Wednesday, June 23, 2010

MPFL Reconstruction

Yes, it's been a long time. The end of the school year is always rough for me. This year, it was awful for a smorgasbord of reasons. First, I received an email in mid May from my school district saying that the academy at my school (for which I am the lead teacher) needed to spend $67,000 by June 1. WT**?!  We were told that our grant money for the year was gone, but someone made a mistake at the district and we did have money--a lot of it. So, I ordered my heart out--computers, document cameras, photocopiers, books, LCD projectors, and more. But the end of the year is stressful, and this was just one worry I didn't need on my plate this year. Normally, I would have a coordinator to help me, but she's been out on maternity leave, so I had to do it all myself.

Second, I had a lot of paperwork to figure for my academy's grant for next year, I had to line up a student teacher for next year, and worry about my paycheck, because we have five furlough days this year and seven next year! My check was $700 shorter than normal last month. Ouch.

Let's see...I also got a new position which will start in the fall. I will only teach two classes, and the rest of the day I will be my school's testing coordinator. I'm looking forward to that challenge, and although I know I'll miss not having as many students, I will not miss having fewer papers to grade. With 40+ kid to a class (and 5 classes per day), it was becoming so hard to keep up with grading. This will be a relief. I may actually get to be the kind of teacher I want to be when only teaching two classes.

Finally, I had surgery--today. I had an MPFL (Medial Patellar Femoral Ligament) Reconstruction. Basically, my own hamstring was used to create a new ligament in my knee. I will describe the surgery more later, as I'm running out of steam right now and drugged out on Percoset. I want to use this blog as a journal to update my progress, as I know there isn't a lot out there about the surgery and peoples' experiences with it. I know because I looked for them!

So, today, I'm hanging in there and hoping to get back on the computer tomorrow!

45 comments:

Anonymous said...

Hey i have to get this done on dec 20 do you rember how hard it was to get in a car cause im going to california a week after surgery. And did it hurt after surgery.

Junkgirl said...

Hi! I didn't really think the MPFL surgery was painful at all. I got a femoral nerve block, which I highly recommend if it's offered to you. Also, take the pain medication before the nerve block wears off, and keep up on taking it for the first three days or so. By the third day, I was off pain meds completely. In fact, the day after surgery, I was walking around without crutches and unloaded the dishwasher! It's not bad at all. Getting in and out the car should be fine, especially if you can use the back seat! I liked to have my leg elevated, and that's hard to do if you have a long ride in the front seat. Good luck, and let me know how it goes!

Anonymous said...

Will do thanks for the information.

Anonymous said...

Hey one more thing how long were u on crutches and what surgery did you have.

Junkgirl said...

I was only on crutches for one day. By the second day, I was able to walk on my own, although it was just to go to the restroom, get something to eat, etc. Some doctors may have you on crutches longer, but you probably wouldn't be on them for more than 2 weeks tops. I had the MPFL reconstruction with my own hamstring graft. I also had arthroscopy to clean the cartilage. I've had three other surgeries--2 lateral releases that did not work, and one realignment. Good luck!

Anonymous said...

Yah they want me in a straight leg cast for some reason that i dont know of and thanks

Junkgirl said...

I had one of those straight leg casts for six weeks. I think that was the worst part, because you can't take it off when you sleep. The best thing, though, is to wear it as directed, and start bending your leg the day after surgery. Push yourself. My doc told me not to baby myself or I wouldn't heal quickly at all. I could bend my knee all the way by week 5.

Anonymous said...

Thats pretty good do u rember when u where back

Anonymous said...

Like cleared

Anonymous said...

Surgery tmr

Anonymous said...

Hi. I'm having MPFL reconstruction on Friday and was hoping to find more research than I have so far but it is limited. Your comments were helpful, and encouraging. I'm curious as to how you're doing today since you should be at the end of your therapy. Has it gone well? Painful? Is your knee significantly more stable? Overall are you happy with the results? Anything you could share would be appreciated! Thanks!

Junkgirl said...

