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Author Topic: Leenie's MPFL Reconstruction  (Read 18840 times)

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Offline Leenie

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Leenie's MPFL Reconstruction
« on: August 13, 2014, 10:38:27 PM »
After more than a decade of recurrent patellar dislocations on both knees, my OS has finally convinced me to have MPFL reconstructions on both knees, 8-10 weeks apart. The right knee is scheduled for surgery on September 22, 2014, so the earliest that the left knee surgery will take place will be the week of November 16. As I prepare for my surgeries, I have a few questions. I have gotten so much helpful information from these threads that I am hoping someone might be able to answer these questions for me.

How much time should I expect to be off work? My OS is being a little sketchy on this point. I have very sedentary work. I have read everything from taking off three days to upwards of three months. My job is very flexible as to how much time I take off, but I just need to give them an estimate. I've never had knee surgery, but for laparascopic abdominal surgery in January, I took a full week off from studying and took it easy for six weeks post-op. Does anyone know how the MPFL reconstruction recovery compares to that for abdominal surgery? It sounds much worse....

Along related lines, for people who rely on public transit, how long did it take before you were comfortable taking public transit? My parents would be able drop me off at the local train station, and there is a bus that goes pretty much door-to-door from the downtown train station to my office. Getting a seat isn't usually a problem on this bus line or on this train line. However, my most recent dislocation showed me just how much walking getting from the train platform to the bus stop entails. My mother offered to drive me all the way to work, but I imagine that would get pretty old pretty fast.

Would you recommend a wheelchair? I am absolutely terrible with crutches. I also thought that using a wheelchair might get me back to work faster, especially if I got one where I could keep my leg propped up.

Does anyone in the U.S. have any idea how likely insurance is to cover an ice machine? It sounds like a godsend. I have BCBS PPO, if that helps at all.

My OS said I won't start PT until six weeks post-op, which sounds relatively unusual. Can anyone whose OS followed that protocol comment on how that impacted their recovery? I would also be in a locked brace for those six weeks. Also, that means that my left knee MPFL reconstruction would be only two weeks after I started PT on the right. Any idea on how I'll be able to get around through that kind of recovery timeline?

How long was it before you were able to conquer stairs? I'm planning on sleeping of the first floor of my house as long as I need to, but my bedroom is on the second floor.

Offline rob2278

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Re: Leenie's MPFL Reconstruction
« Reply #1 on: August 15, 2014, 08:54:46 PM »

Hi Leenie.. sorry to hear about your knees, but hopefully this surgery is a success and your patella instability is a thing of the past.

I had the surgery about seven months ago. I have to commute into NYC for my job, but am 'lucky' enough to be freelance so I could take off as much time as I needed to.

So.. to answer your questions - since you have to deal with mass transit, I would give yourself 3 weeks (if you can) before going back to work. The first week will be hell. The second will be better as you wean of the pain meds, and the 3rd you'll be feeling like yourself again. Your knee will also be at the point where getting around will be a lot easier.

I would opt to learn how to use the crutches - you're much more independent on them then you would be in a wheelchair. Especially if you're talking about needing to do stairs. It's going to take weeks before you're comfortable doing stairs.. And going up will come a lot more quickly than going down, believe it or not. If you're on crutches you can probably manage to lead with your good leg up and down after about a week I would imagine.

My ice machine was covered as a medical necessity by my insurance company. I was also able to get a CPM machine for a few weeks. I'd suggest you look into the same. The quicker you regain ROM, the quicker your recovery..

As for PT - if the DR repaired your existing MPFL (and did not use a replacement) then the recovery is usually a little more conservative to allow the ligament time to heal. I had a replacement and was in PT one week after surgery. By six weeks I was brace free and just about had full ROM.. but every recovery is different
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 Kiramama

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Re: Leenie's MPFL Reconstruction
« Reply #2 on: August 15, 2014, 11:02:41 PM »
Hi Leenie, I had MPFL and MCL reconstruction surgery 4 weeks ago and I'm only just starting to think I could return to work or try public transport, up to this point I've needed to elevate my knee 99% of the day so the thought of sitting at my desk etc. has bedn out of the question.

