace but luckily I was able to sleep ok.

I stayed inside for the first 2 weeks, although I wanted to go out in the sunshine,  I really didnít have the energy to do so. Finally I did a walk around the block and that was enough for another week - it was pretty hard going even for someone like me who 2 weeks ago was in pretty good shape.
As you know the prognosis can be pretty depressing. I was wondering if Iíd ever bike, walk or run properly again but I was determined to do the best I could to have a reasonable outcome.
At 15 days post-op they removed the staples, my flexion was 45 degrees and my knee was still very inflamed with clearly visible bruising.I was given a target of 90 degrees flexion for the next 6 weeks when I had my next appointment with the OS.

The desperate days 3->11 weeks.
I started working a few days after returning from hospital, luckily I was able to work from home but could only manage around 6 hours a day in small chunks in the first week. In total I worked at home for 5 weeks. My first day back at the office was 6 weeks after the accident. At the office I still wore the brace while walking around on 2 crunches and the 500 metre walk to the metro was pretty difficult. After 2 more weeks I left the brace at home and in another week I was down to one crutch.
Flexion had been stalled for 3 weeks now. Almost no progress. I moved my appointment with the OS ahead a week, but he told me to keep trying the PT for the flexion but not to worry, if it didn't improve he would do an MUA (I worried anyway).
At this point my spirits were at the lowest. Progress with walking was slow and painful, no progress on flexion and constant pain which was not improving. I was pretty desperate, with most of the things I love to do impossible for now and perhaps for always I was not feeling like there was much to live for. But in the end it did get better, some days it was a lot better, but there were days when it was a lot worse too.
Often the improvement is so slow that you don't notice it but viewed over a few weeks, there is progress and hope.
At 8 weeks I was able to walk with one crutch and put the other one in storage (I would need it again after the MUA)
At 10 weeks I returned to the gym, still walking with a crutch but really happy to be properly exercising again.

MUA and brighter days ahead 11->15 weeks.
On 6th May I decided to do an MUA and was booked in for the 9th May (Iím really impressed with my OS and the hospital that treated me that quickly - we do pay a lot of taxes here but at least the medical care is excellent).

I will make a more detailed post about the MUA later so only an outline here.

After the MUA I woke up on a CPM machine set at 0->120 degrees for 7 hours and 7 hours the following day (one night in hospital).

When I saw the OS the next day I asked him how he does the MUA (I thought it might be a violent movement). He said he puts his ear against the knee to listen and gently bends it - seems low tech but it was reassuring that it is something not something violent. He bent it to 120.

Three days following the MUA I noticed my flexion was reducing so I hired a CPM machine myself. It was the same model I had used in the hospital and could it could go from minus 10 to 120 degrees - see photos at the link above. The machine confirmed I was now only able to reach a maximum of 110.

After 2 weeks post MUA I was able to work up to 120 (starting at 100 and gradually increasing the limit) and after another week I would start immediately at 120. At this stage (after 3 weeks) I sent back the CPM machine. I was now also cycling on the indoor bike with the seat on its lowest setting (it looked a bit ridiculous but was good for working the knee at maximum flexion).

After the operation, the OS  told me that the tight muscles were now the limiting factor (he was right) and gradually the flexion improved as the muscles stretched.

2nd opinions, More capabilities 15->19 weeks.
At about 15 weeks I visited 2 other orthopedic surgeons to get other opinions on progress, next steps, other ideas etc. Both thought I need to get the hardware removed: with the wires, the muscles will not regain full strength and there will always be irritation.
One told me 2014 will be "the year of the knee" and I can expect future problems including arthritis and weather related pains. He said, due to the fracture, the cartilage on the inside of the kneecap has been damaged and will cause problems. In a worst case scenario the cartilage may need to be replaced in future. The other doctor knew my OS and said he was an excellent choice (I didn't choose, there is no info or time available to make a choice after an accident). He thought I was doing too much exercise and should take it more easy and also take an anti inflammatory. I took ibuprofen for 2 weeks and it helped and still take one when necessary.