Hi, new Anonymous poster! Yes, I am doing much better since MPFl reconstruction, and I am very happy with the results. I still have some pain and muscle atrophy, but it feels so stable that I'd love to get my other knee done some day. The surgery is not all that bad. Some pain, but my advice is to take the pain meds as directed. Don't wait until you feel the pain--stay on top of it. Also, I had a femoral nerve block that really helped. And, make sure to start bending the day after surgery or as your doctor directs. I really worked hard through therapy and am happy I did. You will have some pain and frustration, but I was off pain meds completely after three days, and the day after surgery, I was emptying the dishwasher! Sleeping with the brace was the worst part, but I am very pleased with the results. Good luck, and let me know if you have any more questions.

Anonymous said...

Very glad to hear that! Thanks a lot for your response!

Anonymous said...

Thanks again for the feedback! Surgery was a piece of cake!

Junkgirl said...

I'm so glad that the surgery went well! Isn't it surprising how easy it was? Now, just keep bending and stretching per your doctor's orders, and you'll be back on your feet in no time at all! And, as lame as it is to be stuck in bed, make the most of it with rest, TV, reading crappy magazines, etc! Good luck!

Anonymous said...

just wondering who was the surgeon and where did you have your mpfl reconstruction done. Are you are athele?

Junkgirl said...

Hi! I had my surgery done by Dr. Rick Csintalan at Kaiser Permanente in Irvine, CA. I did quite a bit of research, and he's one of the best in Southern California. If you're in this area, I would highly recommend him. He's done many MPFL reconstructions, and he's wonderful! I'm not an athlete, but I was a dancer for many years. But, I did go through rigorous physical therapy at an athletic rehab facility, and almost a year later, I'm doing great. If you're having the surgery, I hope it all goes well!

Anonymous said...

Hi! I'm 12 and I'm having this surgery in about 3 weeks. I dislocated my knee playing basketball a couple months back, and I need this surgery to set things straight. Doc said after surgery I can't put any weight on my left leg (leg being operated on) for 6-8 weeks. Guess it's different for everyone. At least I know the surgery isn't that painful. Not as worried. Thanks! :)

Junkgirl said...

Good luck with your surgery! I promise that it isn't that bad. I did have a femoral nerve block, so if one is offered, I'd recommend (from my experience) taking it. And, make sure you take your pain meds as directed. When mine said to take them every 4-6 hours, I took them every 4 hours. I was told that you don't want to wait to feel the pain to try to relieve it. I was completely off the meds in about 3 days. And, do your bending and exercises religiously! My doctor told me that if I didn't, I could walk with a limp for the rest of my life. I did not want that!! Good luck. I'm sure all will go well and you'll be back playing basketball in no time. I was out shopping and walking the week after surgery! :)

alyssa said...

Thank you so much for posting your "positive" journey with the MPFL reconstruction. I've been doing a lot of research as I am considering the procedure this fall, and all I seem to find is cautionary tales that seem to contradict all the postitives my doctor gave me. Confusing to say the least!

From what my Doctor says it is a relatively "new" procedure catching steam due to its success rates. Were you concerned at all about this and the longterm success? I havent had any surgeries to my knees and am afraid to open that bag of worms. I want relief, but not at the expense of multiple surgeries and revisions. Thanks Again!

Junkgirl said...

Alyssa--Thanks for your comment! My doctor also mentioned that it's a relatively new procedure. I had three previous knee surgeries before MPFL, and this has been by far the most success I've had. The last surgery I had on my left knee is still done--it's realignment with screws inserted to hold ligaments in place. It worked, but the MPFL recon knee seems so much more stable!


Since I've had so many surgeries, one more didn't bother me. I was tired of living with uncertainty and instability. Personally, I'd just had enough of the knee problems, and am very happy I did this. I did a lot of research on the doctor, asked about his success rate, the rehab, etc., before making the decision. But, I'm really glad I did it. I still have some pain and stiffness from time to time, but it's a small price for the stability, and the doc said it would take a full year and a half to see complete recovery.

I saw some of those horror stories online, too--especially at kneeguru. I had to remind myself that usually people post more when they have negative and/or extreme experiences. It's pretty rare to find the good stuff. There's another blog out there about a young girl (her mom wrote it) who had some good success with MPFL recon. Have you found it? If you haven't and want a link, I can look it up for you. Good luck with whatever you decide to do!

alyssa said...

