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Author Topic: Georgie's MPFL Reconstruction, TTO and Tibial Derotational Osteotomy  (Read 17961 times)

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Offline Georgie28793

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Hello everyone,
 
I am scheduled for surgery on Friday 24th April and wanted to start this diary to remember everything for when I have my other leg fixed and to hopefully help any one else who needs these procedures done at the same time.

The surgery itself consists of an MPFL reconstrucstion using my hamstring, a tibial tubercule transfer, a recession trochleoplasty and a supramalleolar derotational osteotomy ( at the ankle).

I have been told I will be in hospital for 4/5 days, with a plaster cast on my leg for two weeks then into a locked brace. Non weight bearing for 8 weeks, then partial for 4. Should hopefully start walking unaided at 12 weeks but I am hoping it will not take this long.

A little background about my knees - pretty average on this site, my knee caps have been dislocating since I was about 7/8 years old, once dislocated my left patella by making my bed! Dislocated them both at the same time doing a handstand at school. My unpredictable knees have really held me back - I have stopped nearly all sports which I loved, i cannot go on long walks without them seizing up, I have ridden horses my whole life and it's getting to the point where I can only sit on the horses for 15 mins before they really start hurting.

 In August 2014 my knee cap was kicked out of place and I couldn't put it back in for 50 mins until the ambulance arrived and they took me to hospital. I was diagnosed with tibial torsion, grade 4 trochlea displasia and patella alta along with miserable malalignment. I am worried about the surgery but (without sounding dramatic) I want my life back where I am able to do all the things I enjoy without worrying about my knees! And at 21 years old it seems like the best time to do it.

Any advice or knowledge on these procedures and the recovery would be greatly appreciated, I am very worried!!

I will post after my surgery to start my post op diary.


« Last Edit: May 20, 2015, 10:16:14 PM by Georgie28793 »
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline lucha86

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Re: MPFL, TTT, derotational osteotomy + trochleoplasty at 21 years old
« Reply #1 on: April 20, 2015, 08:28:44 PM »
Hey Georgie welcome to the forums :)
I saw your post and thought wow! You have a rather lot done...........
I just want to say to you this remember no matter what you read everyone's recovery is unique and everyone progresses at different speeds............ :D
I think you can understand this as I suffered a lot of dislocation before my mpfl reconstruction with hamstring tendon.... That sometimes trying the surgery or the unknown is your best chance of gaining at least a sense of normality back as when you knee keeps dislocating you just want to live I suppose  :D
Regarding mpfl reconstruction I would say make sure you time your medications so then that way you are pain free I bought a cryocuff which is an Icing system to reduce swelling but as your having other surgeries I would speak with your surgeon before using it  :)
You might get points of frustration and rather tears which is normal for me the hardest was not having my independence for the first couple of weeks .........
Be aware also of heights of chairs etc as when you have had knee surgery I found some chairs were too low for me to sit on in the first couple of weeks ........ :)
Just remember I know it might seem scary this surgery but keep positive and think of the positive outcomes that you will get from it :) keep us posted :) I'm sure others will answer too :)

Offline Georgie28793

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Re: MPFL, TTT, derotational osteotomy + trochleoplasty at 21 years old
« Reply #2 on: April 20, 2015, 09:00:03 PM »
Hi Lucha,

Thank you for your kind reply! Your diary was actually one of the first I read on here!
It is rather a lot of surgery and came as quite a surprise because for years doctors were telling me I 'just had bads knees' and would 'grow out of it', so it came as quite a shock to be told I had so much wrong with my legs.
Thank you for your advise of the chairs - I hadn't thought of that! I can imagine it's the first few weeks that are the hardest - it's great to have people on this site who understand what it's like!

How is your knee now?

Georgie
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline lucha86

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Re: MPFL, TTT, derotational osteotomy + trochleoplasty at 21 years old
« Reply #3 on: April 21, 2015, 07:05:03 AM »
Oh Georgie I know how you feel when I was 16 and my knee kept dislocating they put me in a cast for like 5 weeks a cast on my whole leg lol  told me it was growing pains and I would grow out of it which I didn't lol and then just dealt with it lol
When you have dislocations the damage you can cause us greater to your knee rather than having a surgery to try to fix it :)
Thank you got reading my diary :)
The knee have more surgery in the next few weeks just waiting on the nhs list now my surgeon has three plans but he wants to have a look inside before he decides what plan :) so fingers crossed and keep us posted on your surgery but remember go at a pace that your comfortable with :))

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #4 on: April 26, 2015, 10:38:40 PM »
Today I am two days post op.

