Advertisement - Hide this advert





Author Topic: Dislocation AFTER Fulkerson?  (Read 935 times)

0 Members and 1 Guest are viewing this topic.

Offline shellyme

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
Dislocation AFTER Fulkerson?
« on: September 23, 2014, 02:03:11 AM »
Hi everyone! I'm hoping someone has had the same experience as me -- a sublaxation/dislocation AFTER a Fulkerson, and can give me some advice. Here goes:

In February 2013 I had a left knee Fulkerson osteotomy with lateral release and tightening of the MPFL. All went well, and I had the right one done in November of that year. Also went fine. This past August -- so about 18 months later -- I had a freak accident (involving a swingset, go figure) and had a pretty serious sublaxation/dislocation. Turns out that the MPFL repair had not been sufficient and the ligament had stretched back out. Swelling has all gone down now and I'm in PT, but the kneecap is still very wobbly. My surgeon has never had someone experience a sublaxation reinjury following a successful Fulkerson, so she is monitoring it until November at which time she will hopefully be able to make the call as to whether I can avoid having another surgery or not. If I had to go back in for surgery, she would this time do a hamstring graft to strengthen the MPFL.

Since this is outside the realm of her experience, I really want to find out if 1) anyone out there has had this type of reinjury after a Fulkerson and 2) if they did, did they have the surgery to graft onto the MPFL to strengthen and tighten it? And 3) if yes to both :) did the surgery prevent further dislocation/sublaxation?

I'm willing to go back under the knife if it means an end to the dislocations, but if there's still a chance of it post-surgery, I may be better off just continuing to strengthen and watch my alignment.

Any information/advice much appreciated! Thanks!
Shelly


Offline Summer007

  • Forum Faithful
  • ****
  • Posts: 252
  • Liked: 1
Re: Dislocation AFTER Fulkerson?
« Reply #1 on: September 23, 2014, 09:01:56 PM »
Hi Shelly,

My reply probably isn't going to offer you much help, but I have also suffered instability following a Fulkerson surgery. I had a TTO (with MPFLr) at the end of July in 2013. Everything seemed fine initially after the surgery- my surgeon even said that he thought that he had over tightened things, so basically my knee wasn't going anywhere. After about six weeks my knee became very mobile again and at about the four month mark I was experiencing subluxations again. They seem to get worse after each one but I haven't had a full dislocation.

Like you, my surgeon hasn't had an experience of instability after surgery. He is struggling to find any solution and he has said that it is the end of the road in regards to his capabilities. He did mention doing a MPFLr with donor ligament to see if it would make it stronger, but where it would be the third time doing the same ligament he wasn't too keen.

I would be very interested in talking further to you and seeing how you get on as I haven't come across anyone else that has had instability following this sort of surgery.

Summer :)
October 2011-L LR
August 2012-L MPFL Recon
July 2013-L TTO & MPFL revision
March 2014-L Arthroscopy surgery

Offline schnops

  • Forum Faithful
  • ****
  • Posts: 230
  • Liked: 15
Re: Dislocation AFTER Fulkerson?
« Reply #2 on: September 28, 2014, 04:54:27 PM »
Hi,
I'm with Summer and can't really offer too much help, but I'm experiencing the same thing as you guys! I had TTO's on both of my legs (separate times) but did not have an MPFLr. I had my first TTO April of 2013 and starting subluxing again around Jan of 2014. Like you guys, my surgeon has never had this happen before and is kinda lost as to why. Do you know if your femurs are rotated at all? I've been told that my femurs are internally rotated which could be an explanation for the subluxations.Unfortunately there aren't many drs that know how to deal with these issues.

Are you seeking second opinions at this point? I just made an appt with another OS, but I'm not all that confident that he's going to be able to help either. Can you dislocate just by pushing your kneecap? In the mean time I would keep strengthening. Can't hurt, right? There aren't many people who have had instability after TTO's, but there are a few diaries (they are pretty old) where people had to have either MPFL or TTO redone or have a derotational osteotomy if their femurs were in fact rotated enough to warrant surgery.

Stay strong!!
Schnops
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline shellyme

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
Re: Dislocation AFTER Fulkerson?
« Reply #3 on: October 01, 2014, 10:07:36 PM »
First of all, I am SO glad others are having a similar experience! Sorry I didn't respond earlier, I didn't have my email settings to notify if someone had responded - oops.  It's discouraging news though that none of our surgeons has had anyone to compare us to! In my case, the continued subluxation is pretty definitely due to the overstretched MPFL -- I definitely have genetic "loose ligaments" and it seems this one has just reached its point of no return. My patella is super loose so I think I could sublux it manually, but I certainly don't plan to try it!!

I've thought about the second opinion, but wonder if I'd have to search for a 3rd, 4th, or 5th to find a doctor who has had this patient experience... Maybe we should get all our docs on an email for a consult :) I agree with you Schnops that continuing to strengthen helps big time. I'm back in PT and am also taking personal training with a Pilates specialist who works in a sports med clinic. So far, she's been really helpful in strengthening up my weak spots (VMO, glutes, core - probably typical).

Summer, I will definitely keep in touch and will send any updates as I get them -- my next surgeon appt. is Nov 4 and I'm hoping she can give her recommendation on whether or not to do an MPFL reconstruction at that time... it may just be more "wait and see." You keep me posted too and maybe we'll hear from others out there!

Shelly