Advertisement - Hide this advert





Author Topic: UKR and ligament instability  (Read 3335 times)

0 Members and 1 Guest are viewing this topic.

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
UKR and ligament instability
« on: September 20, 2004, 03:01:46 AM »
Hi guys!

Anybody out there know if it's possible to do a UKR and ligament reconstruction at the same time?  

My unloader brace has stretched out my medial capsule/MCL repair and my knee is now really unstable.  My OS thinks there are few options for my severe arthritis pain, which now occurs at rest and is really limiting my ability to walk.  He doesn't really want to do a TKR because I'm only 30!  

We're trying to find out if it would be possible to do an MCL re-reconstruction and UKR.  He thinks that the ligament instability may be a contraindication to doing a UKR, though.

Any thoughts or experiences with anything like this?  Any help would be appreciated!

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: UKR and ligament instability
« Reply #1 on: September 24, 2004, 06:55:35 PM »
Hmm,

Well, I keep reading the ortho literature on UKR and I can't find squat about MCL laxity!  If there's ACL or PCL laxity, then you can't have a UKR.  Anyway, I'm trying to get an appointment with a joint specialist to see what the possibilities are.

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline RGrelsamer, MD

  • Forum Faithful
  • ****
  • Posts: 191
  • Liked: 1
  • User's Text
    • Ronald P. Grelsamer, MD
Re: UKR and ligament instability
« Reply #2 on: October 04, 2004, 04:23:52 PM »
My first thought is "The Unloader brace could do that???"
I love partial knee replacements, but there's no question that they are "fragile", subject to loosening when the forces across them aren't quite right.
Questions you have to ask yourself include, "how many more operations can I tolerate?",  "just how bad would it be to have a traditional knee replacement?", keeping in mind of course that you are indeed quite young.
R Grelsamer MD
 www.KneeHipPain.com

Due to time and legal restrictions Dr. Grelsamer can respond just once to queries on the Bulletin Board. Thank you for your understanding.

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: UKR and ligament instability
« Reply #3 on: October 05, 2004, 03:25:19 AM »
Thanks for the response.

We're pretty sure the unloader is the culprit.  I had a MCL/medial capsule plication for chronic medial laxity, which (I'm told) is susceptible to stretching out over time anyway.  It's been loosening a little over the past few years.  It seems to be much worse the past few months and I haven't injured it.

Honestly, I've almost reached the point where I would rather just get a TKR and get it over with.  My OS, on the other hand doesn't want to do it unless there is no option, because of my age and occupation (I'm a resident in general surgery.)  

Thanks for your time,
Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: UKR and ligament instability
« Reply #4 on: October 05, 2004, 09:23:20 AM »
Danielle,

I don't have any suggestions for you, just was curious as to how the capsule can stretch out and not go back.  My OS specifically did an insufflation designed to stretch my knee capsule out and rupture adhesions and keep the adhesive capsulitis in check.  He told me that the capsule would go back to shrinking and getting tight soon after the insufflation.  In fact, some people have had repeated ones.

So anyway, I just thought it was odd that we have the exact opposite problem.  I'm wondering if thermal shrinkage or something like that--which my OS Dr. Steadman uses to tighten up loose/stretched ligaments--would be remotely feasible on the knee capsule...?  Probably not, but I thought I would throw it out there.  Might be worth taking at rip to see someone who does this procedure.

Maybe between the two of us we have a whole, normal knee....and FYI, though my job is sedentary (writing on a computer all day) by career is being very negatively impacted by my knee pain.  So it's not just an on-your-feet job that is threatened by these d*mned knees.  I try to work as long as I can before I can't take it any longer and have to go elevation and ice.

Take care.  I'm sure your medical career will be enhanced by the fact that you will have lots of empathy for your future patients.  I know that's small comfort to you now....

Heather
« Last Edit: October 05, 2004, 09:24:23 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: UKR and ligament instability
« Reply #5 on: October 05, 2004, 07:35:53 PM »
Heather,

I didn't just stretch my joint capsule, I tore it wide open when I tore my MCL in 1999.  My OS said he'd never seen an injury that bad without also tearing the ACL and dislocating the knee.  It didn't heal with a year's worth of conservative treatment.  We had discussed heat-shrinking as a possible option at the time, (my OS, incidentially, did his fellowship at Steadman-Hawkins) but the laxity was way too bad for it to work.  I also have to wonder if I have some sort of connective tissue disorder as my ligaments seem to be rather fragile.  I've torn 2 in my knee, 2 in my ankle (one just a few months ago) and one in my thumb with minor traumas.

