Trochlear Groove Microfracture

[ghost]

Oh man, we have to celebrate with the return of Heather's VMO. Only we knee geeks understand how much that means. Sounds so trivial, but is in fact a massive accomplishment. Yahoo for Heather's VMO.

Bit of a rough night last night. As soon as they discharged Steph she started vomiting so we ended up back at the ER at 10 pm and got home at 3 am. Basically, no one could believe that she was sent home with nothing for Nausea. So they put her on Phenogren (sp?) and that seems to be doing the trick, they also realized that she had a nasty bruise near the right temple and decided that she had a concussion as well, which contributed to the headache and the nausea. So far today there have been no issues.

I'm in the wound care business at the moment. It's a nasty looking bugger, but three times a day we unwrap it wash it out with saline, apply a gel that keeps the skin and tissue from drying out and add a ton of padding to absorb the breakthough bleeding and rewrap it. I'm also getting reacquainted with washing a child's hair and cutting up her food. It's been a while since I had to do those things LOL.
Hopefully they'll do the graft surgery in the next couple of days.

Hope everyone had a good day. We didn't get any sun today, but we didn't get ain either so I'll take that.

Sue

[Marjan]

Just when you thought you had her all "growed" up.......SHE'S BACK!!! Seriously, I'm glad she's home and she's not worse off. Phew....another bullet dodged! Poor thing, couldn't have been worse timing.....it's summer!! However, I guess it's better than missing classes, eh?

How are you doing? Is the knee hanging in there? Pure adrenaline has probably gotten you through the last few days, and I hope the knee's not worse. Well, maybe it should be on the worse side........nothing like going to an orthopod with actual symptoms, rather than the adrenaline spurt when you walk in there and feeling fine! In a way I hate that....last time at the OS office I commented on the crepitus that sometimes sounds like walking on crunchy broken glass. He wanted to see.......so of course, the damn knee was as silent as all get out! By the time I got home, it was back to crunch mode.... Maybe I should just take regular adrenaline injections, that'll keep the knee going!

Yea, the appearance of a VMO is truly a sign that the knee wants to get back into the game.....I know it was for me! It's such a delight for me still, to see that teardrop shape when I contract the quads....I can picture Heather grinning when she sees that change there. And Heather, you know what? Once that VMO makes an appearance it starts to build faster than what it took to get to the initial "viewing" point. I agree with, was it Milly, who said that some of your medial pain will start to lessen. I know mine has, it's not perfect, but so much more doable than before I had Velmo on board. Yup, it's ALL GOOD!

Well, Sue, hope Steph has a good night, so that you can get a good night! You'll be ready to join the Red Cross when you're done taking care of her... That wound looks pretty darn big! Do they have a surgery date for patching it up??

Hope your household sleeps well -

marjan

[Heathers_new_knee]

Heya Folks~
Hi Sue! Sounds like you're doing a good job with the nursing care. I'd help ya if I were there. Wound care is my "bag"...just love seeing them heal up. Thumbs up to you! It's gotta be hard to see your kid wounded like that...I'd have trouble and used to do that kind of care everyday. I'd rather it be me than them, ya know. I'm also glad you caught that concussion...lots of reasons why she potentially could be vomiting, too. Is your daughter sensitive (so to speak) to pain meds, which would be a good explanation for her N & V or she may be like me. Intense pain like that (10+ off the charts) won't make me cry as some folks do, I just hurl. If that's the case, her pain may not be covered as much as it should be. What is she taking? Please keep close tabs on her ok? Did they tell you what the warning signs with concussions are?

So...tomorrow is your BIG day. We'll all be waiting in anticipation of Dr. M's say so for you. Getting excited? I am!!!

Heya Marjan!
I'm sorry to hear you were having pain? From your gardening and agility work? Please do take 'er easy there. I tend to over-do sometimes on good days, too. I get busy and try to ignore the knee pain...it's my biggest mistake because I'll pay dearly for it later.