I work out at the gym (leg presses, extensions and leg curls, plus proprioception exercises) 3 times a week and have added one day of swimming. The PT had me hopping around on my bad knee recently so I thought why not a bit of running, and with my new flexion what about some rowing? First day I did 5 minutes rowing and ďranĒ (jogged at walking pace) for 2 minutes at 4km per hour on the treadmill. That was ok so next time 2 mins at 4 km/h and 3 mins at 6 km/h, some pain that evening but not enough to deter me. Next time 3 min at 8km/h and I couldnít sleep from the leg pain (quads not knee).
 
It wasnít even the normal post exercise pain so I gave it a rest for a week. Now back to 2 minutes at 8km/h with only limited quad pain so I hope to make it part of my regular routine and will gradually increase the time. At 8 km/h it just feels really good to just let loose with the leg flexing relatively normally and freely (the stiffness is less noticeable when running).

Sometime after the MUA and CPM sessions I was doing the leg sag/extension exercise with the PT and she remarked that the flexion seemed a lot better. It did seem to be good and comparing it against the other there was only about 10 degrees difference. Not sure if it happened suddenly of it was just at the time we noticed it.
I like the leg sag exercise (not the extension bit, which hurts) - the sagging phase it was a bit like using the CPM. So I started doing this using my diving weight belt. I still do it - i think it is a great exercise for improving ROM.

It is easy to do: on your back bend the knee and lift the thigh to 90 degrees (knee points at the ceiling), then drape the weight (I use 3kg) over the ankle and relax the quads, letting the knee gradually bend. This slowly increases the flexion (and feels pretty good as well) I repeat it many times during the evening and on waking in the morning.

Itís now 19 weeks post accident. Since 3 weeks the inflammation is steadily decreasing, pain is less and less frequent and my flexion is getting better. Not there yet by any stretch of the imagination but the I am more optimistic now.

Iím planning a couple of other posts later. Once I do them Iíll link to them on this thread.
  • things Iíd do differently if I had the time over again.
  • My experience with a MUA
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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Re: Comminuted patella fracture - things I would do differently
« Reply #1 on: July 08, 2014, 08:06:36 PM »
This is a list of things which I would do differently if I had the time again (I hope I never do ;) ) and at the end is a list of things that I did do and was glad I did. But everyone is different and as they say, your mileage may vary...

Iíd already been learning about the injury as much as I could and kneeguru was a great resource, it was enlightening to read peoples stories and I wanted to do my own diary to hopefully help out other people. Unfortunately, in the first few weeks I could barely do anything and I didnít have that much new to say. So Iíve saved it all up for here. Hope it is not too boring  :).


I wish I had:

Hired a CPM machine from the beginning.
Hopefully to avoid scar tissue formation and a reduction in flexion. I didnít do this (my physiotherapist  suggested it by doctor said it wasnít necessary). He may have been right but I wouldnít risk it and would get the machine.  (It cost 75 euro a week but in the scheme of things it is easily worth it)

Controlled the swelling better
It seems inflammation may encourage scar tissue formation and that is a very bad thing - if I had read more I would have know this. I had a lot of inflammation over a long time and ice and Ibuprofen and elevation didnít seem to do anything. Next time Iíd go for a compression/cooler or perhaps one of the machines with a larger cooling capacity.
http://www.amazon.co.uk/66Fit-Knee-Cold-Compression-Cuff/dp/B004OWPEO2/ref=pd_sim_sbs_d_1?ie=UTF8&refRID=1H12FF24FFZ4J4BPV8T8

http://www.breg.com/products/cold-therapy/devices/kodiak-cold-therapy
There is also the dilemma about how much exercise to do. Some people say if it hurts donít do it (then I would have done nothing). For me, my knee was constantly swollen, and even walking would make it swell up, so I just did the exercises anyway.