Isnt it funny how you can walk out of the Dr's office confident and understanding of your options - then go home and do further research and psych yourself out? Doctors must hate the internet! haha... kneeguru: great info, but very pessimistic stories on EVERYTHING. Pretty sure the site could convince you not to have a broken leg set in a cast. I too am constantly reminding myself only unhappy people are vocal! It was great to hear that you were up on your feet quickly, mobile, moving independently, etc. as I wont be able to take much time (2 wks?) off of work and all these things are a must both for my sanity and independence. Your story corresponds with what my doctor was telling me.

My mind is thinking the same way – I’ve always said I can deal with pain, but I hate the feeling of instability and feeling it could go out while turning a corner. I slipped/turned/fell (proud moment) badly a couple years ago dislocating the kneecap and shredding my MCL + one reinjury (due to the instability). We treated conservatively, the MCL healed up fine, but the knee cap stability has never been the same since. I just want my casual semi-athletic (when I want to be) life back!

I feel good about my situation, I think surgery and the first few weeks of rehab just scare me, and I have to sort out all the details and make it practical – My Dr. offered to do the surgery but actually referred me to a top OS in my area that specializes in it. From what I've read up on her, she's the person you want. Timing is my only problem, I can't get into see her until September and am concerned I won’t get things scheduled before the end of the year. Stupid insurance companies. So we'll see how it all plays out.

Thanks again for the great info!

Brian said...

I am going in for a MPFL recon in the morning and your blog has brought me hope for a possible solution of a lifetime of sublux/disloc problems. Thank you so much! I will follow the blog for pointers and assistance attentively! I will post some updates too if i can help othersa!

Brian said...

oh, and I am on facebook too, if you are. email me if you get a chance, us knee people need to stick together!

Junkgirl said...

Brian--Thanks for your comments! How did the surgery go? Hang in there! The worst part is probably over by now!

magdalene bernadette said...

Daer Junkgirl,

Wow....reading about your experiences has really enlightened me about my impending MPFL surgery.
I myself am a Physical Therapist and my work relies on my knees A LOT. Unfortunately my left patella has proven to be quite stubborn and has given me a few recurrent dislocations in the past 20 years.
Although my surgeon offered me this surgery so that I can continue my active lifestyle, a few of my professional colleagues displayed skepticism over this procedure.
I really don't know what to think. All I know is that i want to be able to continue my work for as long as I can , as well as get back into dancing and jogging without fear of my knee popping out.
Yours was such a positive experience which I hope I could refer to when I get out of surgery. 2nd day without crutches.....Awesome!

Junkgirl said...

Hi, Magdalene Bernadette--Thanks for the comment! Like you, I suffered from years (30+--I'm now 37 years old) of patellar instability. I couldn't imagine how the knee could really get any worse after surgery, so I went ahead with it. I've had so many that surgery just doesn't scare me at all.

What I gained in stability more than makes up for the pain and nuisance of therapy. But, as a PT, you know what kind of work goes along with recovery. I had my doctor work closely with my PT so we could follow the exact prescribed protocol carefully. I like to dance, too, and I could confidently dance or jog or play sports at this time. I was always worried about my knee popping out before.

Good luck with whatever you decide to do. Keep me posted!

Simon said...

I had a MPFL on my right knee 2 years ago and although surgery went well, I hadn't appreciated how bad my quads were going to be (in terms of weakness). Couldn't straight leg raise for around 10 weeks, my quads were none existant. Also found the physio a lot tougher than expecting.

I'm also now 3 weeks after after a MPFL on my left knee( 20th June 2011, bummer i know :-) ) and it's already feeling a lot stronger than my right did. I'm already straight leg raising a bit and my leg just feels stronger in every way. There's some pain on bending but that's more stiffness than anything else.
I've had the brace on 3 weeks and got another 3 weeks before it comes off. My consultant here in the
UK has a protocol of fully weight baring from day 1 but brace is straight for 2 weeks, then brace at max 60 degree bend for 2 more weeks then final 2 weeks it's no more than 90 degree bend.

