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Author Topic: TTO for Patella Alta following patella tendon rupture and fractured patella.  (Read 6925 times)

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Offline randoknee

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Hi all!  I'm currently 3 days post surgery from a tibial tubercle osteotemy.  It's taken me almost 5 years and a bunch of surgeries to arrive at this point.  I thought I'd post a diary of my rehab as I've found the accounts of others to be very helpful in understanding these things and what to expect if facing a procedure.  TTO accounts on this site are a bit sparse. 

First a little background on my knee(s).  How I got here.  I apologize that this might be a bit long winded.   I'll start this now, but will add to it over the next couple of days as I'm on a number of pain medications  and my ability to concentrate is somewhat taxed.  Once I finish the background, I'll limit my posts to observations of this experience and responses to questions and feedback.

My lame story began back in late 2008 when I slipped on some ice and ended up rupturing my left patellar tendon.  The night it happened, the ER Dr  I saw, mis-diagnosed my injury as a simple knee sprain.  This resulted in a two week delay in surgery to repair the total rupture of the tendon (which my Dr described as "mush").  I had an ORIF done to repair that.  And after a long and painful period, I thought I was all healed up.  Then one day,  I was walking across my back yard.  I stumbled and fell to the ground in an obscene amount of pain as my patella snapped diagonally.  So I was back at the ER, and who comes around the curtain but the dumb ass Dr. Who previously misdiagnosed my tendon rupture.  I introduced myself, and quickly told him that I had absolutely no confidence in him and asked that the on call orthopedic surgeon be called.  He ran out of the room, and came back a little later after doing some research into out past interaction.  He then proceeded to make up a lie, attempting to revise the facts.  I s**t you not!  Anyway, he comes back in with my new X-rays.  I look at them, and since I could clearly see my left patella was fractured and displaced I was willing to accept his brilliant diagnosis of a fractured patella.    The "on call ortho doc ended up performing an ORIF with two pins and k wire wrapped in a figure 8 to hold the patella together.  My patella was pretty beat up, and it turns out, , the three holes that were drilled through my patella to repair my ruptured tendon, never back filled with bone tissue, and the spectra sutures used to hold the tendon proximal to the patella may have contributed to the fracture mechanism.  Anyway, as I went through the healing process and follow up appointments I got in the habit of getting print outs or pictures of my X-rays.  To be continued...
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Continuation...  So one day I was comparing the side view x-ray of my knee with an on-line image of normal knee anatomy and I noticed that there was a substantial difference with mine.  I pointed this out to my doctor who confirmed that my patella was sitting much higher on my left leg than it should be.    So life kept happening as I was healing up my busted patella... Only it didn't.   After 8 months I was diagnosed as a non- union patella fx.  So we tried ultrasonic bone growth stim, I research and tried whatever i could come up with in terms is dietary supplements etc.  I'm a non smoker and a light enough drinker that I'm nearly a non drinker.  So after 10 months, my Doctor proposed another surgery to remove the existing hardware. Rough up the bone surfaces, slather it up  with an expensive BMP treatment, drill two new holes throw my patella and permanently wrap a wire around my patella.  I could tell he was just making things up at this point.   My fundamental problem with his approach was that if I had lousy enough bone health of my patella that it wasn't healing with 5 holes drilled through it, how was drilling another two holes in it going to improve my bone health?   ???

 I sought and received a 2nd opinion from another orthopedic surgeon  who was recommend to me.  I came up with a different proposal and capped his recommendation with "but we'll probably end up having to remove your patella."

My recreational passion is long distance cycling... So I contaced a long distance cycling coach based out of Boulder, CO and asked him if he'd ever come across a randonneur who did the longer events (up to 1200km) without a patella... He hadn't but recommended I consult Dr. Eric Heiden. (Orthopedic surgeon, pro cyclist, Olympic speed skating gold medalist.  I flew down to see Eric and his partner Dr.  Phil Davidson.  Phil is also a patello-femoral specialist.   I was examined by both who were far more detailed in their exams than I prevously experienced.   I need up choosing to work with Dr. Davidson for a number of reasons but mainly his experience and interest on PF issues.  He also suggested that based on a detailed analysis of other underlying knee pain issues, he suspected I had some ther underlying issues going on in my knees.    So to jump over the last couple of years, I had him remove the original ORIF hardware, scope both knees with chondroplasty clean ups and over the last year I've had PFAs on both knees to resurface the bone-on-bone in the patello-femoral compartment of both knees.   

