What surgery did I have?

[pixiecat]

This might sound like a strange question, but I had surgery when I was 16 that I was told was a "Patella Realignment"

I had assumed that referred to one procedure, but have since discovered there are different types of Patella Realignment.  I've done some reading, but I'm still not sure which I had.

Some clues:

1. It was done in South Africa, 14 years ago
2. My OS said the reason for my patella dislocating was that I had tracking problems
3. He explained that what he had done was "loosen ligaments on one side and tightened them on another side" and I think he said that the tendons had been reattached to the bone in a different place.  Bear in mind this was 14 years ago so I'm just trying to remember.  They also cleaned our debris and, I think,  smoothed the back of the patella.
4. I'm not aware of having any screws or anywhere
5. I have a scar vertically across the knee about 5/6 inches long
6. I was in plaster from the top of my thigh for 6 weeks
7. I was in hospital for about 2 weeks and not allowed to get out of bed for 7/10 days

Whatever they did fixed the problem and there was no more instablity or dislocations.  I suffered from some pain a few years later and was told I had Chondromalacia and two further arthroscopies were done which seemed to do the trick.

At the time they discussed doing the same on my right knee, which was having similar problems but that wasn't done as my right knee stopped having problems until last year when I dislocated the patella again (treated by 6 weeks in plaster).  Since then there was pain and instability and I had a lateral release 11 days ago.

I'd quite like to know what they did when I was 16 on the other knee, partly for curiosity and partly so I can discuss it with my current OS.

[Gab]

Lateral Release

[pixiecat]

Really?

I thought that was only releasing ligaments, not tightening any as well.  I had a lateral release last week and it's an entirely different experience to the one when I was 16.

I didn't realease lateral release would require 10 days in a hospital bed a cast for 6 weeks - everything I've been told about lateral release suggests you can't keep the knee immobile afterwards.  Also, although this recent surgery has been painful, it's not been exceptionally severe and it was just day surgery with me able to walk.  The last time I was being given an opiate painkillers directly after surgery.  Also, aren't lateral releases generally done by keyhole surgery rather than a 6 inch incision directly across the knee?  I also thought they were fairly quick.  I was in surgery for a lot longer than I was just recently.

Am not disputing if you definitely know, but they explained (a lot I've forgotten) doing a lot more than what I've just had done now and it surprises me given everything I've read about lateral releases just recently.

[Gab]

Well I'm not an expert. To answer your question with 100% confidence would require you to speak to an OS.

Also keep in mind that surgical procedures and ESPECIALLY rehabilitation programs have evolved a LOT in the last 20 years. For example, I had an ACL reconstruction, stayed in the hospital for one night, was sent home the next day and was walking full weight-bearing after 10 days. At 6 weeks post surgery I was walking freely without a brace, working on getting rid of my limp. Someone I know had the EXACT same procedure done around 10-12 years ago. She stayed in the hospital for 5 days and in a cast for 6 weeks (i.e. complete immobilization).  4-5 monhts post-op she was allowed to walk with a cane.

So to sum it up, what you described above sounded like a lateral release from what I've read about it, but I'm not an expert. And what was done 16 years ago versus how things are done today can be dramatically different.

Cheers,
Francois

[pixiecat]

Also keep in mind that surgical procedures and ESPECIALLY rehabilitation programs have evolved a LOT in the last 20 years.

Oh, you just said that to make me feel old!  

You do make a good point and I know a lot of advances and changes have been continually being made.  I was more surprised because of what they said they did seemed different and because they were doing keyhole surgery at the time.  I had an arthroscopy prior to them going ahead with the surgery and a bit over a year later (where I went home walking on my own the same day).

Maybe someone else can shed some more light on what the thinking/procedures were back then.  I suppose I could get hold of my medical records, but considering I now live in the UK and it was such a long time ago, it'd probably prove to be a real nuisance.

[anasta5ia]

Hey Pixie-

It is very possible that you had a lateral release as well as medial reefing or medial plication.  With both of the medial procedures, the medial retinaculum and medial patellofemoral ligament are tightened in order to pull the patella more towards the medial side and back into the femoral trochlea.  With the medial plication, often times the retinaculum and stuff is detached, made shorter and then reattached by pulling it much further across the patella and then stitched in place.  It would not have been uncommon to be in a cast after this as to much of anything could have torn the tissue and you needed to wait until it was sufficiently healed.

Glad this procedure worked for you!!

-Heather G.

[pixiecat]

Ahh thank you, I was sure that they hadn't done just  the LR and reading more now it seems as if the medial plication most closely fits how it was explained to me at the time.  I definitely remember they were loosening and tightening/re-attaching.

It did work very well, I just hope the LR I had on the other knee 12 days ago does works too.  Then I had a private Orthopeadic Surgeon who I saw several times for long consultations.  Now I'm in the UK and using the NHS I got to see a surgeon for 10 minutes tops and I'm not even sure it was him that did the operation!  It's still very unstable and sore, but it's early days yet so we shall see I guess :-)