Although i'm still building up my quads on the right knee also, I have to say that even with all the hard work, i'm still pleased with how things are going/gone.


One final thing, I think my biggest hurdle is the mental one for me, as in my confidence in my knee after the operation. I'm still thinking that my knee will sublux which isn't the case but my brain is still thinking it will. Building up confidence after having surgery on both knees is taking some time :)

Junkgirl said...

Simon--thanks for your comment! I've been on vacation, so I apologize for the late response. Wow--you had it done on both knees! I've actually been considering that. Although my left knee hasn't dislocated in over 17 years, it's still not stable, so I've considered getting it done for more reassurance.

I definitely know what you mean about worrying whether or not your knee will sublux. I don't know about you, but I've been dealing with this since about the age of four, so after a lifetime of playing it safe, it's hard to let myself go.

Hang in there and let me know how things are going!

Anonymous said...

I am almost four weeks post op from my MPFL reconstruction. I wish that my experience was as smooth as yours seems to have been. I am still in a lot of pain. Doctor has me in a straight leg brace for eight weeks. Right now I am at 30 degrees, next week 40, then 50, 70, and 90. My quad is COMPLETELY atrophied, but that is because this is my third surgery in two years (first arthroscopy, then lateral release). The pain meds don't even work because I have been on them for so long. I am still on crutches full time (the best I can do is using one crutch around the house), and if I don't have my leg propped up literally around the clock, it is almost unbearable. Since it is my left knee, I can drive for about 5 minutes, but otherwise I have to be in the backseat.
My friend is an ortho surgeon and she told me the first 6 weeks are hell, so in two more weeks, I should be feeling like a new person.
I must say that my knee seems much more stable now, so that's a good sign. At this point, I have abused my "good" knee so much that the surgeon said I need to have that knee done as well, but I need to concentrate on getting through this surgery. I am hoping I have a similar experience as one of the posts that the second time around isn't as bad.

Lacey said...

I had the MPFL recon done in September of '10 on my right knee. It is believed that I shredded my MPFL 10 years prior to having the surgery. I'm 27, female, and a relatively high-level athlete. Though my experience with this MPFL was a TERRIBLE one (developed blood clots, almost lost my life, still dealing with significant pain a year later), this made me think that I just have terrible luck. Though I haven't gone to the doctor about my left knee yet (heck, it took me 10 years to go the first time because I knew surgery was the answer), I have a feeling that surgery is going to be the verdict on my left knee. This gives me a little hope that the experiene I had isn't a typical one and that just maybe, going through with the second one would be worthwhile. If anyone wants insight as to my own personal experience, I would be more than happy to explain the good as well as the bad. Though I had terrible problems, I don't necessary advise against the surgery. I think that it can be a very good thing. I just wish that before I went in, I would have had the insight of an athlete, a year post-op, to tell me what to expect.

Simon said...

I'm now 9 weeks after my MPFL and I have to say rehab has been a lot better than the 1st time around. Although my quads are weak, they are a lot stronger this time around. I'm at physio x2 a week and stretching daily. I'm still getting a fair bit of stiffness if on my feet for a while but that's pretty normal and I know that will ease as time goes by. Another problem is my hamstrings seem so tight so will have to be careful not to over stretch them.
As in my 1st post, the most important thing for me was to stabalise the knee which thankfully seems the case. The rest I can live with and with continued physio/exercise this should make it easier.

To everyone who's recently had surgery, Good luck and keep thinking more about long term gain rather than short term problems you are encountering.

Junkgirl said...

Lacey--So sorry to hear that your experience last year was so bad with MPFL recon. It does seem like your story is atypical, and I hope that if you go through with the other knee, things go much more smoothly!

Simon--You're right--thinking more about the long term gain is the key! Glad to hear things are progressing for you. The doctor told me that it would be a good year and a half before I felt "normal," so I've always expected it to take a while, so I really feel for people who have the surgery and expect to feel better in a month or two. For me, that just didn't happen!