My surgeon decided last minute not to go through with the trochleoplasty, which (especially now the nerve block has worn off) was fine by me. This meant I was having three procedures, the MPFL reconstruction, tibial derotational osteotomy and TTT.

I went into surgery at about 9:15, was given a spinal and then general anaesthetic, all happened very quickly and the next thing I knew I was awake in the recovery room. The clock on the wall read 13:30, so about 4 hours in total. I was wheeled back to my own room, my parents turned up a bit later to see me. I felt fine after the anaesthetic, not groggy or drowsy. My surgeon came in to chat about the op and said it all went fine etc and I am due a follow up with him in two weeks time when I will get the plaster cast removed.....

The plaster cast! So heavy and itches like crazy - although I'm told this could just be a side effect of the oramorph.

I spent two days in hospital, was pretty uneventful except when the nerve block wore off and wow! It hurt. It was so sudden as well. So some advice to anyone about to have this surgery - ask as soon as you come round about pain meds!! I was blissfully unaware as I could move my legs fine and assumed that meant the block had already worn off.

Apart from that, I have felt a little woozy from all the meds, and actually quite achey and stiff all over (although I think that was from seizing up from the pain for 50 mins when the nerve block wore off and I had to wait for more pain meds to kick in) otherwise Igs been okay. My leg aches but all the while the cast is on there is little I can do. Will just have to wait and see.

I was sent home from the hospital with codeine, naproxen and oramorph, which I have been taking religiously.

Will update when the cast comes off :-)

2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #5 on: May 01, 2015, 11:15:24 PM »
Today I am a week post op. I would be interested to hear if anyone else feels far worse 1 week after the surgery than the few days after? I feel like my pain and movement is steadily getting worse.
I understand the nerve block helps originally, and I was on some serious pain meds at the hospital that I wasn't allowed to take home, but it's so de motivating to feel more and more pain throughout the day. I am not doing much due to the fact I have this huge plaster cast on, and every time I try to do a bit of walking around it feels ten times worse than it did before.
If anyone else has experienced this or has some advice, I would be grateful to hear from you!

Negativity aside, I should be getting the huge plaster cast off this time next week, and going into a locked brace with either small plaster cast of my ankle or a stabilised boot thing. Either way it will be great to go into something a bit lighter!

I wonder if having my leg straight for 2 weeks post op will affect the movement I have in my knee compared to someone who starts physio as soon as they have their surgery. I hope not. Again, if anyone has experienced this I would be interested to know.

Not really much to say until I have the cast off. My days consist of going downstairs in the morning, watching tv and heading upstairs again in the evening! Getting so bored, at least the brace will give me a bit more freedom.
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline lucha86

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #6 on: May 02, 2015, 12:21:09 AM »
hey georgie
remember the first two weeks of any surgery is painful for anyone, =) i had for the first two weeks shooting nerve pains, some pains you couldn't even describe because  were that strong codeine phosphate seemed to be my friend for the first two weeks which turned me into dory the fish out of finding nemo lol remember screaming down the phone to my doctor to ask for stronger painkillers lol i planned my longer walks when the painkillers had just set in so if i had any pain it wouldnt be as strong......
i dont know your area of where you live generally my neighbours were awesome as i started walking down the street and they kept shouting you can do it keep going or kept an eye on me if i go too far from the house sometimes i felt just by walking up the street by my house i felt less enclosed lol living in the house can get frustrating especially when you rely on others for the first few weeks

for me i found it was hard to start walking on it but once i got moving on it it got easier the pain management but as you have had other surgeries i can comment on those but only mpfl
remember your quadriceps top part of your leg will be weak (atrophy) it will take time to build that group of muscles to work  and fire up but keep up with the exercises your physio gives you and you will be fine......=)) keep us posted =))

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #7 on: May 03, 2015, 09:11:02 PM »
Lucha - took my pain meds before I did anything today, and that definitely helped! Trying to stay ahead of the pain but Im not taking half as many meds now so just trying to gauge when I might need them before the real pain sets in.

So I have read a lot of the post op diaries on here for TTT and MPFL, and I seem to be having it a bit easier than some people on here!! So far the pain is bad, but manageable, and I'm just moving around fine on the crutches, can get up and down our two flights of stairs easily, all in all I'm doing pretty well. I don't know if it's because I did a lot of muscle work before hand, or that I'm in a plaster cast that is obviously offering me a lot of support, but things seem to be going well. I had a good day today, just waiting to hear back from the hospital for a date to have the plaster cast removed.

After that, the real hard work starts! I'm hoping these 2 weeks in plaster won't set me back when it comes to the physio, I can tell my quad is very weak already no matter how much I tried to strengthen it before hand.

