Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11

To let us know how you are getting on for the first days and first few weeks after your operation or injury. We would be interested in knowing about pain levels and meds, dressings, using the CPM machine, swelling, icing regimes, mobility, exercise regimes, bathing and travelling issues, etc.
JFVolleygirl27

Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11

Post by JFVolleygirl27 »

I am now a little over 2 years post op since my left knee surgery. It's doing fantastic! I began playing competitive volleyball again.....however, 3 weeks ago, I suffered a patella dislocation on my right knee and will be getting surgery on Oct 3 in Houston, Texas.

I started a new post op diary for this procedure: https://www.kneeguru.co.uk/KNEEtalk/viewtopic.php?t=9
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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11

Post by jrfrerichs1 »

It's been 12 years since I kept this journal following surgery on my left knee, and 10 years since undergoing the same surgery on my right (October 2013). For anyone reading these journals years later I must say that I can no longer recommend Dr. Sanders of Houston, TX. It's quite sad because there was a long period of time where I revered this surgeon. Both surgeries were successful in terms of stabilizing my patella and preventing dislocations. Since these surgeries, I have had no further dislocations nor issues of instability, and have had no limitations to my physical activity level. That being said, Dr. Sanders did overcorrect my right knee to the point where I now have 4.3 degrees of varus--which is a far cry off from the 2 degrees of valgus/normal alignment on left leg. It's noticeable, but not something that I ever worried much about since it didn't cause pain or issues.

On Feb 16 this year, I went back to see Dr. Sanders for a grade 4 cartilage defect under my patella from a dislocation 10 years ago that was starting to become symptomatic. Still, it was only occasional pain on top of my kneecap and only happened with certain activities like lunges, squats, and occasionally stairs. I was running 8k's with no pain before the February surgery. It was supposed to be fully arthroscopic to retrieve a cartilage biopsy as I was considering moving forward with the MACI procedure on my patella to be proactive. I woke up from the surgery with a long incision and radiating pain below the knee on the lateral side that would shoot down my tibia. I was on crutches for near 6 weeks. Dr. Sanders brushed off this extreme lateral pain as a nerve injury from the nerve block but never ran an official test like an EMG to confirm. He only put me on Lyrica, a nerve med, which was completely unnecessary as I did not actually have a nerve injury.

I made appts for a second and third opinion with two other DRs (Dr. Frush, MI - Studied under Dr. Teitge and Dr. Cole, IL) in early April. It was at this point when a post-op CT scan and MRI were ordered, and I discovered there was a large grade 4 cartilage injury along the weight-bearing portion of the femoral lateral condyle, a lower grade spot on the medial side, a large loose body, a small piece of metal, and an extreme amount of bone edema, particularly on the lateral condyle. Both of my condyles were in pristine condition prior to the February surgery. As a result of the new damage, I had to get a second arthroscopic procedure to assess and measure the new damage and remove the loose body. The grade 4 cartilage injury on the lateral condyle is much worse than the defect I had to my patella, in terms of its size and symptoms, and a "divot" in the subchondral bone underneath was pointed out, where there was evidence of a fracture. The Dr. also said its very typical for pain to radiate down the tibia/lower leg from a lateral chondral defect, whereas chondral defects on the medial side typically cause more focal pain. Prior to this second surgery, he had also ordered some nerve testing to determine if I did, in fact, have any nerve injury as Dr. Sanders suggested--the test came back perfectly normal.

So now, not only am I dealing with a large grade 4 chondral injury to the weightbearing lateral condyle, I also have a bony defect there. This has caused continual catching/locking sensations when bending my knee past a certain point like when walking. I have not be able to run since February 15. And I still deal with occasional sharp pains on the lateral side below the knee joint. Obviously, if I could have predicted that a low-risk, routine arthroscopy could go so so wrong, I never would have done anything. But who goes into an "arthroscopic" procedure expecting to wake up with an incision, a subchondral bone fracture, and grade 4 cartilage injury to a weight-bearing condyle? There are always possible complications with any surgery, but this was egregious error, far beyond a 'complication.' I was trying to be proactive and prevent the cartilage defect under my patella from worsening. But I barely notice patella pain any more since the new lateral symptoms have been so significant and I'm obviously not doing squats and lunges any more. The only thing that triggers patella pain right now is actively extending my leg out to full extension.

This all has led to me needing an osteochondral allograft to fix the new damage. I just received a donor graft recently and will be moving forward with the surgery early next week. Needless to say, this has quite frankly been the worst year of my life, has weighed enormously on my mental health--I've struggled with depression and anxiety in the past, but this is the worst it's ever been--and this was all so avoidable. Worse of all, I feel entirely betrayed by Dr. Sanders, who I had a very positive relationship with for years and very much trusted his expertise. It's clear that something went wrong during the surgery, but worse, it seems something was covered up. It clearly started as an arthroscopic procedure as planned, and somewhere along the way, the decision was made to open up a long incision--something I never consented to. On the operative report, the incision was omitted and the report referred to the surgery as an arthroscopy. Both surgeons I saw for second opinions have stated it should have been written down as an "open arthrotomy" since there is an incision, and they also cannot figure out why an incision was never mentioned in the report. It's all very sketchy.

I've spoken quite highly of Dr. Sanders on here over the years, but now I'm eating my words. While he did what I consider to be a perfect job on my left knee in 2011, and a fair job on my right in 2013 (bearing in mind the varus overcorrection, of course), and vastly improved my quality of life for 10 years in terms of fixing my knee instability issues, he made me so much worse off with the February "arthroscopic" procedure this year. My active lifestyle was ripped away from me in an instant. This has all had a domino effect on my life with two subsequent surgeries and my mental health in the worst state it's ever been in.

As such, I no longer recommend Dr. Sanders. If you suffer from knee instability or dislocations or a bone deformity, I recommend Dr. Todd Frush in Novi, MI for alignment surgeries. He studied under and was personally mentored by Dr. Teitge (the realignment king) for years, who is now retired. If you suffer from cartilage/osteochondral defects, I recommend Dr. Brian Cole in Chicago, IL.
Attachments
comparison of post-op MRI vs Jan pre-op MRI
comparison of post-op MRI vs Jan pre-op MRI
Screenshot 2023-04-13 at 4.05.19 PM.jpeg (116.59 KiB) Viewed 724 times
Feb post op2.jpeg
Feb post op2.jpeg (101.35 KiB) Viewed 724 times
Alignment of right (varus) vs left leg (valgus)
Alignment of right (varus) vs left leg (valgus)
IMG_5722.JPG (76.39 KiB) Viewed 724 times
Last edited by jrfrerichs1 on Thu Aug 24, 2023 8:46 pm, edited 3 times in total.
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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11

Post by jrfrerichs1 »

More photos.
Attachments
comparison of post- and pre-op MRIs
comparison of post- and pre-op MRIs
Screenshot 2023-04-13 at 4.08.21 PM.jpeg (89.04 KiB) Viewed 723 times
arthroscopy photos of the LFC/bone divot
arthroscopy photos of the LFC/bone divot
arthroscopy photos.png (143.83 KiB) Viewed 723 times
Feb post op3.jpeg
Feb post op3.jpeg (78.4 KiB) Viewed 723 times
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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 6/13/11

Post by jgardner »

Wow! Sounds like a nightmare. So sorry to hear about your difficult experience! I hope your new care team can help you out and get you moving again.

Thanks for having the courage and taking the time to post this. Hopefully this information will help others avoid a bad experience and give them some good questions to ask of their surgeons before agreeing to a procedure.
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