I have a question for you--do you still feel stiffness the knee on which you first had surgery? I have a lot of pain and stiffness at night when sleeping because I like to bend my knee up. Just wondering if you have/had that and if it's just something that I'm going to have to live with!

Simon said...

Hi Junkgirl,

I do still get some stiffness in the knee which was operated on 2 years ago although not while sleeping. I tend to get stiffness when standing still for a bit then start walking. I'm a nurse and the time I feel it most is when rolling a patient and staying in a certain position for a while or standing at a bedside.
I also got a lot of stiffness when i'd do tasks like washing up (my wife thought it was just an excuse :) )just standing at the sink washing pots then moving away and back again in a standing position seemed to cause the stiffness. This though has certainly improved over time. Like you say, it's going to take 1-2 years to feel fully better.
I do find though that exercising regularly does help improve the stiffness, whether it's on the bike or swimming.
On a final point, I started taking ChondroMax which is 500mg Glucosamine and 400mg Chondroitin - 3 tablets once a day. They are pretty expensive but after taking them for last 4 months, i do feel less pain/ache in knee.

I know your outside uk but here's the info on it.

http://www.healthspan.co.uk/glucosamine-supplements/chondromax/productdetail-p300-c142.aspx


Simon

Anonymous said...

I got knee stabilaztion surgery 3 days ago and all I can say is so far this blows!! Haha. I am looking forward to the full results but this straight leg cast thingy is really cramping my style. I must have had a different type of surgery than you because I have two small incisions where they put the arthoscope in and then one large one (4-5 cm) on the inner side of my knee cap. I was not expecting the incision to be so large but maybe they had to do more work than initally thought. I have to keep my leg in this brace for 6 weeks with no ROM. I am off of the pain meds they prescribed but am taking tylenol extra every few hours. This is going to be a long recovery...

Anonymous said...

I got knee stabilaztion surgery 3 days ago and all I can say is so far this blows!! Haha. I am looking forward to the full results but this straight leg cast thingy is really cramping my style. I must have had a different type of surgery than you because I have two small incisions where they put the arthoscope in and then one large one (4-5 cm) on the inner side of my knee cap. I was not expecting the incision to be so large but maybe they had to do more work than initally thought. I have to keep my leg in this brace for 6 weeks with no ROM. I am off of the pain meds they prescribed but am taking tylenol extra every few hours. This is going to be a long recovery...

Craig said...

I had my MPFL recon 2 weeks and 2 days ago. The surgery appears to have been completely successful. The patella is already clearly more centered than it has been in years. I fully expect to be more capable of pushing myself in athletics and dancing after the healing is completed.

I had a nerve bloc too which seems to really reduce post-op pain, although it is very strange to feel paralyzed. I think the nerve bloc did have lingering effects up to two weeks following the surgery and I think potential surgery candidates should remind themselves that as you start rehabbing, some feeling and strength might be missing for a longer time than you'd reasonably expect as a direct result of the bloc. Still worth it IMO.

Also, my brace required adjustment at my post-op visit two weeks after surgery. I woke up from anesthesia with it on and never felt comfortable adjusting it on my own because I assumed it was perfect. My surgeon lengthened it about 3 inches at the thigh 3 days ago and that seems to have made my PT a tremendous amount easier AND more effective. I'm not suggesting adjusting the brace ones' self. Just make sure your surgeon confirms your brace is fitted perfectly right from the jump. I'm doing straight leg raises 15 days out and can bend the knee to 90 degrees which I'm really excited about.

My first PT was the day following surgery as well. It seems cruel and unusual, but it's definitely the way to go. I feel like my flexibility and strength (and as a result frame of mind) are way ahead of where they would be if I had waited a week or two to initiate PT.

I feel very confident this surgery is going to leave my knee better off than it was at birth! I'll check back in a few months to give an update.

Jen said...

I'm having MPFL reconstruction on my right knee in about 5 weeks. I'm 27 and have had 7 dislocations of my patella since I was 13...tried physical therapy MANY times, but this most recent dislocation was the worst. My new orthopedic surgeon (at the Hospital for Special Surgery in NYC, supposed to be the best for orthopedics in the country) said this was my best option.