The biggest issue with my occupation is the amount of time I spend on my feet (16+ hours every day).  This has negative ramifications on how long joint replacements will last  (and also means that nobody would even consider doing something like Carticel - which I'm not a candidate for anyway, because the damage is too extensive)

I'm not saying that folks with sedentary jobs aren't affected by knee pain.  But I have to feel that it is more difficult to have bad knees and a job where you can't sit down, or even stop, no matter how bad things hurt!  

Hopefully, in the long run this whole thing will make me more empathetic.  While I really feel for the folks who have pain after major problems, I find that my constant severe pain, lack of sleep, and personality of not complaining make me rather empathy-impaired for patients who whine and complain about all the little things.  Anyway, I have an appointment with a joint reconstructive specialist in 2 weeks, so hopefully, we'll be able to get some answers.

Take care,
Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: UKR and ligament instability
« Reply #6 on: October 06, 2004, 09:02:15 AM »
Danielle,

I totally agree that your job exacerbates the knee pain...and the swelling.  I can't imagine what your melon-knee looks like at the end of a 16 hour shift.  And I imagine your 'cankle' is a truly impressive thing (that would be the calf-ankle, whose borders have been obliterated by swelling).

Anyway, I just wanted to let you know that even if you were to think of doing a completely sedentary job, pain would still likely have a big impact.  Sometimes people are told the strangest things, like 'just get a computer job and your knee will get better.'  WRONG.  Kind of like story of a good friend of mine with terrible patellar arthritis--she stepped in a deep hole on a construction site where she was a secretary for the contractor.  She snapped her ankle and somehow gave herself a massive chondral lesion on the knee...which then turned into AVN (I think that's the right term) where the cartilage was gone and the bone was crumbling.  Anyway, she was in a ton of pain.  She was also 100 pouds over weight (12 pregnancies in 8 years, with four live births, an emergency hysterectomy, and depression-fueled eating will do that to you).  

Her doctor said "lose weight and your knee won't hurt any more."  She actually managed to lose 108 pounds in two years--fantastic results.  But her knee hurt as much as ever, and she was kind of bitter.

So anyway, didn't want to leave you with the impression that a sedentary job would cure the knee pain.  If the cartilage is gone, it's gone.  You and I are going to be the patients that benefit from advanced cartilage repair techniques, and maybe even stem cells.

I'm really sorry the lack of sleep and grinding pain are getting you down.  I'm right there with you.  The last two months have probably been some of the longest in my life.  My career has been negatively impacted; for the first time in my adult life I missed a deadline.  Kind of upset about that...I've never had my best not be enough before, but that's what this whole knee thing has unfortunately taught me...that sometimes whatever you do you can't control the outcome.

So enough introspection.   I really hope the joint reconstruction specialist has something to offer you.  Also, have you done the genetic testing to determine if you have EDS or some other connective tissue disorder?  That would certainly provide a lot of new paths to explore.  I do have HMS to a certain extend.  My physiatrist called it something like acquired gross joint hypermobility, which sounds suspiciously like something she cobbled together ;-)  But the gist of it is that my largest joints (hips, knees, shoulders, and SI) are hypermobile.  So is my entire spine.  I also have a pronounced Dowager's hump that if I don't stay on top of will make me look like Quasimodo.  But my PM doctor things the hypermobility I have is acquired to a certain extent, from years of gymnastics and competitive swimming during all the formative years for my musculo-skeletal system.  In short, I'm Gumby!  Not sure how much this helps anyone in determining a regime for me to follow, but it's probably worth exploring.

Hang in there and  keep me posted.  I've never met anyone who tore their knee capsule, and it's terrible that it didn't recover and shrink back to its original size.  Hopefully the specialist will have some ideas.

Heather
« Last Edit: October 06, 2004, 09:05:23 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Beauzer

  • SuperKNEEgeek
  • *****
  • Posts: 855
  • Liked: 0
  • I want to become the person my dog thinks I am
Re: UKR and ligament instability
« Reply #7 on: October 16, 2004, 05:42:25 PM »
Well, my appointment with the joint specialist is Monday at 11:30.  I'm getting really nervous about it and I'm not really sure why.  :-/

The pain's been really bad the past couple of days.  I actually took some vicodin the other night (which I have to be pretty desparate to do).  All it did was make me nauseated and dizzy, but didn't help the pain at all.  

Proving to me that the ligament instability is getting worse, the knee went out on me and popped last night, just walking from the living room to the bedroom.  Ouch.  It's still really painful today.

I'm on vacation this week, but I'll try to post what happens with the OS.

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05