Taken painkillers for longer
I stopped painkillers pretty quickly (after 2 weeks) and think it would be better to continue for longer. With an analgesic you can take more physio and exercise.

Been more careful with the other knee/lower back etc.
When descending stairs I developed a pain in the other knee, and flexion exercises gave me hip pain (trying to go a bit further but instead using the hip - not useful). Doing things carefully and with good form is important (even though it doesnít seem so at the time when you just want to get it done).

Bought an indoor bike/turbo trainer from the beginning
I wasted money on bike hire and needed to buy one anyway. It's for the long term I think.

Read/Learned more and earlier
I read quite a bit about the injury (kneeguru is great and peopleís stories helped a lot) but I should have read more. Sometimes it is pretty depressing and the first few weeks you donít feel like doing much but you should push yourself to do it. I wish I had read more about arthrofibrosis and inflammation earlier.

Things I did do which I think helped

Indoor bike.
Initially it was quite frustrating because I couldnít do one revolution on the highest seat (even with a cushion to make it higher). But even at that stage it was useful to work on the flexion by pressing down on the other pedal with the good leg. I hired a bike initially but eventually decided I needed one long term and bought a turbo trainer for my mountain bike (I donít feel like risking traffic again).

Had an MUA.
At 11 weeks post-accident my flexion was blocked at 80 degrees and I made little progess for the past 6 weeks so I opted for the  MUA recommended by my doctor. Some articles in the kneeguru seem to be quite anti-MUA, and I understand there is some risk but it worked very well for me. This also helped convince me: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765009/

I had a little extra pain after but after 2 weeks I was back to how I was before the MUA except with assisted ROM of minus 10 to plus 120 degrees measured on the CPM machine.

After 6 weeks my (assisted) flexion is at 135 which is only 10 less than the good leg (Iím not very flexible normally).

Exercise
Started going to the gym again and exercising after 10 weeks and on crutches, but it was great to be able to work out again and use different bikes and machines. Started leg presses, leg curls and leg extensions (the bad leg was just along for the ride on this one). After 3 months post-accident I started swimming once a week and at 4 months I started on the rowing machine and running on the treadmill (initially 2 minutes at 4 km/h but soon at 8km/h). Running was a bit premature and I paid for it with quite a bit of pain the following days - it was a weird muscle pain not what youíd expect from exercise at all, but no knee pain. Will continue but more gradually.


Kept in touch with the OS
My OS was very good about scheduling regular appointments (judging from what other people say I was lucky). At one point when I was making little progress I left a message with his secretary and he called back personally and had me come in the next day (he said he doesnít sleep if his patients are worried).
I found the contact reassuring and the advice useful. When I needed the MUA it could be done quickly (following an exam it was scheduled for 3 days later). Apparently it is important not to wait too long with scar tissue adhesions.

Got other opinions
I have been quite impressed with my OS but no-one knows everything and I sometimes think surgeons work in a bit of a bubble so I also consulted 2 other orthopedic surgeons. While I felt my progress was poor/mediocre, one thought it was normal and the other thought it was good considering the injury (I have 4 Kirschner wires, a figure of 8 and a circle). Both said I wonít improve much until they remove the wires. According to them, the wires irritate the tissues, and the muscles wonít become as strong as before with them there.

Decided on Early Removal
My OS is also in favour of early removal. If the CT scan is OK, he will do it early september, 6.5 months after the injury, (normally it is 12 months). Weíll have to wait and see the outcome of this but Iím looking forward to getting rid of the hardware which Iím fairly sure is causing pain and inflammation.

Ate well
I have a good diet normally but added a bit of extra whey protein and continued with multi-vitamin/mineral/omega 3 supplements. I hoped to maintain the muscle mass on the affected leg with the extra calories. Still lost quite a bit of muscle on the injured leg as well as the other one, but the OS seemed to think the loss was less than average.