I was pretty nervous at first, especially after making the mistake of googling the procedure and watching a 9min long YouTube video of it! I was terrified after I saw it!

I have to say though, from most of the comments here, I'm SO much more at ease now.

My doctor told me I'll be out of work for 6 weeks, which is mostly due to the fact that I live on the 5th floor of a walk-up building (that's NYC apartments for ya!). Her basic instructions to me during my visit were: no leaving my apartment AT ALL the first week (my parents are going to drive in from out of town for the surgery and stay with me for a few days to help out), then the next couple weeks I can only leave once per day, again probably due to the 5 flights of stairs.

At my 10 day post-op visit, she's going to evaluate how I've been doing with those bending exercises at at home, and as long as I seem to be having enough movement, she's going to hold off on starting my PT until after the 6 weeks at home.

Back in 8th grade, when I had my first dislocation, I was in the immobilizing brace for a few months, so at least I'm prepared for how awful that is to sleep with on!

My parents are pretty nervous about when they have to leave after the first few days, but I'm actually going to send them this page to hopefully put them a little more a ease as well!

Craig said...

I'm now at the 10 week mark and everything is going very well. I returned to work 2 weeks ago. I have to take it easy and not push to much to avoid bad swelling and discomfort, but it's hard not to work for an extended period. PT has graduated to leg presses and stationary bike and elliptical. I will rejoin my own gym this week as well, but with very light routines to begin. The rehab process has been a very slow and patent process. At ^ weeks my surgeon manipulated my knee to break up scar tissue. Hurt like hell, but increased flexibility a ton and I think hurried the whole process along. My quad is still weak and much smaller than the other. I think I'm about 2 months from jogging, swimming, dancing. THe whole process has been a success so far as I can tell. To anyone who needs a good surgeon or evaluation I used Dr. Marc Kowalsky at Lenox Hill. He seems to be great.

Chelsea said...

I am scheduled to have my right MPFL reconstructed on June 8. This will be my second surgery in less than a year; I had an arthroscopy with lateral release last July. In March 2011, I dislocated my knee and bruised a couple of bones slipping and hitting my knee on a concrete floor. It was not until about 2 months after the surgery that my kneecap started slipping out and completely dislocating. I could feel and see it doing this multiple times a day. As a result, I was not able to get off the crutches because of the pain and inability to put weight on it when this happens until I was put in a different brace in February.

My doctor said that this surgery is my best option because physical therapy is not helping, but I am a little concerned about it because I also have a neuromuscular disease. With this disease, it is nearly impossible for me to build up strength in my muscles. When I read that you had atrophy in your quads, I knew that my rehab would be longer and more difficult, but I am looking forward to finally getting out of this brace and back on a horse for the first time in over a year.

Ryan Marie said...

I am having MPFL reconstruction with an allograft in one week. I have had a VMO advancement and lateral release previously. My ortho has me out of work for 12 weeks.

caligirl55 said...

hey i just had this surgery yesterday and i have severe pain in my left knee. i have been taking percacet and got the nerve block however i am not sure when i should start bending my knee. It hurts so bad i dont know when i should start. I was hoping someone could give me some advice

Chelsea said...

caligirl - Do not start bending your knee until you begin physical therapy and they tell you to. It is going to be painful for a while. I had an MPFL reconstruction in June and started PT 4 days after the surgery. For at least 3 weeks it felt like my kneecap was going to shatter whenever I bent it or even just moved my leg by myself.

Anonymous said...

I have my mpfl tomorrow. OS told me I needed to be out of work for 4 weeks. As a teacher, you know that is impossible. I am planning on going back to work after 4 days of rest. I can sit at school and I have had multiple knee surgeries in the past so I feel that I will be okay. With your experience.... How long were you out of work teaching?
Thanks,

Anonymous said...

I'm getting this surgery in a few weeks. I haven't been able to talk to anyone who has had this surgery, and I'm still having doubts. My knee has dislocated at least once a day since I was 8 years old. I've tried everything and surgery is my last resort. None of the doctors I've talked to seem very hopeful about my results, and I've read that chronic dislocations have less than 50% success rate. Did you think it was worth it? How were your results?