What sort of physio did you start with for your MPFL? I'm not sure what I will be doing as I will have to be in a below knee plaster for the derotational osteotomy I had at the ankle. So most likely just bending and things I suppose.

Weirdly I am able to tense my quad with absolutely no pain, but occasionally I move and feel the sharpest acute pain in my knee where I'm assuming they performed the MPFL. But of a stupid question but do you know what's causing that sharp pain?

So far I can't feel any hardware in my leg which suprises me considering how many screws I saw on the x Ray. Not that I'm complaining!

A good day today, going to try to get a wheelchair as I haven't been out of the house in 10 days now and it's driving me mad!!

2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline lucha86

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #8 on: May 03, 2015, 10:41:32 PM »
i know what you mean georgie i dont know where you live but im from the Uk and there are talk shows called jeremey KYLE on television and they are enough to drive you out of the house there that bad after a week lol
I found taking the painkillers waiting for them to work did the bigger tasks first working to the smaller tasks at the end......... I think sometimes its good to get out and feel some sense of independence or normality =)

in relation to your exercises for MPFL reconstruction i was given heel raises with a towel, standing on your feet behind the back to your chair, leg raises, heel drags as in to flex the knee towards me etc, i found straight leg raises took time as lost a lot of quadricep function which is normal, it takes time so do not worry it does become in a way funny but frustrating that your telling your quad to lift your leg and your leg doesn't do it but its normal lol but i cant comment on for the TTT..... another think was alot of massaging techniques to help the knee and reduce scar tissue etc....

with the sharp pain they catch you off guard and make you jump at times? i had them they ease back after the first few backs i got told it was part of the healing process/ nerves or sometimes felt like a jolt of stabbing pain??

one thing i will say georgie is remember everyones recovery will always be unique and you will know what you can and cannot do and when your ready to do things =) know what your comfortable with and ask the physio when you see them any questions you have or extra exercises they can give you for me through the mpfl i had i found to my cost that having a physio is vital and to keep the leg moving.........=) keep us posted  georgie

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #9 on: May 04, 2015, 10:54:38 PM »
Lucha - I am from the UK also and can't bear to watch Jeremy Kyle!!! So I agree with you there!!


I think I jinxed myself by saying I was having a good day yesterday.

Today I have been admitted to the Emergency Department Observation Unit because it is thought I have a blood clot in my calf. By now I am used to the rushing blood feeling when you stand ups, it's not nice but goes away after a few minutes. But this morning I woke up to agony, the back of my calf was so hot I could feel it radiating out of the plaster cast. Rang the out  of hours Dr, who proceeded to tell me to get to the hospital Asap and I would be seen within  the hour. I ended up waiting in A&E for about 2 hours in real pain before my mum demanded to be seen, where the receptionist told us she had accidentally marked me as minor injuries which had a waiting list of 3+ hours.... I was then seen straight away. Had to take my cast off, which was actually the worst pain I've felt since the surgery. The two nurses couldn't work out how to get the cast off and ended up pressing down on the incision sites. I went through a whole tank of 'happy gas' and oral morphine before I was cast free. First time I've seen my leg since surgery and wow! The incisions are really neat, the bruising is terrible!!! My whole ankle and heel are purple with blood and my leg is covered with yellow and purpleish bruises. To be expected I suppose. Anyway, now staying in over night as they had no one to work the ultra sound machine on the bank holiday.... So scheduled first thing in the morning. Was given blood thinning injections and a new temporary plaster cast put on as it was a whole other pain having no support around the broken bones! In a lot of pain but going to try and get some sleep and hopefully will be fine tomorrow.

Not a great day!
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline lucha86

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #10 on: May 04, 2015, 10:59:23 PM »
hey georgie i also had blood thinning injections too then they thought i had a blood clot too my leg swelled to triple the size couldnt feel my foot i went from 30mg of celexane to 180mg of it per day, even my surgeon was shocked with my leg didnt say anything for 10 minutes my leg calf foot swollen blistered red and hot lol  its a rather worrying experience but they are the most important medication to take they hurt in the stomach but they are there to keep you safe luckily i got cleared with the ultrasound , i hope all goes well for you tomorrow with the ultrasound, keep positive =) your in the right place  great to hear your incisions are good keep us posted and remember if you have questions ask the doctors to give you the answers and dont let them leave until your happy =)) happy gas is the best experience lol i started speaking spanish on it rather than english  lol
« Last Edit: May 04, 2015, 11:02:50 PM by lucha86 »

Offline OSVictim

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #11 on: May 05, 2015, 04:28:15 AM »
Georgie,
So sorry to hear of your terrible day.  I thought I had a blood clot with my bad surgery in 2012 (lateral retinacular release, TTT, and arthroscopic debridement) and wound up in the emergency room 3 times in the first 2 weeks post op. My foot, ankle, and lower leg had swollen to a ridiculous size, were all bruised and purple like crazy, and so painful. I was fortunate, I did not have a blood clot. But I truly believe that those conditions were brought on because my leg was in a fixed brace, and immobilized after that surgery. With my recent MPFL, LPFL recon, and tibial / fibular derotation, I wasn't externally fixed, and so while I was in great pain and miserable, I truly believe the range of motion exercises that Doc had me doing around the clock, along with these things called vena pro cuffs that he had me purchase and use the first few weeks went a long way toward heading off potential blood clots. The swelling, while still substantial, was nowhere near as bad as it had been with the 2012 surgery.
Confirm you have a plate and hardware holding the 2 ends of your tibia together in the new position? Did they plate your fibula? How high above the ankle did they do your osteotomy on the tibia and the fibula?
I traded lots of texts with Natenix, another patient who had distal tibial and fibula osteotomies. We traded X-rays, and I noticed that his fibulas had both been cut much higher than mine. He had told me that the fibula that was cut lower hurt much worse than the one cut higher during the recovery. My fibula was cut 8 cm above the ankle, and it can tell you that pain was far worse than the tibia. Seems like the closer to the ankle = more pain and more adverse effect on the ankle and supporting structures. Once the fibula was plated, it felt a lot better - still painful, but much more support.
I hope you get some sleep and wake up to good news tomorrow. Recovery after what you have gone through is challenging enough without added complications like this. Hang in there!
Aug 2012: Rt Knee Arthroscopy/debridement, Lateral release
TTT/open Fulkerson tibial osteotomy
Aug 2013: Hardware removal (TTT)
Nov 2014: LPFLr, MPFLr, Distal Tibial  Osteotomy/derotation, Gastrocnemius lengthening, Rt Leg
Apr 2015: fibula (Rt leg) plating, iliac crest bone graft

Offline boxerlover

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #12 on: May 05, 2015, 03:14:25 PM »
Georgie....are you feeling any better?  That's one nasty surgery you had!  I feel for you!!!

Lucha....Dory - hahahahaha

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #13 on: May 05, 2015, 07:25:50 PM »
Hi everyone,

I am out of hospital now, stayed over night and had the ultra sound. Luckily no sign of a clot but Was given blood thinning injection anyway as they said being in a full leg plaster cast means I'm higher risk from DVT.

The consultant and co believe the plaster cast that I was out in whilst unconscious wasn't done properly - too tight, too much padding and not enough space for my leg to swell. Therefore there was a build up of pressure in my leg with no where to go, and that's what likely caused the pain. I would guess that's whynit hurt so much when the original cast came off!

Home now topped up with more pain killers, also a new cast called a back slab? where only the back of my leg has plaster cast and then bandages across the front, so my leg can swell comfortably. Feels tonnes better already!

Lucha, glad to hear you too were clear of a blood clot, it's a big relief to know you don't have anything else wrong after a big surgery! How is your leg now?

OSVictim - in reply to your post, my tibial Osteotomy was cut literally above my ankle!!! Complete guess but from my x Ray I would say only a cm or two above my ankle, so I am going to try and forget that part of your message where you said the closer to the ankle the more painful it is! I am trying to get the x Rays sent to me and will show you when I can. I will attach a photo of the incision site and you can sort of see where it is. I did not have the fibula broken, just the plate and screws on the tibia. Feels so much better with the plaster cast back on supporting my ankle, was agony having my foot out of the cast and my ankle flopping forward!!
I should also only be in this full cast another week or so, then hopefully will start at least a little bit of physio. Do you think being able to move straight after surgery helped your recovery?

boxerlover - out of hospital now and feeling better now I am dosed up on meds and at home, thanks! I'm sure I read some comments from you somewhere on here quite recently, have you just had surgery or are about to have it soon?
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy

Offline Georgie28793

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Re: Georgie's MPFL, TTT and derotational osteotomy
« Reply #14 on: May 05, 2015, 07:29:25 PM »
Here are two photos of my new leg! In the first you can see the immediate difference in angle compared to my right foot, which flops to the right side! So bizarre to see my left foot sticking upwards!

I am 12 days post op now and am glad my leg has been covered up - I think the bruising looks bad now, I'm sure it would have looked a lot worse last week!

OSVictim - not a great picture but the plaster nearest my ankle covers the incison where the plate is, the plaster to the left covers the little incisions for the screws. Is that similar to your osteotomy?
2000/14 - multiple dislocations of both knees
August '14 - bad LK dislocation
April '15 - LK MPFL reconstruction, tibial tubercle osteotomy and supramalleolar derotational osteotomy















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