Is it hot out by you folks, too? How does your doggy fare with agility when it's hot? I'm thinking about Roxy, too. When a dog is with-puppies and they can't sweat, what can happen? Miscarriages and other bad stuff? I'm giving her plenty of water and she lays right infront of the fan but, inside our house was 88 degrees yesterday. Think maybe I should do the inevitable and shave her?

Hey! You should've seen my PT's face when he saw Velmo pop up! It was priceless...he just gets so excited when good things happen. We've been in partnership for such a long time together and has seen me struggle so hard with this stuff. He is very sweet to care like that. I'm so glad for you guys, too. Only KG's (away from the professionals) get this stuff. Bringing the VMO to life IS a huge milestone!!

Cheers to healthy and strong velmos for us all!! Hey Francine! Where's the pink champagne? I want some!! I noticed something about the difference between being off and on the stim with it. I get a bigger muscle contraction while stim is going. The patch is placed just adjacent to the VMO. When that happens Marjan, does that mean it'll eventually look/feel just as strong without stim? Man! I sure do hope so. Right, strength should help surpass some of the pain I'm hoping, too. I had MASSIVE soft tissue damage on the medial side. Almost comparable to like a crush injury, that's why so much scar tissue was in there. It's also where the kneecap displaced when it shattered. The medial retinaculum was opened and revealed what says "many, many bone fragments." I think I need to follow Popeye's spinach rule...LOL!

Ok, ya'll be good and have a nice day. It's a sticky, icky, hot, humid watering hole day here. The PT pool might actually feel too hot today at 94 degrees. Gotta go get 'er together here. TTYL...

Heather

[Marjan]

Heather, I'm doing a fly by here since I'm on my way out.......will write more later, but wanted to say, Don't shave your pommy!! Believe it or not, coats on dogs also serve to keep them cool!! Having plenty of water available and a shady spot (in front of the fan, no less) is all a pregnant mama could ask for. The one place you could cut her fur and that is around the paw pads. Dogs "sweat" through their feet and their nose, so keeping those pads exposed to the air is a good thing. If you think she's getting overheated, you could lay down a moist towel and see if she wants to lay on it....but for the most part, it's plain old inactivity that keeps them cool!

Catch ya later.......leave them scissors alone! LOL

marjan

[digginit]

...inactivity and a good ol' air conditioned brick floor.

[Skinnycatz]

Hey, Heather...just a note to you really quick...I never used stim to get my VMO to fire...just used plain old hard work and determination! LOL

Don't know about you but alcohol still makes my knee heat up more! Don't know why! Another one of those mysteries...

Oh well...just have to ice more when I indulge! :)

Francine

[Marjan]

Hi Heather, have the pommies cooled down??

About the e-stim and VMO contraction....so far I have not seen the same "massive" contraction that an e-stim unit can produce. But then I think that type of contraction comes when your legs are called upon to sprint out of a burning building, and who is going to be looking at their VMOs then? Hmmmm, maybe us KGs

For the longest time, and it still happens when I'm tired, if I compare my "good" VMO to the opped knee VMO, I notice that the opped VMO is like a flag waving in the breeze....it sort of ripples, but not ripples out of strength, rather out of weakness, as if I can't HOLD the contraction like I can on the "good" side. I say "good" side in quotation marks because it is starting to show the wear over the last 6 years of messing with my other knee. I notice that it has a tendency to swell a bit behind the knee (Baker's cyst?) and sometimes it doesn't want to go to the same "hyper" extension that my opped knee has. But, I'm like an ostrich with my head in the sand...LALALALALA, I don't see it, I don't feel it! LOL It still is by far the stronger knee, and has the most defined quad muscle still.

Sue, you are going to have to borrow a "crackberry" and tell us what Dr M has to say the minute you get out of there! Can you believe that I'm anxious and excitable about your visit tomorrow? Maybe cause we're MFX sistahs, but I so have you on my mind right now, it's hard to believe we've never met! I'm rooting for ya!!
Hope Steph is doing better today and that your wound care nursing is paying off. Hope she's feeling better because you haven't even gotten to the "what in the heck were you doing driving an ATV while drinking" speech yet.....I almost feel sorry for her, although I would imagine her soreness and big road rash is probably speaking volumes in that regard!

