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April 2013 I had my first knee reconstruction, two different procedures done at once on my left knee. The easier one is a Tibial Tubercle Transfer (Osteotomy) and the second is called a Medial Patellofemoral Ligament reconstruction. Last Wednesday I had the exact same procedure done on my right knee, only apparently this knee was getting arthritic. I'm currently sitting on my rear end at home for the next 3 to 4 months while I rehab the poo poo out of this guy. The Tibial Tubercle Transfer is a procedure whereabouts they chop off the insertion point of the ligament that keeps your kneecap aligned. With the ligament in tact and still attached to the bone, they screw it back into your shin, further down. This procedure is used to realign kneecaps. In my case, the ligament was intact, but not holding my knee cap in it's groove. Or even anywhere near it's groove... Here is an image of a TTT:  (click for big) The MPFL is a procedure where they create a new ligament to properly anchor your patella to your femur. They usually harvest part of your own hamstring, but if for some reason that isn't an option, they can also use a cadaver. For this they drill into your femur, anchor the new ligament, then drill two holes into the patella and stuff the ligament into them using dissolving anchors. Here is an image of a MPFL reconstruction:  (click for big) I am 28. What led me to these surgeries was years and years of terrible instability, despite gobs of physio. My left knee would fully dislocate if you gave it a scathing look. The last three dislocations I had before I opted for surgery were: Stepping out of the shower, while on vacation. Vacuuming Petting my cat The right knee didn't dislocate as much as it chronically subluxated. Subluxed? Because my knees never sat right, they never fired the right muscles. My quads are terribly underdeveloped. The repair to my left leg has left me with more muscle development in a year and a half that 26 years of sports and physio ever did. Here is a disgusting photo of my leg 4 days after my surgery, when I was allowed to take off the bandages.  This is actually my third major joint surgery. I also had a Femoral Acetabular Impingement corrected when I was about 23. So uh. Questions?
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Oct 10, 2014 01:01
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| # ? Apr 23, 2024 16:32 |
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How painful was it post-surgery? I had bilateral knee surgery done related to this hip/knee valgus deformity* I have when I was 12/13. I remember the post-surgery pain not being that bad (with painkillers obviously) and having fun with the crutches, but my surgery was also way, way less serious than yours; from what I understand they just had to send in something through a few arthroscopic incisions and scratch up the region under my kneecap in order to stimulate it into producing more cartilage. Prior to the surgery I would have pain when doing things like walking up stairs due to the cartilage not attaching correctly or something. I actually hosed up a bit and didn't do as much physical therapy as I should have afterwards, so I still have some minor pain in one of my knees but not enough to cause any real problems. *If I stand with my knees pointed straight forward, my feet point outwards like I'm duck-walking. If I try and make my feet point straight, my knees point inward like I'm walking really pigeon-toed. I also can't do any outer hip rotation but can go really far with an inward rotation. Ytlaya fucked around with this message at 01:43 on Oct 10, 2014 |
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Oct 10, 2014 01:40
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I was very fortunate, both knee surgeries I had a femoral nerve block. They're apparently only supposed to last 8 to 12 hours, but for some reason they both lasted 48 hours. I had spinals for both surgeries, so I was up and eating right away. You wouldn't believe how much healing you can do in 48 hours, when your body isn't also coping with pain and trying to clear out general anesthetic. My femur aches and throbs quite badly at random, but I ignore it most of the day. The first 5 days I took 500mg of Naproxen twice a day and 500mg of Tylenol 3 or 4 times a day, with a percocet at night. Now I'm only taking a tylenol at night. The incisions don't really hurt, but the swelling in my leg does. When it gets out of control my leg feels like it's on fire, and it gets red and hot to the touch. I'm still icing it constantly. I've heard it said this is a terribly painful surgery, but I am doing exceptionally well. I have a high pain tolerance, too. The ache where they drilled into my femur is definitely the worst. I somehow twisted it a smidge yesterday and then couldn't stand to put much weight on it the rest of the day.