So this brings me to this TTO procedure.  Continued on the next post.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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OK,  I'm back.   I'm almost three weeks post surgery for this TTO.   I'll try to cover my experience with the procedure up to this point.  With my Patella Alta, my knee has been very unstable over the past 5 years.   When my knee transitions from straight to a bended position, the engagement of my patella into the femoral groove is very rough and painful.  When walking, if I don't consciously contract my quads to pull my patellar tendon tight, the knee is floppy and loose.  If I relax and walk, I frequently stumble painfully and potentially overload my knee joint when trying to catch myself.  My patella on my left leg sits approximately 25 mm higher than on my right leg.  I had a patella-femoral arthroplasty on the knee back in June. The new surfaces took up a couple of mm, and our plan was to move my tubercle down my tibia about 11 more mm and adjust medially to take care of a bit of lateral tracking in my patella.   Hopefully this will allow my patella to engage the femoral groove sooner and smoother.

So about 3 weeks back I hopped in my car and drove from Bellingham, WA down to Park City, UT for my procedure.  Actually I had a minor hand surgery for a trigger finger release on the friday before my TT0 which was scheduled for the next Monday.   Traveling nearly 1000 miles to have major knee surgery adds a bit to the logistical challenges, but I'm getting used to it.  The hand surgery was a snap with just light sedation.  I managed pain for that with just some extra strength Tylenol, but I'd already collected by supply of post op meds for my upcoming knee procedure, so I knew I had plenty of dope should I need it for the had…   I didn't. 

I checked in for my TTO the next day around noon, and went through the pre surgery routine.  My doc  set this up as an out-patient procedure and figured around 75 minus of OR time.  I had a femoral block as well as general anesthesia.  My doc first scoped my knee to visualize the compartment and performed a synovectomy to clean up some stuff in the compartment.  He then cracked open my knee with the incision starting about the top of my patella, extending down on my shin a bit further.    This was the fifth major open knee procedure that I've had on my left knee since December of 2008.  The tubercle was distalized 11 mm and rotated  medially 5-6mm.  Things were temporarily pinned then position verified using fluoroscopy followed with some beveling of the bone and screwing everything back together with three countersunk canulated screws.  They closed everything back up finishing with 24 staples to close up the skin and moved me to recovery.  I came around and a friend took me back to my rented condo in Park City.  As has been consistent with my 4 prior knee procedures that I had performed at the Park City Medical Center, I felt I was in very good hands.  The docs who placed the femoral block, nailed it.  The anesthesiologists in the OR and everyone else I can remember did a great job.

A friend took me back to the condo that I'd rented for the week.  I had a couple of people check in with me for the next 24 hours till my wife flew down from the NW to drive me home a little later in the week. 

In my next reply I'll talk about pain management and traveling for surgery...
« Last Edit: November 16, 2014, 01:31:50 AM by randoknee »
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Pain management and Traveling.

Before my surgery, my doctor gave me prescriptions for my post surgery recovery.  These included the following:

An antibiotic that I took the night before surgery up to the day after surgery.
Oxycontin 10 mg - 12 hours between doses for long lasting pain control.
Percocet 10-325 mg  -1-2 tabs every 4-6 hours as needed.
Lyrica - 2X/day
Celebrex-200mg -  1 tab the night before he surgery and 1 tab daily
Xarelto -  Blood thinner  - 1 tab daily for 2 weeks.

As an experienced knee surgery consumer,  I'm fairly experienced with pain management for these procedures.    I have had femoral blocks for all of my major knee work.   While they tend to make the knee pretty dead or numb for a bit after surgery, I find them a great way to deal with the pain related to the procedures.   I had one bad experience in the past with my very first surgery related to my original knee injury repair.  I'd asked for a femoral block on that one, but I suspect the candyman missed the mark and ended up overmedicating me in the OR.   They said I kept quitting breathing in the OR.   When I was recovering in the hospital from that one, they insisted I must have undiagnosed sleep apnea and refused to release me until I scheduled a sleep study.   My sleep study said I had no apnea. 

In the past, I have made the mistake of falling behind in the pain med department with the femoral block totally masking pain for up to 48 hours past surgery.  When that puppy wears off and I'm behind the curve in pain meds, It's pretty miserable for a bit while catching up and getting back on top of things.  I was careful and stayed on top of things, setting an app on my I-phone to give reminders of what and when I needed to take my meds… (very helpful in managing meds). 