Electrical Stimulation
I bought a compex muscle stimulator after reading a study which showed better outcomes for the group which used one. Muscle contractions were almost non-existent at first and so it was a bit disappointing but apparently this is normal and the muscle simply wonít react when there has beena trauma. Gradually I saw improvements. Overall I think it may have helped but canít be sure.
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline mjeffrey

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MUA Experiance
« Reply #2 on: July 09, 2014, 06:22:57 PM »
Last post in the series. I hope this may give others an idea of what is involved in an MUA. I'm glad I did it but I've heard it can be risky if the scar tissue is older and therefore stronger.

I found these links helpful when considering an MUA.
http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-12-part-course-frank-noyes-md

Older article but still relevant I think.
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=8903.0


It's 10 weeks post-op and flexion is not improving (see previous posts).

I was booked in for Friday morning but it wasnít until about 2 oíclock that I was wheeled to the recovery room. It was the same porter from last time and I was surprised when he recognized me (it is a medium sized hospital, but the staff are very friendly).
I spoke with the OS and the anaesthetist (who also remembered me from 3 months ago) and soon I was in the OR. A bit of gas and the next thing I know I was waking up attached to a CPM machine (I was a bit surprised as no one even mentioned this).
It was set at 110 degrees, a few minutes later the PT arrived and tried it on 115 and then 120. I was still ok so they left it at that.
 
It was about 4 o'clock when I got back to the room, the PT restarted the CPM machine and suggested i use it until late at night. I was able to control the CPM machine myself and so I could have got up if I'd wanted but I wasn't feeling particularly active :). Apparently it is possible to use the CPM machine overnight and I was willing to do it but the PT said the leg needs rest as well.
At 23:00 I had the machine removed from the bed and got some sleep.

Saturday morning and I was able to take a real shower although I needed both crutches and the nurses were quite reluctant to risk me falling over but I felt quite stable.

The PT was late and I only got on the CPM machine at 09:00. The OS arrived a bit later dressed in motorcycle leathers (I warned him about the dangers of biking  ;)). He seemed happy with everything and said I could go home that afternoon around 16:00. I was given 1000mg paracetamol tablets but I decided not to take them, but did need them a bit later.
On the CPM machine It wasnít super painful just uncomfortable at the maximum flexion (120) and later in the afternoon.

Before the operation I was walking without crutches inside and with a single crutch outside. Now I was back to a crutch inside as well. I was a little unstable again on the bad leg and needed a crutch to walk, even inside. This would last a few days at home and 2 weeks at the office.

Before the MUA I would start with the bike seat on 10 and go down to 8. On Saturday evening, on arriving home from the hospital I could start on 6 and go down to 3. Each turn of the pedals was still painful (at maximum flexion) but at least I was making progress. I was pretty optimistic at that stage but by Sunday I could only get to 4.

Monday back to work, a little more pain than before but not significantly so, not walking as well and still needed one crutch. Monday evening I was still able to cycle on 4 but it was more difficult. Tuesday flexion was worse. The PT suggested getting a CPM machine. I located one on Wednesday and had it that same evening: 75 euro a week through the local Red Cross. Driving was difficult but possible (I was happy I had recently bought my first automatic) and so could pick it up.

The machine has a digital readout of the range of motion and I set it to -10 -> +90. After a time I was able to increase it to 110 but that was it. I was pretty disappointed that I had lost 10 degrees in 3 days and was more than a little worried that it would continue to deteriorate.
I used it for 2 hours the first night and over the next few weeks I would have a routine of waking at 06:00, 30 minutes on the CPM, 10 minutes bike and  in the evening, 2 hours CPM and 15 mins on the bike (plus Mon Wed Fri at the gym with 20 -30 mins bike).
 