I've started a post-op diary which goes into detail should you need it.

Not once have I iced my knee, I'm not even sure if an ice machine is available here in the UK but I have found a gel which I had imported from the US and I honestly could not live without it - Biofreeze. I found it on Amazon and its a greeny blue gel which freezes the area you apply it to and completely numbs the nerves, honestly I would give up anything to keep this little beaut. Worth a try if your medical costs are mounting up.

Good luck and stay postive, this is start of your new life where you are able to achieve anything.

Offline lucha86

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Re: Leenie's MPFL Reconstruction
« Reply #3 on: August 16, 2014, 08:49:04 AM »
Hi Lennie I'm from the uk as well... I'm post 12 weeks mpfl reconstruction
I travel a lot due to my work I found to be comfortable in public transport I would say 6-7 weeks if your going on undergrounds subways, as escalators can be a pain...... I had to go to heathrow airport for a flight to Mexico City x4,by underground and I forgot how fast escalators are lol

Icing I was doing as my leg did swell a lot I managed to get a cryocuff for 90 pounds which I must admit was the best buy possible I could sleep with it on and it would remain cold for three hours........

Crutches I agree with rob are a good idea and also by swinging on crutches it gives your upper body a workout and will get you moving quicker....and it will make your legs work harder........ And I had no brace so it was harder at some points

As for pt I was shocked that under nhs in England I had to wait 5-6 weeks post op for a physiotherapist so I hired my old gym trainer to cone to my house as she is a qualified sports therapist best thing I ever did as she pushed me and got me going quicker and I started jogging at post 80 days surgery because of her... I'm now running post 12 weeks, but like rob said if they repaired the mpfl that might be why he is asking post 5 weeks of you as I had a full hamstring replacement.....

Stairs you can conquer post 2-3 weeks post op to be comfortable with the stairs add another few weeks going downstairs is a lot harder than going up.............escalators will take around 5-6 weeks
I have also done a post op diary you can certainly have a look as well

But remember everyone's healing and body is different like rob said everyone's recovery is different I wish you all the best and a speedy recovery....

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #4 on: August 18, 2014, 02:43:21 PM »
Hello Rob, Kiramama, and lucha. Thanks so much for the advice.

It sounds like I should tell my boss to expect me to be out for 3-4 weeks after the surgery, and longer if I have to commute on the train. Maybe I will see if my mother can drive me between the office and my house, at least for a few weeks before I'm ready for the escalators and walking in the train station.

Did you use underarm crutches or forearm crutches? Like I said, I'm not very good at using crutches. I was practicing with some underarm crutches yesterday, and I reminded myself just how much of a disaster I am. I should probably keep practicing though, so it isn't a shock to my system when I have to rely on crutches post-surgery. If I end up using underarm crutches, I'm definitely going to get some padding for the underarm and hand grips.

That's interesting about a lot of doctors pushing back PT with an autograft, as I'm actually getting a cadaver graft. I'm having three ligaments reconstructed on each knee, so maybe that's a reason why I will wait so long for PT? One of my biggest worries is with that schedule, I will only have had two weeks of PT on my right when I have the reconstruction done on the left knee. It seems like my right knee and right leg will not be very strong at that point, but suddenly that will have to become my good leg. I did a lot of research before picking this OS though, so I guess I have to trust him.

After hearing about your recovery processes, I'm anxious to have the surgery so I can start what sounds like a difficult recovery! But I guess it's good that I have time to prepare.

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #5 on: August 27, 2014, 09:02:45 PM »
Ugh. I just got a job offer I have to turn down because I would have to start on September 22. Which is the day of the surgery on my right knee.
It wasn't the greatest fit for me, because it's not really the kind of work I want to do and I would have had to move across the country. But man, for what I do, it's a lot of money to leave on the table.

Offline Kiramama

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Re: Leenie's MPFL Reconstruction
« Reply #6 on: September 21, 2014, 06:55:10 PM »
You never know Leenie, you may have had to let the opportunity go this time but when your fit and well something and better will hopefully come along.