The use of the Celebrex and Lyrica were new to me for this procedure and my doctor prescribed them to deal specifically with the deep nerve pain and inflammation from the bone work involved. 

I'd used the Xarelto before and found it much simpler to deal with rather than the rat poison with blood testing  routine I had with my first two procedures here in Bellingham.

After I arrived back home, and after my Lyrica prescription ended,  I did have a set-back in the pain department.  My leg from my knee to the ankle became very painful moving from a 1-2 up to a 7-8 when I shifted my leg from elevated above my heart to down.   I contacted my Doc down in Utah and with cooperation of my local family practice doc, I had an ultrasound vein study of both legs and my lower abdomen to verify I did not have any DVT issues going on.  The vein study was negative.    To accomplish the vein study, we had to  take down my full leg splint.  When we reset the splint we added some padding and loosened things up a bit.  Over the next couple of days the pain declined and I was much happier.

I hate taking the drugs that start with OXY.  They sure have their purpose but I hate the fog and the GI tract side effects.  My basic strategy is to gradually space out my pain meds a bit further and then start to swap out one of the oxy-codone with 500 mg of acetaminophen, taking care not to exceed 3000mg of acetaminophen in a 24 hour period.   At this point, I'm down to 500 mg of acetaminophen 2-3 times per day.  It's getting better.

On Traveling…    Traveling to have major knee surgery adds to the logistics, but it's getting pretty easy.   My knee surgeon is based out of Park City, UT and I live in Bellingham, WA.    If you've got lousy knees, go to a ski town.  My doc is a patella femoral specialist and I've found his perspective more nuanced than I've found in my local orthopedic specialists and he has more options and experience in dealing with my patella-femoral compartment issues.  Unlike docs in my local market, he's interested in getting me back to doing what I enjoy doing as opposed to relegating me to pain and or a life of reduced functional activity.

It's a tad under a 1000 miles.  I have taken flights to an from UT for past procedures and have driven.  When I've flown, by the time I've dealt with TSA BS, early check in and catching multiple flights, it still takes approximately 10 hours to get from a Condo in Park City home to seattle with the additional BS of TSA swabbing my bandages for explosive residue and marginal comfort, even if I spring for first class as well as uncomfortable layovers to work my way back home.   

I can easily drive down in one long day with one or two power naps along the way.  When coming home after surgery, Ive had both family members and friends drive me home.  I can stretch out with my knee elevated higher than my heart, and plug in a Don Joy Ice man into an inverter making for a very comfortable and affordable transport by breaking up the trip home over two days…   much nicer.   Down in Park city, I've rented the same two bedroom condo for my last 3 knee procedures.   If I plan my surgeries between the major travel seasons in Park City, it's pretty affordable and can be quite quiet, with lots of first class restaurants and fun stuff to do for my care giver when I'm snoozing or sitting on my ass.

In the next reply, I'll post where I'm at  currently and a couple of pics.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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OK,  Just a quick status and a couple of pics.

My pain is way better.   I'm totally off of the narcotic pain killers and am only taking acetaminophen 500mg 2-3 times per day as needed for pain.  The majority of the pain I fell right now is related to discomfort from the surgical staples and some minor ankle pain from immobility of my splinted leg and ankle.

On monday I'm going into my local family doc, taking down the full leg splint and getting my staples out.  At that point I'll switch to a full leg post surgery brace with the brace locked mostly straight when walking.  I will remain toe touch only till I get to 6 weeks post op.

Also on monday or tuesday I should be getting a CPM machine delivered and since I'll be out of the splint I get to begin passive ROM, working up to 90 degrees max ROM over the next couple of weeks.  I can begin PT too, to include quad activation and patella mobilization.

Since I'm off the narcotics, I can drive an automatic transmission car!   Since I've been sitting on my ass for nearly 3 weeks now, my leg muscles are starting to atrophy.  My plan is to also set up my bike on a trainer and start dong some one leg pedaling.