I felt it was important to do it in the morning because the knee was at its stiffest then.
Initially on the CPM machine I needed to start at around 90 degrees and got to 110 but gradually I could start higher and go higher as well. After one week I was starting at 105 and going up to 115. When you are pushing the limits the machine pushes away from you (and those last few degrees hurt) so I attached it with ropes to the frame of the sofa bed where I had it was set up and would rub the muscles hard at full flexion to reduce the pain. It was the tight muscles which were causing the pain as much as the knee itself.

After 2 weeks I visited the OS again and he seemed satisfied with the progress - he thought hiring a CPM was an excellent idea and suggested I increase PT sessions to 3 times per week.
He removed some fluid from the knee for the second time (not much this time) and replaced it with a bit of cortisone :). The cortisone worked really well and I felt much better after it. I could walk normally again and the inflammation went down a lot. The knee looked like a real knee again (when it is swollen you donít see the kneecap at all) and stayed pretty good for most of each day (even now it is always more swollen in the evening or after any exercise). The Cortisone wore off after a week or so, but I think it allowed me to get walking properly again so was worth it. I kept the CPM machine for 3 weeks and at the end I was able to start the machine on 120 degrees (the maximum). I was also able to go down to ď1Ē on the bike seat height (it looks ridiculous but it works the knee flexion pretty well).

I have read on some sites that MUA does not cure arthrofibrosis and the scar tissue needs to be removed surgically. That may be true but an MUA treats the problem at a critical time and the OS will remove any scar tissue when the wires are removed (soon).

If you have an MUA, hire a CPM machine so it is there when you get home (I waited too long - 3 days after and you are already losing flexion).

So it is now 7 weeks post MUA. My (assisted) flexion is at 140 degrees. I am now doing 2 PT sessions a week and will probably drop back to one or zero until the operation to remove the hardware.

BUT
Knee is stiff, it does not move anywhere near as freely as the other. It has been improving with time but at this stage I canít imagine it becoming as free as the other without some sort of intervention. I donít know why this is (scarring I guess) but I hope when they remove the wires and the scar tissue that it gets significantly better. This makes the flexion that I have not so ďusableĒ (but much, much better than pre-MUA).

Knee is always stiff in the morning non-assisted flexion is only 100 but it warms up pretty quickly, a few bends and it is at approx 125 or better non-assisted.

Sometimes it is painful at night (normally after too much exercise e.g. running) Seems to be a muscle pain rather than a joint pain.

The knee still swells up after any exercise even walking  500m (it is not at all swollen in the morning)

Knee is still always hot after any movement. In the last week it has been normal in the morning in bed but after walking up/down 2 flights of stairs it is hot again :(.

Every day is different, yesterday was great, I felt really good, today not so great, the result of a bit of running no doubt.
« Last Edit: November 21, 2014, 07:20:55 PM by mjeffrey »
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline Gina1972

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #3 on: July 09, 2014, 06:49:46 PM »
Thanks for sharing your story.  I find it particularly helpful because I just got home from seeing my OS and he scheduled MUA for Tuesday.  I'm so nervous!  I hope I have as good of results as you have had.  I can't get past about 50 ROM which is horrible.  I'm 9 weeks post op so he feels now is the time to do it. 

4/28/14 Slipped and fell at the pool on vacation, Displaced left patella fracture.
5/6/14 - ORIF, no hardware, heavy duty sutures only
6/9/14 - trying to bear weight, no PT yet, (not so)patiently waiting

Offline Madyakker

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #4 on: July 09, 2014, 07:37:00 PM »
Hi Mjeffrey, I have been trying your "sag exercise" for the last 3 days (using my icing belt as a weight) and you are right it does seem to help. It is good to try something new.  So far the only exercise I have had for bending is pulling my leg in with a belt or rubber band which I have tried in various different positions (it is easier on your back with your leg in the air). The sag seems to be very different and aches in other places and since I am not pulling against the belt resistance helps me to relax whilst bending. Don't know if it achieving anything but it feels different. Will let you know next time I am measured. Disappointed on my last visit to the physio since my flexion seems to have platteau'd again at 110. Some weeks you just feel like you have put yourself through hell with the exercises for ages with no obvious gain. I guess all I can do is keep trying.
15/12/13 Kayak accident trap under by leg diag. depr. lateral TPF
20/12/13 ORIF 8 screws
21/12/13 Vasovagal episode
22/12/13 Walk + frame
24/12/13 Home
02/1/14 stiches out vasovagalattack sono physio
16/1/14 1st phys  crutches
27/2/14 PWB
20/3/14 FWB
29/4/14 no crutch occ stick
08/5/14 1st step up