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Oct 10, 2014 05:03
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Have you been tested for any collagen disorders, or disorders of bone/ligaments? I only ask because that is a lot of surgeries for such a young guy.
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Oct 10, 2014 07:24
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Yep. I've had full auto immune work ups a couple times. It would appear I have Ehlers-Danlos, but nothing ever shows up in bloodwork. I have a lot of muscle pain.
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Oct 10, 2014 16:35
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Hey, I have something like this but all over my body! I'm 21 and have had shoulder and ankle surgery because of subluxation. I have hyper mobility syndrome and can do all sorts of fun flexibility tricks like "jump rope" with my arms and touching my thumb to my forearm. FYI, if they ask if you want a pain block before surgery: DO IT.
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Oct 11, 2014 21:21
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Nerve blocks are tha bomb. They gave me mine while the spinal was still in effect, so I didn't even feel it.
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Oct 12, 2014 01:10
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I have EDS. All of my doctors have recommended against surgeries because surgery can't fix your defective collagen / ligaments and I have such poor healing from EDS anyway. Hope it goes well for you, and I'm definitely interested in hearing how it works out. My knees are pretty drat bad too. Oh, did they use cadaver tissue, since yours is inherently jacked up?
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Oct 12, 2014 06:40
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Nope they used my hamstring. The other knee is done and healed, same surgery. They took the screws out during this surgery. It's doing quite well, s far. Part of the problem is that my knee caps were just not in the right place, causing more damage. This time they moved my patella 7mm to the side and 9mm down to get it into it's natural groove.
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Oct 12, 2014 22:46
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Had TTT done myself in 2007/2008, right knee then left. Was an ordeal but worth it in the end.
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Oct 16, 2014 10:29
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Did you hit the screws on everything? Are they still there or did they remove them? They decided to wait until I had the right knee done to remove the left screws, but by the time it came around they were pushing out of my knee so far, you could see them through my skinny jeans. Most of my recovery is for the MPFL, the rehab is a bit more complicated. I had my first physio appointment yesterday and my rom is 60 degrees flexation, -13 extension, so I have a ways to go....
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Oct 17, 2014 02:14
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Yeah, hitting the screws on anything was pretty painful. I had them out of both legs about 6 months after both knees were done. I also found they were starting to work their way out of the bone which looked nasty. Keep working hard to get ROM back. Getting the movement happening will help break up the leftover scar tissue.
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Oct 18, 2014 04:45
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Mine were rejecting like crazy. They waited to take them out until this surgery, but here is an x-ray from about 2 months ago  I kept the screws, too. She said she nested the screws deeper for this one and didn't put washers in, so they shouldn't protrude so much. I am quite lanky and thin, so they were very obvious. I'm doing my ROM but as expected, the exercises piss off my hamstring because they chopped part of it out. My incisions are healing really nice though. Last time I got a staph infection in the TTT incision, so it healed quite ugly. These ones are nicely knitting.
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Oct 18, 2014 18:02
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Wish I'd thought to keep the screws as a souvenir. I can't imagine getting a staph infection was very pleasant :/
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Oct 19, 2014 08:16
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It's interesting how the body will just start pushing out foreign matter. I had a bad fall back in high school where I smashed my palm into some coral, causing a metric fuckton of blood to spill everywhere and the people I was with to call an ambulance (which in retrospect wasn't really necessary, as long as I kept pressure on it). About 3 months later I felt this pain in my palm and over the course of several weeks this chunk of coral started emerging from my scar. It looked super hosed up. I ended up having a dermatologist remove it since it would have gotten really infected.
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Oct 20, 2014 23:11
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Unless bullets are in an area that causes problems, they are generally left in, unless you happen to see it while rooting around. But in most extremities, they just leave them there unless they complain about it causing pain, like it its next to a joint and it hurts when they move it. Every once in a while, someone will come in with a bullet that has been migrating its way towards the surface. A shot of local anesthetic is enough to dig it out eventually. Fun fact (that I fortunately learned secondhand): you can not give it to the patient as a souvenir. It has to be turned into the police, and a chain of custody maintained until it does as its now considered evidence!