Offline lucha86

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Re: Leenie's MPFL Reconstruction
« Reply #7 on: September 21, 2014, 08:05:33 PM »
remember leenie some things happen for a reason because they lead us onto more greater things =) hope your recovery is going well keep us posted

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #8 on: September 23, 2014, 02:05:23 PM »
So, yesterday I had the MPFL reconstruction on my right knee. I am able to get around better than I thought I would, although the nerve block hasn't worn off yet, so I know that the worst is yet to come. I was sent home from the hospital with an ice machine, which I'm trying to use as much as possible. The scariest thing so far is not knowing if I am putting too much weight on the right leg. How on earth am I supposed to know what 20 pounds of weight is???

Lucha and Kiramama, thanks for the support, especially regarding the lost job opportunity. I am just trying to tell myself that things will sort themselves out once my knees are stronger.

Offline HerbM

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Re: Leenie's MPFL Reconstruction
« Reply #9 on: September 23, 2014, 05:10:15 PM »
Congratulations on the surgery and getting home.

Twenty pounds is about the weight of a medium to large leg (I am a big guy and my weighs about 25 lbs, don't ask :) ).

So even if you are small, this likely means only a little more than the weight of the leg itself.  (To be safe if this is a hard limit, that's probably what you should estimate UNTIL you can check with your surgeon, e.g., call the nurse or PA if in doubt.)

One trick with the cold therapy machine that was given to me and works is to freeze water BOTTLES and just pop them in the machine (then back to the freezer for next time.)

I have a Polar Care cold therapy given to me at my hip surgery -- it was eating a 10lbs bag of ice for a couple of runs, but now I have 12 medium water bottles frozen for loading it.  (I think they are the 12 oz size, or maybe only 10oz.)

The machine has the pump hanging down into the water reservoir, so I fill it with water as marked, then add 4 bottles with the pump in the center (5 bottles fit but then there was no room to insert the pump.)

Your machine may not be the size or shape of mine so you may need shorter bottles or be able to use larger ones etc.

With 12 bottles, I have 3 sets so there is time for the first set to freeze by the time the third set is exhausted.  (This setup will keep cold on for a couple of hours OR MORE, haven't run it beyond about 2 hours yet with this method.)

It also makes for a pretty easy replenishment if you can't easily take the machine to the freezer.  Just get a plastic bag (to catch the drippy bottles and make carrying easier) then take them to the freezer and bring back four more (or however many your machine needs.

As to the missed job, I think this quote from you says it all, "... it's not really the kind of work I want to do and I would have had to move across the country. ..."

Ok, a lot of money, but for doing something that doesn't fit or make you happy?  Probably good to pass that.

Also, if someone is willing to pay you a lot to do something as a bad fit, then you can likely get close with what you REALLY love.

Best wishes
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HerbM

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #10 on: September 24, 2014, 05:41:49 PM »
Herb, thanks for the tips! I have learned so much from this site.

Today my mother and I removed the bandages as instructed. The knee was really swollen, but not as gross as I expected. Now I am really feeling the ice.

I am getting around alright, although standing up gives me the worst pain. For the most part, the pain meds seem to be doing their job.

Yesterday, a man turned up with a CPM machine. Which would be normal, except my OS NEVER talked about it, and there was nothing in the post op instructions. And it was sketchy because he had no paperwork, just handwritten instructions on how to use the machine. It turns out that the OS decided to prescribe it at the last minute. I'm glad I called the office though, because his CPM protocol is different than the instructions that came with the machine.

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #11 on: September 29, 2014, 10:48:41 PM »
Today is post-op day 7, and I can't help but feeling like I've hit a plateau. It's harder to measure daily progress at this point. The pain is bad but manageable. I still have trouble getting around, but I've figured out how to do what I need. I'm up to 50 degrees on the CPM machine.

I started developing a rash on my thigh, which I have to imagine is from the brace because it is right where one set of pads and straps wraps around my leg. The other pads hit me where I am wearing an ace bandage around the knee and where I am wearing compression stockings. Does anyone have any advice for clearing this up?

