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Author Topic: Six days until TTT and Lateral Release  (Read 1016 times)

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Offline justlikemusic

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Six days until TTT and Lateral Release
« on: February 13, 2015, 02:32:38 PM »
Hello, I am six days out from my first 'real' operation and I am starting to get a bit worried (like I can imagine we all do). I have spent a few months now reading this site and it has helped a lot, thank you.

I am getting major knee pain in both of my knees and my surgeon has put it down to patella misalignment. I cannot even get up and down without my kneecaps grinding and making noise (no dislocation at all). One day the left one gave way on me playing with my children, then a month later the right one at work. After they gave way, each knee was never right since. There was no sudden bad even in each circumstance. Just mucking around with kids and walking up stairs at work.

I am just fearing that there may be other things here which aren't getting addressed (such as ligaments or something). After a MRI, the surgeon has commented that the Patellar apprehension test is positive bilaterally, and the Patellar grind test is positive and reproduces anterior knee pain.

The results of the MRI read:
Mild diffuse chondral fissuring of the patellofemoral compartment and a single focal
full-thickness fissure at the median ridge with minimal subarticular signal change, Subtle low signal thickening of the medial patellar retinacular, Trace of fluid in the region of the semimembranosus bursa, Subtle undersurface high signal at the posterior horn of the medial meniscus is seen on a single image only, and is equivocal but it would be difficult to exclude a very small undersurface meniscal tear.

The Patellafemoral CT Scan basically said that my Tubercle Lateralisation is 14mm (and the limit is 13mm)

On a CT Arthrogram of the other knee two years ago (I decided to do the right knee first now) the conclusion was "Grade III to IV chondromalacia patellae", Please correlate clinically with regard to the integrity of the anterior cruciate ligament and MRI would be of further help in evaluation.

I was booked in for an operation a couple months ago, and i went to see my surgeon this week to ask some more questions, but I just want to know that if he is doing a Lateral Release via Arthroscopy and TTT, would he not only assess the condition of the cartilage and meniscus, but also clean/repair these while he was there? Also what are the chances that he screws my bit of tibia bone back into the wrong spot and we have to do the operation again?

Also I have bought - DonJoy ICEMAN3 with Universal Pad, DonJoy Cool IROM Short Brace, Crutches, Shower Chair (and setup my 42" plasma, queen size bed with gaming PC to kill the hours). Is there anything else that I may need?

I have stopped anti-inflammatory medication (Naproxen) just over a week and a half before the operation and I stopped codeine over a week ago, but I've started taking it now very sparingly when needed together with paracetamol. Should I stop upper body weight training so my body doesn't need to heal when I go into surgery? Should I continue with one protein shake a day and a night time REM Sleep/GH formula (CycloREM). Should I not do anything to keep the weight gain off - so I heal quicker (such as light upper body weights).

I run my own single man business (selling industrial pumps and pump related products) any I really need as little downtime as possible. I can still work from home a little, but driving is a big part of my job. I've been saving for months for this operation and basically if I don't work I won't have any money so I am pretty desperate and wishing everything goes well. Thank you for taking the time to read my post, and I hope to help the Kneeguru community out with my diary once I am in Post-OP phase.

Offline schnops

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Re: Six days until TTT and Lateral Release
« Reply #1 on: February 13, 2015, 08:42:24 PM »
Hey!
So you have a lot of questions, some of which I can answer and some maybe someone else on this site might have a better answer to! Just a little background, I had a TTT and LR on both legs (at different times!) so I hope I can be of some help.

Misalignment can be a pretty debilitating diagnoses. It's pretty common for the leg to give out, but you are right, there could possibly be something else going on in there. If you have malalignment then it can often put you at a greater risk of tearing something, which is why they do TTT's- to address the root of the problem. I have no idea what those MRI results mean, haha ;) but hopefully someone else will! Your OS must've read them and gone over the MRI so I would think if something was torn that he would be aware of it.

On the bright side, usually when they do procedures using the arthroscope, they just kinda "tour" the knee first. Meniscus tears are often missed on MRI's and they also get a better look at the condition of the cartilage. So I would think that your OS would take a look around the whole joint before doing the LR. The success rate after TTT's is extremely high. Of course there are the few people who have had to have the TTT's redone, but I would say it it very rare. They make precise measurements in the OR and will use x-rays to confirm everything before you even wake up.