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Oct 20, 2014 23:22
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I caught the staph infection before it got really nasty. The incision was weeping and not closing well so I went to the doc before it had a chance to start oozing puss. But they put me on a metric fuckton of Keflex to murder the poo poo out of it. The screws migrated pretty slowly, and I'm pretty sure it was related to me continuously bashing them into things. My coworkers and friends were pretty creeped out the last month or so before my surgery. I was getting nerve pain too. These ones aren't visible yet. I can't feel them when I gently press on either side of the incision. The swelling has gone down considerably, so I am hoping they won't be apparent. I tried to do a bit of yoga and the screws were so pronounced I couldn't do anything on my knees. Ended up not being worth it.
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Oct 21, 2014 01:15
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swickles posted:Unless bullets are in an area that causes problems, they are generally left in, unless you happen to see it while rooting around. But in most extremities, they just leave them there unless they complain about it causing pain, like it its next to a joint and it hurts when they move it. Every once in a while, someone will come in with a bullet that has been migrating its way towards the surface. A shot of local anesthetic is enough to dig it out eventually. Fun fact (that I fortunately learned secondhand): you can not give it to the patient as a souvenir. It has to be turned into the police, and a chain of custody maintained until it does as its now considered evidence! Thanks for this tip, now I know to have my vet friend remove the bullet for me next time I get shot so some prick cop doesn't steal my bullet
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Oct 21, 2014 05:20
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What kind of insurance do you have? I did a bunch of damage to both of my knees a few years ago before I had insurance and the cost of just the diagnosis was enough to discourage me. Now that I have pretty good insurance I'm thinking about looking into it but the 3+ months of being immobilized seems like an impossible hurdle to get around.
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Oct 22, 2014 00:26
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:I I live in Canada. So. My surgeries were covered. All I had to pay out of pocket for was the stabilizing knee brace they put on after the surgery, the prescription meds, and the cryo cuff. And my insurance covered all of that. I should mention that 3+ months off work is my particular recovery, because I don't work in an office environment. I work in healthcare and I am on my feet all day. If you had an office job you could definitely go back around 6 weeks. I'm not immobile, either. I'm "weight bearing as tolerated" on crutches and with a leg brace. Physio once a week with home exercises every day. They generally don't want you immobile for very long, if at all. I can drive, and a lot of malls and grocery stores either have wheelchairs or scooters. So yesterday I went to physio, stopped by work to fill out some paperwork, then grabbed pet food on the way home (the staff carried it out to the car). Last Thursday I drove to the farmers market and my mom wheeled me around. She has no peripheral vision though, and kept running me into poo poo. On the weekend a friend wheeled me around the mall. Get a lot of really good books, Netflix, and just get it done while you have the insurance. Make people come by and visit. Once it's done, you'll be so happy to have fixed knees. EDIT: this is a cryo cuff. It's a cooler that pumps ice water into wrap that you tie around your knee. My surgeon makes all her patients get one and it is a life saver. 
Echeveria fucked around with this message at 01:58 on Oct 22, 2014 |
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Oct 22, 2014 01:55
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confonnit posted:What kind of insurance do you have? I did a bunch of damage to both of my knees a few years ago before I had insurance and the cost of just the diagnosis was enough to discourage me. Now that I have pretty good insurance I'm thinking about looking into it but the 3+ months of being immobilized seems like an impossible hurdle to get around. My first surgery was under Tricare and the second under BCBS (Obamacare!). The total for the shoulder reconstruction was $25,000 and I paid $25; the second for the ankle was $17,000 and I paid $270. You don't have to do both knees at the same time - a lot of doctors won't do it specifically because of being immobile for weeks! However, there was a 60ish year old man who came to pt at the same time as me and the therapists said he must be a stubborn old man since he got both knees done at the same time. It depends heavily on what you get done. Anything involving bone is at least 6 weeks to heal. I was back at work after ankle surgery in 2 weeks and I stand 8 hours/day. This ridiculous thing was amazing: http://iwalk-free.com/sale/buy-the-iwalk-2-0/ although it got me a lot of funny looks. Seconding the cryo cuff. The only annoying this is how loud it is and that you have to have like a hundred pounds of ice per week or something like that.