Below is a photo.   of my post op X-ray showing my new screws and staples.  You can also see the femoral implant from my PFA I had last June.  In it, you can see the bottom of the patella is flat.  I have a plastic button installed there, but it doesn't show on the x-ray. 
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Today is 3 weeks post surgery.  Went into my local family doctors office and we took down the full leg splint and removed my incision staples.  The incision line looks really good.  Everything looks nicely joined up.    Swapped out the full leg splint for a full leg brace.  Soooooo much nicer!  :) The brace is to be locked at zero when moving around on crutches.  I am non-weight bearing (toe-touch w crutches only) till at least 6 weeks post op.    Tomorrow I get a CPM machine and will progressively work up to 90 degrees ROM over the next couple of weeks.  I will also work on patellar mobilization and quad activation.  I'll give my incision line another week off and then start gentle wound mobilization.

Yesterday I booked my flight and rental car for my 6 week post op with my surgeon down in Park City in another 3 weeks. 

I took a good look at the inter-operative pictures from both the knee scope done at the beginning  and the bone work during the "cracked open" part of the procedure.   There was a fair amount of "feathery" synovitis in the PF compartment - probably due to the crappy patellar engagement"… all cleaned up and sucked out.  The bone pics with in progress pinning and screw placement were… a bit gross…
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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It's nice using the CPM machine.  I get to take the brace off a freely wiggle my ankle around while letting the machine work the knee.  I'm going to slowly increase my ROM.  I started yesterday at 35 degrees flex and am only going to progress about 2-5 degrees  per day.   

It was ice taking a shower today without having to completely cover the leg.  I got to scrub away 3 weeks of itchy dead skin that resultd from the full leg splint... Ahhhh!  I did end up placing 4 stiri strips on my incision line as a couple of areas looked a tad stressed.  My knee is still pretty puffy.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Yesterday morning the CPM machine started to develop a squeak and shortly thereafter quit working.   Had the supplier bring out another one so I'm back in motion.   

I also added a slight zap across my patella to help bring down the swelling.   10 HZ criss crossed 15 sec on with 5 sec rest for 30 min at a session.
« Last Edit: November 22, 2014, 08:08:46 PM by randoknee, Reason: Correction »
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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I spent Monday trying to do too much workwise.  I spent way too long without properly elevating my leg. By the end of the day my leg down to my foot had swelled up enough that it would make a suitable umbrella stand.  Much better today.  Tomorrow I have to over do things again, but I'll only over do things about 50% of what I did in Monday.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Today I'm 5 weeks post surgery.  I'm up to 90 degrees flex on the CPM machine.  I sent my surgeon an email today and got permission to progress my rehab therapy to my bike on a trainer.  I've set up to TTO side of my bike cranks with a device to effectively shorten it by about half to abot 3.5" in length.   This give me the ability to make a pedal revolution an not exceed 90 degrees flex.  My non surgical leg will do all of the work until and my bike time will be all passive range of motion on my surgical leg till my doc clears me for active ROM.   Still, this will increase the number of passive range of motion cycles from about 2 per minute on the CPM machine up to about 30 RPM when pedaling very slowly.  This gets the blood moving in both legs and helps with swelling in that leg.  The added benefit is I get to work my non surgical leg and improve my mental attitude.
Below is a pic of my crank setup.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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I'm 6.5 weeks post surgery.  Yesterday, I flew down to Utah for my first in person follow up with my Dr.  The X-rays showed things are healing up nicely.  I was at 100 degrees of flex and had good patellar mobility.   I am now cleared to work on working toward my ultimate flex and begin to slowly progress with active leg function.   I can also remove the stops on the leg brace when walking or take the brace off and use my forearm cruches (just in case) when moving about.  So progress is happening.

I started the day yesterday at about 3 AM to catch the first of the two flights to get down to Utah. The trip home also had two flights.  A wind storm was forecast to hit Western WA in the evening about the time my first flight landed in Seattle.  It did.  I had a scheduled 3 hour lay over before a short hop up to Bellingham and home.

Hanging out at a busy airport with a post surgical leg really sucks.  Traveling with a full brace and crutches is just plain uncomfortable.  My leg tends to swell up if I don't spend a reasonable amount of time elevating it above the heart.  It's a tough thing to do at an airport.  About the best I could do was to slightly elevate it on a chair with little or no relief.    I finally figured out that I could use the horizontal handles of my forearm crutches as a makeshift support to elevate my leg enough to provide effective relief.  It looked a it odd but it worked.    I was hanging out in the concourse with my leg up on my make shift support whe a guy zipped by in a motorized wheelchair and saw me out of the corner of his eye.   He pulled a quick u-turn and stopped right next to me and said, "that's brilliant!"   His artificial leg was off and sitting in his lap.  He said that whenever he flew, his stump would swell up so much he couldn't fit his stump back into the prosthesis sockeot.  He related  his frustration with the lack of adequate public accommodation for traveling with his orthopedic challenges and we chatted and laughed about my solution and he offered some experienced suggestions for dealing with getting around while traveling.   We bid farewell and he rolled off to his flight. 