Heather, wanted to let you know that once my VMO made an appearance and decided to stay, I went through a period where other parts of my knee started making themselves known, and my total unprofessional belief is that since the VMO is now firing and pulling the kneecap medially, the rest of the knee is having stress (good stress) put on the soft tissues. It didn't hurt per se, but certainly felt weird and at first was a bit alarming...but as the VMO is settling in, the rest of the tissues have adapted to their new(older) function again. Most of that feeling, BTW was on the lateral side......almost as if that side was saying, "whoa....who is pulling on that patella?"

Today was an ok day. I finished painting my laundry room and did all the things new paint requires....like a deep cleaning, washing of windows, etc etc. Man, I'm tired......knee's tired, shoulder is aching and neck feels like it's going to allow my head to fall off.......such a pathetic soul I am.......ah well, a good hot tubby and I'll be snoozing before long!

Go get em, tomorrow, Sue!!!! Bloody the man's nose if he gives you the wrong (whatever that is) answers!

marjan

[ghost]

Morning folks,

It's 2 am and I'm up and drinking coffee. Me thinks the stress is affecting my sleeping pattern (or lack thereof).

So here's the scoop on Steph. We met with the surgeon yesterday morning and her graft surgery is scheduled for 4:30 this afternoon. I couldn't figure out why he was waiting but yesterday he told me that he wanted to make sure that the remaining tissue was going to be ok and since the underlying tissue is now pink and healthy he feels it is safe to proceed.

On the knee front ususally pre visit the knee is on it's best behavior, fueled by adreneline. Not today, it's being a PITA. Even a little bend on the stairs is hurting it. I'm guessing the extra mileage in the hospital parking lot and corridors is adding fuel to that fire. I have to be at Dr. M.'s office at 9:15 for xrays and my appt is 9:45. Without traffic it is an hour and a half ride so to be safe I'm leaving at 6:45 am to give myself an extra 45 minutes just in case. (Besides I suck with directions). I'm hoping to be back around noon and will update you when I get back. Then a bit of a nap and I have to have Steph at the hospital for 3:30. I have PT at 6 pm so once she's taken into the operating room I'll pop out for a quick bite to eat with hubby and head to pt and should be back just as she's coming out of surgery. They are planning on keeping her one night, maybe two depending on how she does with the pain.

Heather, she does have an issue with pain meds. She's like her dad, nothing works for her so she needs higher doses than the average bear and that trigger's the nausea. The first go round they sent her home with oral morphine and no nausea meds. Bad idea. At first I thought the nausea was just the pain and meds but then when I looked at her (for the first time looking at something other than the elbow) I could see a bruise developing between her cheek bone and temple and kind of figured that we might be dealing with a concussion so I took her back to the ER. I was right, they hadn't caught the bruising either. She wasn't complaining about headaches but between the massive headache and the vomiting I kind of figured that she had a concussion.

By the way, does anyone know anything about care for skin grafts. Is there anything special I should know about ahead of time so I can pick up the proper supplies.

BTW only us KG's understand the importance of the VMO and the excitement of seeing it return. I had no vmo after my second surgery and then I got it back before the 3rd surgery. Oddly, mine gets its best work out on the ellipitical. I'm wondering if it has something to do with my stance/weight distribution. I must admit though that velmo is still ready to throw in the towel long before the rest of the quad cries uncle.

Ok, it's 2 am now and I'm going to try for a couple more hours of sleep.

Sue

[madel23]

So today is the big day, Sue? I hope your appointment makes you more confident in your decision rather than less. I went and saw a new OS yesterday, and he agreed with my surgeon that it's too early to tell if the mfx worked, and that an MRI wouldn't tell me anything. However, he did think that halyuronic (sp?) acid injections might help, so he's going to try to get that approved my insurance (I guess I'm considered too young for them, LOL!). I wonder if that's why my surgeon didn't want to try them. Sometimes I wonder how much these doctors dictate their protocols by what insurance companies cover. I just started taping my knee to correct the lateral tracking, and I think it might be helping. Sometimes it feels almost normal, but then I try to bend it a lot with weight on and remember it's not. However, with taping, I was able to run to catch a bus yesterday--it was a really awkward, fairly straight-legged run, but still...