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Oct 23, 2014 01:59
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Echeveria posted:EDIT: this is a cryo cuff. It's a cooler that pumps ice water into wrap that you tie around your knee. My surgeon makes all her patients get one and it is a life saver. They gave me one of these after surgery on my right knee for a torn meniscus. They called it an Ice Man. I would also highly recommend it.
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Oct 23, 2014 02:49
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Cat Army
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Haha we bought 140 bucks worth of ice for the first two weeks. Thankfully we have a deep freeze. The brand I used this time was Arctic Rush and it was quieter than the kodiac one.
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Oct 23, 2014 05:04
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What was your experience with pre surgery PT like? You mention having atrophied/underdeveloped quads which would definitely exacerbate any type of patellofemoral tracking problems. The accompanying patellofemoral reconstruction implies your patella had been tracking laterally. Presumably a protocol targeted at strengthening your quad, specifically the vastus medialis (and training your motor patterns to fire the VMO) could've helped stabilize the joint. Curious as to what approach your ortho/PT and anyone else on the medical team took in regards to your PT program.
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Oct 24, 2014 10:59
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Through junior high and high school I did physio, and then a few years after I started seeing one again. I saw a few different physios, orthopedic specialists and sports med docs. I did pretty much everything you could imagine doing in physio, plus I did sports. Squats, clam shells, leg lifts, every variety of exercise with a rubber band, fencing, dodgeball, lots of walking. They never developed, at all. Since my left TTT and MPFL my VMO has developed significantly. It's now visibly larger than the right, which was the former strong leg. Once the right is fully healed and I have the ok to resume full activities, I'm going to strengthen the hell out of my legs. I look forward to it.
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Oct 25, 2014 01:13
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For me surgery was an absolute last resort. I had Physio on and off for years prior, with 6 months intensively before going under the knife.
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Oct 25, 2014 01:54
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Yeah mine were both basically last resort. I let it go for a few years because there was no improvement, and then one day my husband (then boyfriend) jumped on the couch and landed on my knee cap. After that it was easier and easier to dislocate it, until the last 3 dislocations totally blindsided me, I'm not even sure anything touched me two of the times, but I was on the floor. I told my doctor I was worried they'd dislocate while I had a needle in a patient. He referred me to a sports med, the sports med referred me to the surgeon, and the surgeon was like holy gently caress. I guess my knees were some of the most unstable she's ever seen. And this surgery is one of her specialties. I remember my first consult, it was rough. I was expecting some arthroscopy, maybe a small incision or two. Then she described it to me and I was so devastated. Major knee surgery, lots of time off work, both knees needed to be done. It's a hard pill to swallow.
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Oct 25, 2014 04:45
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Those are some impressive knees you've got there. I've worked with two MPFL patients (I'm a PTA in an out pt clinic), one was a teenage girl who chronically dislocated, and the other was a teenage boy who tore all 4 collateral/cruciate ligaments and his MPFL in a bad football accident. It seems to be a rarer knee surgery, as opposed to the standard ACL/meniscus repairs you see every day. Good luck with your rehab process, it's amazing to see the recovery from something like that on a week to week basis.
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Oct 25, 2014 14:46
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It's coming along well. The rehab part is more painful than it was last time. I had to stop wearing the brace because it sat directly on top of the femoral anchor. I'll have to talk to my physio about it Monday. But I'm finding I can fully weight bear on it most of the time. I'm still supposed to use crutches for like 4 more weeks, but I hobble around my kitchen and bedroom. I hate crutches. Incisions are pretty well completely healed, just a scab on the longer incision. Once that's gone I'm going to start going to the pool and just walking and doing whatever I can tolerate. I have a partially torn labrum in my right shoulder and the crutches are pissing it off.
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Oct 26, 2014 07:30
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