The plan was to go back to work next Monday, but I'm not sure that will work out. Physically, I think I will be up for it, but my parents are backing out on their agreement to drive me to work until I can take the train again. Since we did the right knee first, I can't drive myself. I need to get out of this house!

Offline Kiramama

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Re: Leenie's MPFL Reconstruction
« Reply #12 on: September 30, 2014, 08:22:29 PM »
Hi Leenie, I think your right re the rash, try to always have something between you and the brace (eg. Tracksuit bottoms) or try not having the straps so tight. I also removed the brace as much as I could when I was resting, I know it's pain to take off and on but your leg needs to breathe still.

I really wouldn't recommend returning to work so soon, I know you feel guilty for being at home and I too wanted more than anything to get out and be amongst people again but if you can't manage to get there unaided how are you going to manage carrying files, getting a drink or even making your way from and to the restroom. These are questions your employer needs to be asking. Also are they willing to provide a stool so that you can continue to elevate your leg, if you think you won't need to do this then I would suggest sitting as if you are at your desk when you at home and you'll be able to accurately judge your own levels of discomfort. Another thing when your back at work is you will be expected to deal with your normal levels of work and processing, which you may struggle with if you are currently on medication as the side effects can effect you more than you realise.

I'm certainly not wanting you to not go back, but I'm just wanting you to think over the things you should be considering before committing to returning. I struggled 2 weeks into my return as I still wasn't sleeping and felt physically and emotionally drained, unfortunately this wasn't good enough for my employer and although I don't agree with their actions towards me I can completely see from a business point of view I was not  performing adequately.

As a side note I'm now booked in for my other knee a week on Saturday and I'm completely sick with dread on how I'm going to cope, just gotta keep focusing on the positives !!!!

Offline lucha86

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Re: Leenie's MPFL Reconstruction
« Reply #13 on: October 01, 2014, 07:00:17 AM »
Hey Lennie I think kiramana is right try to have something between the brace and your leg I got a rash / irritated skin from the cryocuff ice cooler machine and I put cream to moisturise the skin on it and something between the cuff and skin......

Don't worry you haven't hit a plateau remember your body has been through a lot in only 7 days so it is normal especially after mpfl reconstruction to feel that I felt like that around 7-9 days post mpfl surgery

Staying in the house foes drive you mental after a while lol what I did was I walked one block next to my house to give me done normality on my crutches and my neighbours would come out and talk to me while I tried to walk :))

With work it took me 5-6 weeks to get back as I had complications but do what you feel is best for you if your still on a lot of Meds it might be an idea to take a little extra time off before you return to work.... And until you feel stronger

Keep us posted :)))) take care

Offline Leenie

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Re: Leenie's MPFL Reconstruction
« Reply #14 on: October 08, 2014, 04:58:50 PM »
I've started wearing leggings between my skin and the brace, so by now the rash isn't bothering me, which is great.
Late last week, I switched from the pain meds to ibuprofen, which has been working pretty well.
Yesterday was my two-week post-op appointment. I didn't see the OS, but his physician assistant said that the incisions and swelling all looked good. Now I can slowly work my way up to 90 on the CPM machine, and I can unlock by brace to 90 when I am sitting. My knee still feels best when it is elevated. The bad news is that I won't start PT for four more weeks! I know that I have lost a ton of strength in my leg, so I'm anxious to get started, not least of all because that is only two weeks before I am scheduled to have my left knee done on November 17! Right now, I am terrified. How will I possibly get around when my "good" leg has only had two weeks of physical therapy???
I decided to try returning to work today. So far, work is slow because other people were covering my assignments for the two and a half weeks that I was out. My mother was amazing and drove me into the office this morning, and she is on standby to come pick me up this afternoon. We imagine that sometime between 3:00 and 4:00 I will be exhausted and sore and have to leave. The hope is that I will be able to work part time from home, so I only have to get to work three or so days a week until I am able to take the train in again. My boss has been very understanding so far, but wish me luck having that conversation!
I hope that I haven't pushed myself too hard, but I really needed to get out of the house and be around more people!