[ghost]

Well I'm back with good news, Dr.M feels that prf is the right next step for me. We talked about ACI or OATS and he says that the success rate of either of these is starts at 74% and goes down from there following mfx because it changes the surface of the bone and therefore doesn't recommend it.

He checked the q angle and said that there would be a 50/50 chance that I would wake up to find he had done a tibial tuberosity to recenter it, but that would be a decision he would make after checking the tracking once the TG and the patella work was done. He says he knows Gill and his work well and that Gill has alot of experience with pfr and he said Gill also would make the tt decision during the surgery and I should not be surprised to wake up to find this had been done. The point of the tt is to realign the patella and help prevent the non steel parts from wearing. He felt that the pfr should last 10 to 15 years unless other issues develop sooner. He does indicate that there is a large section of the medial meniscus gone from the first surgery and that is a good indicator that the rest of the knee will fail at some point. Finally, the prf can be easily revised to a primary tka when needed and one of the reasons he uses it so frequently is that it doesn't burn any bridges or make a future tka a patch job.

So the good news is that he, his assistant and Dr. G are all on the same page.

The other thing he was impressed with is how much quad strength I had and more importantly, the vmo is showing up strongly.

Sue

[Heathers_new_knee]

Heya Sue~

Congrats in getting opinion #1 and #2 in matching sequence there! That's awesome news! Feel better? I feel better for ya! Ha! Glad to hear it from a different OS in another part of the US about the TTT, too. That part is soo encouraging to hear. Yes mam, it does give you extra PF space in preventing wear on the plastic. The post-op x-rays really demonstrate that...it's almost like an exaggerated of stretching on the tendon but, it's all good. The patella moves up with quad contraction and stays centered with flexion. VERY good results with it so, no complaints here. Even though it "feels" foreign, obviously it is and takes some time to get used to. I'm calling shiny and plastic new parts "my own". They DO make a great team. THUMBS UP TO YOU with your appt today!

Good luck with Steph's surgery today, too. I wouldn't buy anything specific just yet. The surgeon will tell you the specifics of her post-op care once she's DC'd ok. Hope she's ok with her pain meds, too.

WOWEE wow...you have an uber busy day. Take care of you and please don't over-do! Did you get any sleep? Shucks, all the walking you'll be doing might=PT for the day.

Hi Marjan~
The pommys are hot. :P Thank you so much for telling me not to shave them back, my aunt just shaved hers. I was just assuming all that fluff would hold the heat in. We didn't have the A/C in until yesterday and the house is better. Ok for us but, it's awful outside. Just REALLY muggy hot. Storms are coming.

Are you recouped from the paint job yet? That's some hard work right there. It'll plum wear you out in a day. Our first home was competely remodeled and I did so much painting, I thought my back/leg/arm muscles would never recoup from it. Shoot though, I was in my early 20's and on a mission to Git R done and sell the place. It was 4 bdrm, 2 bath, kitchen, dining room, living room, sunporch, and family room + the basement, garage, and shed were painted. All back to back after revamping plaster to drywall. Can't imagine doin' all that right now...gimpy would never tolerate it. Hope you're ok but, thumbs up to a job well done in the mean time!! Doesn't it make you feel good to see a newly done room?

Hey! Velmo gave us the same results yesterday when stimmed! This really is such a good sign because after many sessions throughout the past 2 yrs, this has never happened. When I'd do quad sets, you couldn't feel/see anything and there is finally some tone to it just above the knee. At rest, it's mushy gushy. All very good signs...I can't wait to see more. Did you have that feeling too? Kinda feelin' a little greedy already but, hey, hey, hey that's ok!