Offline fsugirl

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #5 on: July 10, 2014, 01:41:19 PM »
mjeffrey - I think these posts are fantastic! Thanks for sharing!  I haven't read them completely yet, just skimmed through them... and intend to read them soon.  The concept of sharing what you did & didn't do... what you wish you did... what worked, etc. is awesome!  When I get a little more time I plan to read thoroughly and share my experiences as well.  Just a couple things right now...

I, too, had an MUA and am glad I did.  I also came out of the procedure with 120 ROM; however, I didn't maintain it and again plateaued (at this point, I can't remember at what degree - it may show up in my signature :) ).  Similar to your sag leg exercise, what eventually got my ROM back was a device called the Dynasplint - http://www.dynasplint.com/ .  The concept is similar in that it is spring-loaded and you attach it to your upper and lower leg... and when you are wearing it, it gently pushes the lower half of your leg toward the top.  I could wear it at home or at work.  I could wear it in different positions; however, as you might imagine, it worked best if I were sitting up with my leg able to dangle over my seat/chair.  I'm a firm believer in the product - so much so I even considered taking a sales job with them... but since I'm not truly a sales person, after talking with them, we decided it wasn't the best idea.  I do suggest you check it out if you are having difficulty getting back your ROM.  I read a lot of negative comments online about the financial side of using this product, but I can tell you that my experience was totally fine!  I think my insurance covered a portion of the cost and I paid about $28 a month for the time I was using it & then sent it back with very clear, detailed, easy instructions - at no cost to me - and they cancelled my automatic draft payments as soon as they received it - which was pretty quick.  HOWEVER.... it does sound like the sag leg exercise is a similar and less expensive method, so if that works for you, you may not want to spend the extra money.  Just putting it out there because I believe in the method. :)
3/17/12 patella fracture
3/22 ORIF - 3 screws, wire, immobilizer
4/2 - sutures removed, crutches, nwb
4/30 new brace-locked, referral for pt ~20/25ROM, pwb
5/9 started pt 30ROM
5/18 45ROM
5/25 50ROM-brace to 30
6/1 60ROM-brace to 50
7-MUA
More PT
Dynasplint fullROM
10/30-PT release
4/30/14-HW remova

Offline mjeffrey

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #6 on: July 10, 2014, 07:49:27 PM »
Hi Gina

Good luck with the MUA, from what I have read, if it is done early, before the adhesions have hardened than it is relatively low risk.

There seems to be a lot of concern on the board about MUA so I wanted to document the positive experience I had so others would know what to expect. Most doctors don't seem to communicate so well: I was pretty surprised to wake up on a CPM machine for example.

My only worry now is that while the adhesions were broken, they are still there an I worry if they are hardening in the knee. Some doctors also remove the scar tissue arthroscopically at the time of the MUA, so maybe if you start to get problems this is a future course of action.

The 12 part article by Doctor Noyes is very interesting but also a bit scary and I admit I had to stop reading at some points. I was also a bit annoyed that my OS (perhaps most OSs) didn't address the arthrofibrosis earlier even though I showed classic symptoms from the start.

Maybe read Dr Noyes article, towards the end he gives detailed advice on (extensive) exercises after the MUA.
Strange you haven't had PT yet, but PT on it's own is not enough, you need to exercise yourself throughout the day and without PT guidance it is even more important to follow some exercise protocol.

