Recurrant patella dislocations and surgical questions.

[cmteed]

Hello,
I have had recurrent Patella dislocations on my left knee (5 to be exact) and one patella dislocation on my right. After my second left patella dislocation I had a TTT surgery which was successful for about eight years. In 2008 I had my third dislocation (left). About a month ago I logged my 5th patella dislocation on my left knee. Facts about my knee. It has practically no groove to support stabilization and I have patella alta meaning my patella sits high. My current OS is recommending the MPFL reconstruction as the only viable option at this point. From the MRI, it is observed I do not have much MPFL left from the multiple dislocations. Is this the only treatment option that is available? The doctor feels "my angles" continue to corrected from the TTT surgery. Does anyone else know of other options?  I have had one dislocation a year for the last three years and if I am making the choice for surgery I want to be sure it is the correct one. From my discussions with OS there is no way to surgically fix the lack of groove also it sounds as though they would not consider me for knee replacement due to age (31) and it is not a bone on bone issue. I would truly appreciate any feedback from people. Thanks!

[vickster]

Sorry to hear of your issues

Is there a reason why a trochleoplasty can't be considered to reshape the groove? It's a rare procedure, with not many surgeons doing it, so it might be worth seeking out a second opinion from a super specialist in PF issues. Some info here and possible surgeons to contact. Where in the world are you?

http://www.kneeguru.co.uk/KNEEnotes/primers/patella/patellofemoral-dislocation

http://www.kneeguru.co.uk/KNEEnotes/specialist-commentaries/dr-lars-blond/2014/arthroscopic-deepening-trochleoplasty

http://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

http://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-trochleoplasty

Good luck

[cmteed]

Thank you for the reply! I am in Rochester NY and have one of the knee specialist here. He commented on that surgery however noted that they often are not performed in the US. Which leaves me lind of stuck. Previously  (years ago) when I had made a joke of can you just create a groove a doc commented on the creation of arthritis through that. I have also asked about knee replacements but I do not seem to be a canadit...

[cmteed]

Hello,
Thank you for prompting this thought. From this I have been in contact with a few surgeons and now have an appointment with a Doctor in Connecticut, about 5 hrs from me who does the Trochleoplasty surgery. I have so many questions and look forward to have a wonderful conversation in apx a month when I see him. Are you familiar with this procedure? Do you know anyone who has recovered? Any and all information would be fantastic. Thanks so much for starting a life changing conversation for me

[vickster]

You can do a search on the procedure to bring up patient feedback. Learning portfolio for educational material
Good luck

[leahjg-90]

Hi cmteed,

I have a similar history - recurrent patella dislocations since I was 14 (now 27). My right knee dislocated 8 times, with the last one being severe.

I had an MRI and was diagnosed with trochlea dysplasia (flat trochlea groove) and a completely disintergrated MPFL. I saw a specialist at an orthopaedic hospital in the UK to discuss a trochleoplasty vs. MPFL.

I am now 8 weeks post MPFL reconstruction. A trochleoplasty was decided against by my surgeon for multiple reasons.

There are 4 types of trochlea dysplasia and generally they operate on type C and D - I am type B (flat trochlea). The reason being it is a major operation, with a tough recovery and the best operative results are seen with type C and D.
My age was one reasons to not operate too, strange I know - but due to dislocations I already have some damage to the underside of my kneecap due to the dislocations and what he called 'scuffing' of the patella as it comes out and goes back in.
My surgeon also believed an MPFL was enough to secure my knee for the future.

I am so happy I had the MPFL reconstruction done, despite the general ups and downs of recovery - as expected anyway. My knee feels so stable now and I am confident for the future.

This is just my experience. Good luck.

[cmteed]

After meeting with a doctor who has done apx 37 trochleoplasties he is recommending that I move forward with the procedure. We are also looking into connecting with a surgeon who does the procedure arthroscopically. In searching for information I have found general mixed reviews. I am curious what people's length of time of recovery, pain, and functionality has been after Trochleoplasty. I feel as though I have constant questions. Although this is the option of fixing my knee instability I continue to be nervous and apprehensive. Thanks!

[NatalieC]

Hi there, I'm 3 weeks post surgery so early days. With meds the pain is controlled (paracetamol, tramadol..) And I stopped taking pain relief probably after 1.5 weeks.

Generally speaking it's not been easy and I still have a tough recovery ahead. But coming from a similar medical history to yourself, I honestly thought I had no other option than becoming more and more arthritic, and waiting for a very early knee replacement (I'm 27). Looking at my knee now, I'm amazed at my kneecap being settled into the front of the joint (my left kneecap is still a bug eye, looking to the left!).

You can only go what feels right for you but personally, I thought it was worth a go to save and preserve my natural knee. I couldn't do much pre op so I had not much to lose! I'll also be getting my left done when I can.

Hope that adds to your food for thought...

[cmteed]

Hi there, I'm 3 weeks post surgery so early days. With meds the pain is controlled (paracetamol, tramadol..) And I stopped taking pain relief probably after 1.5 weeks.

Generally speaking it's not been easy and I still have a tough recovery ahead. But coming from a similar medical history to yourself, I honestly thought I had no other option than becoming more and more arthritic, and waiting for a very early knee replacement (I'm 27). Looking at my knee now, I'm amazed at my kneecap being settled into the front of the joint (my left kneecap is still a bug eye, looking to the left!).

You can only go what feels right for you but personally, I thought it was worth a go to save and preserve my natural knee. I couldn't do much pre op so I had not much to lose! I'll also be getting my left done when I can.

Hope that adds to your food for thought...

Thank you for your reply. I am scheduled for Oct 19th. I am hopeful that this will be the answer to my long history of knee dislocations. Trying to plan for the worse and hope for the best

[NatalieC]

Hi there, I'm 3 weeks post surgery so early days. With meds the pain is controlled (paracetamol, tramadol..) And I stopped taking pain relief probably after 1.5 weeks.

Generally speaking it's not been easy and I still have a tough recovery ahead. But coming from a similar medical history to yourself, I honestly thought I had no other option than becoming more and more arthritic, and waiting for a very early knee replacement (I'm 27). Looking at my knee now, I'm amazed at my kneecap being settled into the front of the joint (my left kneecap is still a bug eye, looking to the left!).

You can only go what feels right for you but personally, I thought it was worth a go to save and preserve my natural knee. I couldn't do much pre op so I had not much to lose! I'll also be getting my left done when I can.

Hope that adds to your food for thought...

Thank you for your reply. I am scheduled for Oct 19th. I am hopeful that this will be the answer to my long history of knee dislocations. Trying to plan for the worse and hope for the best

Fab, good luck with your op! I'm now 2 months in and still get a bit of stiffness, and I'm not at full strength yet (but I wasn't starting from a good place with muscle anyway!) However things are really great. Consultant said my recovery is quicker than expected which is always nice to hear! I'd just say take it easy, rest it and don't go too heavy on the exercises. My first few weeks were slow but it's actually paid back tenfold. Ice, lots of Ice! I used CBD balm on my scar and joint, I bought a mini cycle from Argos, and remember the first 6 weeks the bone is healing.. after then I saw a huge improvement 😁

[reflex_nl]

Goodluck - hope all works out well.

What type of pain did you experience / any cartilage damage?


[/quote]

Thank you for your reply. I am scheduled for Oct 19th. I am hopeful that this will be the answer to my long history of knee dislocations. Trying to plan for the worse and hope for the best
[/quote]