I am just giddy over here...all VERY good stuff happening around the knee issues this week. I'll be 5 months post-op tomorrow. And YES! ROM IS STILL GOING UP! GOT 140 YESTERDAY! Who'da thunk that would ever happen again. Really....I was stuck at 123ish FOREVER, for months and months before this past surgery but, minus a prosthesis (which takes up space, right). Now, I have well surpassed that and may even get that whole 155 back. Who knows but I AM BLESSED!!! I still swear my PT is practicing to be a magician, LOL! I tell him See? My knee likes you and behaves for you better. He just laughs because he knows he's good at this stuff. Just a continuing concern about that passive end-range pain, though. It's still very, very intense around the medial joint line with flexion. Heck! Maybe he can make a magic wish someday and my pain will vanish, too. That'd really be great.

Have a good one folks and hope all goes well with the rest of daily events on board for you guys. TTYL...

Heather

[Skinnycatz]

Hi Sue...this is great news for you! It also gives me hope that at some point, someone will be able to help me too. I have a large part of my lateral meniscus missing but nothing wrong with the medial. The worst thing about my knee is the back of the kneecap. The q angle thing bothers me though...I know mine is high. I wonder if that is why the knee replacement guy wouldn't even talk to me. Oh well...I am sure he didn't think my joint was that bad yet either. Maybe I shouldn't give up on the replacement people. Hmmm...

I hope the surgery gives you more function for a long time! I will celebrate your good news in Vegas as well! ;D

Hope your daughter's surgery today turns out well...I feel for her about those pain meds. They make me sick too!

Francine

[Marjan]

Sue, just came in from town to read about Dr M's second. YEAH, good to have everyone on the same page...now it's going to be real! A PFJR it is! Gotta unpack groceries, but had to check in here real quick to see if you'd posted!

Best of luck with Steph's surgery!....oh, and right now you are in PT!! Bet he's going to be pleased that all ducks are aligned!

marjan

[ghost]

Morning All,

It did feel good to have both OS' agree with the treatment plan. As much as I wanted Dr. M's opinion I was anxious about the possibiliy that he would recommend something entirely different. He did want to know what I was doing to work the VMO and I told him that I thought the most effective thing was the armless elliptical. I stand with both legs as far to the inside/touching the inner part of the foot rest force the vmo to pull it's weight.

Mark, was thrilled to learn that he had gotten it right when he told me 2 months ago that I needed a replacement. We talked about the tt and he felt that made perfect sense as well. He said he knows a number of surgeons who try to correct it with a LR and he feels that make it worse since the problem is that the knee is already tracking laterally.

Steph did well with the surgery. She got into a room around 8 o'clock last night. At 9 o'clock she decided she was hungry (she had't eaten in 24 hours) and I had to drive around to find someplace to buy a turkey sandwich since the hospital cafe was closed. Thankfully I found someplace close and we got home around 10:30. I will go back to check on her in a couple of hours. They gave her one a patch for the nausea and it kicked in after about 1/2 hour so she was feeling pretty good. The arm is wrapped so she can't bend it at all because you can't have any movement for 5 days until the graft starts to heal. The hip is pretty sore and that has some sort of patch on it that you can't get wet and will stay on until it comes off on its own in about 3 weeks.

Heather, I agree with you. It was tough changing the dressings. I would rather it be me than her, but as a mom you do what you have to do.

Hope everyone has a good day.

Sue

[Heathers_new_knee]

Hey Sue!
Glad to hear your daughter pulled through the surgery ok!! Just glad it wasn't any worse, too. Poor kid! She's gonna be pretty sore but, hopefully she'll heal up fast as she's young. I'm still chickening out myself. Need to have plastic surgery to fix the big scar of my forehead...knee is first, ya know. Only so much we can take at once. Gyaa!! Not sure if I still have glass in there...kinda feels like it sometimes.

Considering the condition of your kneecap/TG and poor mechanics, I'm actually pretty surprised about the strength you still have. That's just awesome and hopefully it'll mean faster healing for ya!! So, are you staying with Dr. G or Dr. M to have the surgery?

About the LR...right! Dr. S doesn't do them in isolation without doing other procedures at the same time. It worked as he repaired the tightened up the medial side at the same time. Viola! no more lateral subluxation with that knee. YAY!! I am thoroughly convinced Dr. S does magic, too. LOL!

Hope you're rested up from Steph surgery and your appt day. Bet you were bushed out tired! Don't forget to take care of you, too ok? TTYL...

Heather