Only other thing you may want is a shower stool. Sounds so silly but depending on the set up of your shower, it can be really difficult to get in and out. Shower stool allows you to sit so you don't have to worry about slipping or even just standing for that period of time. I found it extremely useful!

In my opinion, I would continue your normal workouts and diet up until a day or two before the surgery. Honestly, you are going to be laid up in bed and taking it very easy for awhile so enjoy the workouts while you can! Maybe just do something light in the 1-2 days before. Really the only things you need to worry about stopping are the things they listed to you during your pre-op appt. After surgery I would stay as active as you can. You will get stir crazy and staying active is good. You'll have some very basic leg exercises to do (quad sets, ROM, leg raises, ext) but if you have the energy to do doe light upper body stuff then I would go for it! But definitely take it easy!!

After my TTT I missed about 1.5 weeks of school, but if you can work from home then you should be feeling up to working within a few days. Are you staying overnight in the hospital? Let me know if you have any other questions! Again, every thing I just said is from personal experiences, I'm no doctor!
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 justlikemusic

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Re: Six days until TTT and Lateral Release
« Reply #2 on: February 13, 2015, 11:02:51 PM »
schnops, thanks for your reply, I really appreciate it.

They have booked me for 1-3 nights in hospital, this coming Friday, with my surgery time after 11am. I have a wife and three children staying at my mother-in-law's house while I am incapacitated at the hospital (as we live about 100km's away) so basically if I get my own room (which they said is highly likely) I will probably stay one night (since the operation is on Friday). I really don't want to stay in the hospital at all if I can help it, they drive me insane. Especially if I am in a shared room I won't want to stay at all.

I am just a little paranoid that it is being done 'by a surgeon of my choice' but in the public health system. So basically the 'trainee doctors' will be doing some parts of the operation, or if he is called away on the day to an emergency, a registrar may do it.

The biggest problem I have found so far is that the two physios I have seen seem to not really know alot... One was really old and wanted to stick needles into me and sell me orthotics and his own personal herbalife style pyramid marketing scheme. The other one said that I needed four physio visits per week to achieve anything (So that's $240 per week...). He was too interested in selling me foam rollers and rock tape for really expensive prices and I'd rather google excercises and see a physio once a fortnight or once a week at the most, I believe that is enough.

Offline schnops

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Re: Six days until TTT and Lateral Release
« Reply #3 on: February 14, 2015, 03:02:55 AM »
I stayed in the hospital one night and was ready to go home the next day. Have you ever had surgery before? Honestly, after a procedure like a TTT I really liked staying over in the hospital only because it just let you relax after surgery. You didn't have to worry about getting up and moving with PT right when you wake up, and you don't have to worry about traveling back home and getting comfortable at home. But many people do have TTT's done outpatient and they do just fine so it really fine either way! Do you know if you will be having a nerve block? After nerve blocks your leg is completely numb and "paralyzed" in a sense because you can't move it at all. A lot of times this delays discharge because PT needs to come work with you before you can leave. But every hospital and OS is different!

If you are going to a teaching hospital then a resident will probably be helping with your surgery. But, there always has to be an attending physician in the OR who supervises them very carefully, so don't worry.  Basically what I'm trying to say is that they won't let anyone who is under qualified touch you during your surgery!

As for pt, I had to go to 3 different PT's before I found the right fit. (That was over a period of time, not one after the other) While TTT's seem pretty common on this website, they aren't so common in the general public and PT's don't deal with them as much as say an ACL tear or something. But I would advise you to find one who has treated patients who had TTT's before. Or ask your OS who he recommends!

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 justlikemusic

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Re: Six days until TTT and Lateral Release
« Reply #4 on: February 15, 2015, 08:53:46 PM »
I am unsure about the nerve block. I know it's going to be done under general anesthesia (maybe gas?). I previously had a lipoma cut out of my back which was pressing on my spine but that's the only surgery I've had done. The problem I have is that the pain meds which they give me (Codiene or Tramadol generally) make me really hyper, like I just want to work. So I am wondering what options I have there also.

I've experienced the physio problem first hand. It was obviously my last physio didn't know what was going on as he was just trying to fix my knee pain by doing exercises like squats etc Taping across the top of the kneecap and moving it to the side a little. All that did was grind my patella even more, and then make it worse. I refused to do it and he couldn't understand why. And yes I still have to pay for the session and I don't get a time extension!

Thanks for your comments, I will post lots of pics and detail the operation in a diary when it happens.















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