They loaded us on the plane and put us on a deal as the wind conditions at the destination were unsafe for landing.  The ended up canceling the flight.  What should have been a 20 minute hop by plain evolved into another 7 hours of hurry up and wait culminating in a two hour bus ride home.  It was a 25 hour day by the time I got to bed.

So today I'm taking it easy.
« Last Edit: December 15, 2014, 05:02:21 AM by randoknee »
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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I'm really sore today.  I've started to increase my activity w both legs.  After nearly 7 weeks of limited ROM, limited weight bearing on the surgical leg and no active ROM with that leg, I'm experiencing predictable soreness just about everywhere around my knee and lower leg with this transition.  When it hurts and things swell up, rest it elevat and maybe a little TENS.  When things feel better...maybe a little more work.

Also, I thought I'd add a quick photo of my recent x-ray showing the progress of the bone healing post TTO.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Merry Christmas all.   Next Monday I'll be 9 weeks post surgery for this TTO.   It's been about a week since my last post.

I'm making pretty good progress overall.  I'm full WB and getting around well without a brace on the leg and haven't been using cruches.  I am very careful though with every step I take.  My Knee flex is over 110 degrees in the surgical leg.  When navigating stairs and steps I make a conscious effort to find and use the handrail.  Most of the time I'll try to take a bit of the load off the leg on stairs but am able to use the surgical leg actively going both up and down stairs. 

When working my leg on my bike, I've lengthened the crank arm on my  bike about an inch from my starting point.  I'll probably move the pedal out another 1 cm tomorrow.  I find that cycling, indoor,on a trainer gives me great therapy for improving my ROM and mental health.  I'm hoping that in another 4 weeks or so I'll be at the full length of my pedal and maybe bet out for a spin in the road.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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Oops... A bit of a setback.  :-\

So yesterday was a very cold but lovely day.  I decided to putter around the yard and take care of a few chores that have been neglected since my surgery.  I stepped on a frost heave which unexpectedly collapsed and dropped about 4", instantly overloading my TTO leg.  As the pain ramped up I quickly yeilded to gravity and took an undignified fall on my arse rather than attemp to arrest the fall and tear my relocated tubercle off my tibia.  Fortunately I can still walk and everything seems intact.  My TTO site is a tad swollen and sore today.  The moral of the story- is, to be very careful for a while... Especially in icy and cold conditions.  Use a leg brace when negociating potentially uneven surfaces.  It's better to be a bit of a wimpy chicken rather than end up back in surgery.

I'll take things easy for a couple of days at least till the leg calms down and the swelling and bruising are gone.  If things aren't better in a week or so, I'll check in with my OS.    Oh yeah... Happy new year!
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment

Offline randoknee

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So the surgical leg is still a bit sore.  But it's getting a tad less sore... I think.   I say "I think" because, I've made a change in my meds...   I've quit taking all pain killers and or nsaid's...   Cold turkey.   With this last round of surgery,  I had been taking 1,000 mg of acetaminophen 2X day.   Well below the stated max,  but over the years I've bopped between Naproxen, and Ibuprofen and max daily doses.   At times it feel like someone has been kicking me in the kidneys.  As a result I've developed a horrendous case of tinitus.   I have a constant ringing in the ears that at times drives me nuts.  :o  I think I'm beginning to have a bit of a reduction in the ringing...  it seems to come and go, but last night I was able to sleep without too much aggravation.

But,  With the cut back in the the pain relieving meds,  I'm feeling all those middle age aches and pains that I was effectively masking with the over the counter pain meds.  I'll use this "new year" opportunity to work on this get of the pain meds experiment  and loose some weight that should make all of the knee bits work better and with less pain.

Since my fall on Jan 1,  things have improved enough to get back on my bike and move the leg a bit.  I ice my knee and elevate it a couple of hours every evening to get swelling down and control pain.    I'm finding I have some pain on the medial side of my left knee  that is more medial than the site of my relocated tubercle.   It seems to work fine.  I can extend the knee to zero and my ROM is over 120 degrees in that knee.   I just have to work through the pain.  I'll give it another week before I fess up to my OS.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment