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Author Topic: Positive MPFL surgery experience  (Read 927 times)

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Offline zendamme

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Positive MPFL surgery experience
« on: January 15, 2018, 05:16:59 PM »
Hi all,

I've found KneeGuru really useful as I recover from this surgery, but at the 6.5 week mark, I thought I would share my story. I know some people have a lot of difficulties but I wanted to share the success I am having so far, despite some complicating health conditions.

I'm from the North of England in the UK. So - I'm 28, in reasonably good health. However, I have osteogenesis imperfecta, a genetic disorder that causes brittle bones and problems with the collagen around your joints. Luckily I have the mildest type;  I had a lot of fractures in childhood but none since puberty, fingers crossed. I have had many soft tissue injuries over the years though. Because of the OI, I also have hypermobility syndrome and generally lax ligaments. Now, to where it all started. I dislocated my right knee when I was 14 and recovered from it fairly quickly. As I went into my twenties, I noticed that sometimes if I bent down, twisted, or even rolled over in bed that my knee would feel like it was about to 'pop out'. I know now that my knee was actually subluxing and that should have been a warning but had no idea at the time.

Flash forward: in my late twenties, I was working overseas when I squatted down on my heels and my right knee slipped to the side, dislocated and popped back in. I immediately experienced huge pain and swelling. Had an MRI which indicated there was damage to my MPFL ligament. I had several sessions of physio, rested and tried to rehabilitate the knee over several weeks but I couldn't bend down and it wasn't getting better. It was making it impossible to do my very physical job, so my employer and I came to the decision I would have to leave and come home to my family in the UK to have the surgery.

Because I had been employed overseas, I was still under my insurance and was lucky enough to have it done privately. I only had to wait 3 weeks. On November 30th, I had the surgery: an MPFL reconstruction with a hamstring autograft. It was done under a GA, I also had a nerve block and some IV fentanyl afterwards. No anti-clotting meds given as I was low risk and they got me up straight away to avoid that.

Came round quickly, spent 1 night in hospital with thick bandages wrapped around my leg. Managed to mobilise on 2 forearm crutches with some wobbling and pain, but was glad I could get to the toilet by myself. The next day, they removed the bandages and I found walking on the crutches hard, my knee was very wobbly and unstable. Went home with instructions that I could PWB on the leg and bear as much weight as tolerated - no brace as my surgeon find the rehab progresses faster without. The hospital physio discharged me with some instructions for heel slides, quad sets, hamstring exercises and extension exercises which I could do straight away. I was to start physio 2 weeks later.

Day 1 - really tough, my pain was not managed adequately at first, was only prescribed codeine with additional ibuprofen and paracetamol which wasn't doing it. So until I got morphine I was struggling to sleep and walk on the crutches. I slept on the sofa as it was close to the bathroom and the only space we had available. Needed a lot of help just with basic things but could get to the toilet and back by myself using crutches. The anaesthetic had made me really thirsty but of course that meant going to the bathroom more which was the worst part! I found sleeping on my back hard but quickly got used to it. I was elevating and icing from day 1 with frozen peas wrapped in a tea towel. I also started my PT exercises from day 1 despite the pain, just doing a little when I could and resting in between.

On day 2, I had a setback when I forgot myself and tried to lift my leg by itself. It wrenched the tissues in my knee and I experienced agony and swelling for the next couple of days. Managed to get in to see my OS the next day at his clinic. He said everything was holding and looked good so it was just a small setback and would resolve itself soon. It started to improve but by Day 5, the pain was still unmanageable so I had to go to the Urgent Care clinic and beg a doctor to prescribe some liquid morphine. This helped so much and I was immediately able to tolerate my physio and able to bear more weight on the leg when using my crutches which made me feel more stable. I still had to lift my leg using my hands and couldn't raise it by myself.

On day 6 I had full extension, but very little bend when doing heel slides due to the swelling. Maybe 30 degrees or so. By day 7, my quads still seemed asleep, barely anything was happening when I pushed my knee into the bed and tried to contract it. But I kept at all my exercises all the same, and slowly I was finding it a little easier to walk on my crutches.

I got my stitches out on day 12 and the incisions looked good. The same day, I started physio - again, I chose to have it privately due to my employer insurance. NHS physio is fine but you never get as many sessions and they don't spend as much time with you. My PT measured my bend and said we only had about 70. She only tried to take it a little further than I could do comfortably, then we had to stop. She said the priority was to get the swelling down, she lent me a CryoCuff which I started using. Within 2 days of using it my swelling had reduced enough that I was able to do a straight leg raise. During this time I also got a shower stool and could finally shower after days of sponge baths - it was HEAVEN, I tell you. After the 2nd week I switched from morphine to tramadol as it made me less sleepy and controlled the pain adequately.

At first I was going to PT every 5 days and getting new exercises each time. My quads were weak, but I worked hard to build them up. By week 3, I was down to 1 crutch. For the first week I had a lot of problems (probably due to hypermobility) with my knee hyperextending backwards when I walked, but I made sure to lock my quads when I put weight on the leg and that quickly stopped. In PT, we added proprioception to my CKCQ exercises - things like heel-to-toe walking forwards and backwards, semi-squats and so on.

At the 3 week check-up with my surgeon, he thought everything looked great. My ROM was 100 when I slid my foot back (about 120 when sitting up with legs hanging off the bed and a gravity assist) but he said he wasn't worried about the bend as that comes with time. He would have preferred that I was off the crutch but said that as I could now do SLRs things would progress quickly. My knee buckled a couple of times when I forgot to lock it but I managed to right myself and the setbacks were only temporary.

By Week 4 and beyond, I was down to seeing my PT once a week. Still rested a lot during the day, and it was only now that I had the concentration to watch a movie or read a book. I was starting to be able to walk without crutches in the house and my balance and proprioception had really improved. I still relied on a crutch when going out as my leg would get tired, and I still couldn't walk far at all. Was still using the CryoCuff a lot and the overall swelling was gradually reducing. For my PT, I was focusing on bearing more weight on my operated leg and doing my exercises using only the right knee when possible.

My ROM was coming along and by week 5, I'd reached 120 and could bend my knee even further back when gravity assisted. When walking, I no longer needed to lock my knee to keep it stable. I was still relying on the tramadol to do my PT and to walk but no longer needed it at night. As opioids tend to >.<, it gave me terrible constipation which was not fun. I tried a lot of different stuff including glycerin suppositories (boy do they work!), senna and finally settled on Fybogel, a psyllium fiber supplement that you mix with water and take daily. That seemed to fix that problem.

Week 6 - my gait was improving and could bear more weight on the leg without the knee buckling. We added step exercises to my PT as well as clamshells, prone hamstring resistance exercises pushing against the other leg and going up on my toes using only my bad leg. I still need to rely on my hands on a surface a little to do that last one, but it's getting easier. My physio also showed me how to massage the tissues around my knee to loosen it. Along with the CryoCuff, the massage has worked wonders - my knee can now get to 128 when prone. I still need opoid painkillers before my PT but the overall pain levels are reducing as I gain ROM and the swelling continues to decrease.

I had a 6-week check-up a few days and all is looking really good, the knee is stable and things are healing up inside. My ROM is up to 130 when I slide my foot back towards my bottom. Compared to my other knee, my thigh looks a little shrunken but I am gaining quad strength all the time and developing a more normal walking pattern. Have completely ditched the crutches around the house and can walk a short distance outside without them, and a little further with 1 crutch. I am still a long way off from my standard level of fitness but it is encouraging. I can get snacks for myself, make a cup of tea, walk around quite a bit. Standing to cook a full meal or doing the washing up is still a way off, but it gets better all the time.

Now I only see my PT every 2 weeks and in a few weeks I'll been cleared to start pilates classes to further rehab the knee and build strength in my core.

The hardest part for me was recovering during the UK winter; we've had snow, rain and there's always a kind of damp cold that just gets into your bones. That makes my knee ache terribly sometimes and I wasn't confident to go outside much at first other than for PT, the doctor and short trips in the car with a friend of mine. Another unexpected side effect was weight gain, partly due to the swelling but also because of the Christmas period and the fact I was comfort eating a bit at first. Managed to get that under control by now, have lost the 8lb I gained by reducing portion sizes, having smaller amounts of wholewheat carbs and fewer carbs in general, and cutting out sugar apart from fruit.

My main problem is I have an extremely active job that also involves tons of stairs, so I won't be able to return to it until my knee is a lot more recovered. We're probably looking at 6 months but I am trying to stay positive. I know it can take up to a year for full rehab. The loss of income and independence has been tough as I have been living on my own since my early twenties, but I am grateful for all the help my family have given me. My PT has been great and never pushes my knee beyond what I'm capable of, she'll try and get a little more bend and extend my ROM beyond what I can do myself but never forces it. I've been able to complete some work from home and am reading a lot of books - I've even set myself a Goodreads reading challenge to motivate me.

Shout to all you guys recovering from an MPFL, I know how tough it is and you gotta take it one day at a time.
« Last Edit: January 15, 2018, 05:49:24 PM by zendamme »

Offline leahjg-90

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Re: Positive MPFL surgery experience
« Reply #1 on: February 17, 2018, 08:16:34 PM »
Hi,

I came across your post and am in a similar position with regards to the MPFL surgery.

I had my first dislocation age 13 and have had a few subluxations since and then a pretty traumatic dislocation in October 2017. I've had an MRI, consultant appointments and a referral to an orthopaedic hospital.

I'm due to have my MPFL by the end of April I have been told and am pretty anxious. I have never had surgery before - so have worries about GA / that side of it and then I am worried about the recovery / pain afterwards. I'm quite independent and hate having help to do things, like get to the bathroom / up the stairs / in the shower.

Your experience sounds really positive. I am at the stage where I am trying to convince myself that I'll be ok without surgery,as long as I am really careful about moving and the positions my leg is in!!

How are you find everything now?

Offline zendamme

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Re: Positive MPFL surgery experience
« Reply #2 on: February 22, 2018, 05:07:29 PM »
Hey, I hadn't had surgery either since an emergency op when I was 5 (which I hardly remember) so I was really apprehensive too; I understand you must be nervous.

It sounds like you really do need the surgery, if you have repeated dislocations it stretches out the ligament which means there's a 100% chance of it happening again. Better to fix it before.

I was partial weight bearing (as much as tolerated) and independent from day one so on 2 crutches you should be fine to get around by yourself. I didn't need help to get to the toilet, just needed a little help lifting my leg back onto bed and so on. If you can avoid stairs you should, if you have a downstairs bathroom I'd recommend moving to the couch for the first few weeks. It made it so much easier for me. Set up everything around you - water, painkillers, snacks, stuff to read, TV remote etc. so you'll be all set up for the first few days. And you will need help with things like making meals and doing chores, I couldn't manage that for quite a while.

You can do it! Be prepared for the pain, the first week is rough and make sure they give you opioid pain meds. Don't worry about addiction, if you're using them for pain your body will not get addicted and you'll know when you don't need them anymore. Ice like crazy and elevate above the level of your heart, priority is getting swelling down because it impedes ROM - if you can rent or buy a CryoCuff ice machine they are absolutely fantastic. Start some PT from day one, I did it straight away and that helped. Just as much as you can manage - heel slides, quad sets, hamstring sets with ankle on a rolled towel; but I am sure your PT will advise you.

Your quads do shut down at first so don't panic too much, keep working them and they'll come back to life! And don't forget to work your good leg too, it takes a beating in terms of strength also. This surgery is worth it though for real, so I hope you go ahead. Stick to your PT schedule, over time it gets easier and you can do more and more.

12 weeks on from my surgery

Things are going well, I'm feeling positive. For the first time in my life when I shove my kneecap or move it side to side it stays put and locked in place. I'm pretty much off my 1 crutch except if I have to walk for a long time, I bring it with me for when my leg tires. But I can walk more than a mile now without crutches so I'm pleased about that. My gait is still a little off, but as my quad strength comes back that's improving. I still need pain meds when doing PT but have reduced them a lot.

Right now I'm doing an intense gym rehab session twice a week, with rest days in between and a physio pilates class mid-week. I'm focusing on quad strength and knee movement so I do the bike, elliptical, leg extensor, leg press & a lot of mat work - bridges, clamshells, squats bending forward from hips and step ups.

Good luck with it all!
« Last Edit: February 22, 2018, 05:17:41 PM by zendamme »