So again, good luck, I'd be interested to know how it went.
 
Mark
2014:
20 Feb: Comminuted patella fracture, 4 K-wires, Cercalge, Figure of 8
11 Mar: Staples removed Flex 50
22 Apr: Control Xray, flex 80, progress stalled
09 May: MUA: flex 120, 3 weeks CPM
23 Jun: Slow Running, Flex 135
06 Jul: Flex 140
08 Aug: Hardware removed
10 Sep: full flexion

Offline Gina1972

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #7 on: July 11, 2014, 08:43:52 PM »
Hi Mark,

I feel like I have so much scar tissue that I may need the arthroscopic to remove it but I hope I am wrong.  OS didn't even bring it up so I'm trusting that he feels it's best not to operate if it's not necessary.  I have been in PT for 4 weeks and only gained about 15 degrees in that time.  It's just frozen.  So very frustrating. 

I'm super nervous so I don't know if I will read that article except for the exercises.  I already let my OS know I better not wake up with anything torn or a bone sticking out!  LOL.  I just fear that it won't work.  I know everyone is different so I guess we'll just see what I find when I wake up.  For now I'm still pushing it with PT and hoping for a breakthrough so I can avoid MUA but so far nothing monumental has happened :(  This is NOT how I planned to spend my summer!

Gina
4/28/14 Slipped and fell at the pool on vacation, Displaced left patella fracture.
5/6/14 - ORIF, no hardware, heavy duty sutures only
6/9/14 - trying to bear weight, no PT yet, (not so)patiently waiting

Offline fsugirl

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Re: Comminuted patelar fracture and MUA. The story so far.
« Reply #8 on: July 11, 2014, 09:14:28 PM »
Gina - I TOTALLY know how you feel!! It's so weird... it's like anything else where you look back and think, "why was I so worried?" or whatever.  I had actually forgotten how upset and anxious I was at that point until I just read your post. I remember going to each appointment, hoping to gain a little more - enough so that my therapist and/or OS would not think I needed the MUA. I felt like a failure or something... like a weirdo. Granted, everyone around me had much different injuries, but it was so sad to see people coming... progressing... and leaving. :( We would laugh and joke about how long I had been there (especially nearer to the end - I don't think I was in the joking mood earlier on) - I was there when my therapist announced she was pregnant.... and still there when she gave birth (and had to see a different therapist)!! :/

I actually had my MUA around this time in 2012, so I know what you mean about your summer. It all was definitely NOT how I wanted to spend my summer (going to the pool or beach with a brace on was so not cool), but honestly... I said many times that I couldn't have timed it better.  From the day I injured my knee to the day I was released from PT I didn't wear long pants - and the weather was appropriate for that! Annnnd.... I was recovered before the ice & snow came.
The MUA really wasn't bad.  I actually intentionally didn't watch any videos about it - I thought that would just increase my anxiety. I did read up on people's experiences here, though. Since I learned (the hard way) about getting ahead of the pain with my meds from the initial procedure, I was fine... and I did progress...
However...
As I mentioned - the MUA was not THE cure for me, but it was a good push start.  Once again, I plateaued... and once again I worried and felt like a failure. :/ Until I used the DynaSplint... Hopefully, you will progress better and faster than I did, but if not - just know it will get there - one way or another.

It does get better.... you WILL get your ROM... it just varies for everyone... and, unfortunately, I think a lot of that has to do with your OS and how he/she handles post-op. - mine was very conservative (in comparison to many I see on here).

- Anne
3/17/12 patella fracture
3/22 ORIF - 3 screws, wire, immobilizer
4/2 - sutures removed, crutches, nwb
4/30 new brace-locked, referral for pt ~20/25ROM, pwb
5/9 started pt 30ROM
5/18 45ROM
5/25 50ROM-brace to 30
6/1 60ROM-brace to 50
7-MUA
More PT
Dynasplint fullROM
10/30-PT release
4/30/14-HW remova















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