FIXED my failed lateral release! (Exercises for medial patellar instability)

[CarolO]

Hi Angela (ClippedWings),
I found your post and signed up so that I could participate in this discussion too. Your most recent post where you said your knee did a little circular motion was the "right on" description of what I experience too. I hadn't been able to describe the sensation until then, but I know what you mean.

I had a right LR in '98 with a torn ACL. That went fine. Because of the success with that, I had a LR done on my left in '04. I've had problems with the left ever since. I suspect, as this thread is named, that it was a failed LR. Since then, I've had PT, another surgery where the OS removed the medial plica (whatever that was). Still, my knee gives out quite a bit (some days more than others) and I've started experiencing the "circular motion" of my knee with each step as if my knee is going to give out medially as I step forward but then swings back around. It feels as if my knee is only connected by a rubber band that's about ready to snap. Add to that the fact that my knee tightens up frequently (it doesn't lock, it tightens). The only thing I can do is to suffer the pain until it loosens enough that I can make it pop. It feels better for a while after that.

Thanks for starting this thread. I hate that others are in pain, but I'm glad to know that I'm not alone.

Carol

[WorkinWings]

Welcome to KneeGeeks, Carol!

I am sorry you are having problems, but you are right--you will not feel so alone here. I'm glad you have found this website. It has helped so much...

Thanks for your message. I've been traveling, and couldn't reply sooner.
Unfortunately, I really don't have much of an idea about what happens with my knee when I am not wearing my newest brace... That feeling of instability around my tibiofemoral jointline has gotten a lot better since starting to wear the brace about two weeks ago. My knee now feels a lot less inflamed and less painful than it has for many months. I am very hopeful that the instability I described is only due to the inflammation and weak muscles, but I really don't know yet.
I of course had started to worry (I'm good at it ) that there might have been an undiagnosed ligament problem with my knee that was now, after being so challenged since my lateral release a year ago, finally starting to rear its ugly head. But I've had that MRI done, and two doctors (plus one very helpful and knowledgeable KneeGeek thanks Kathat!) tell me there really was not much to worry about, and nothing wrong with my ligaments. So I've calmed down!


But as far as what is happening with your knee, I would definitely look into having a good knee OS look into it, especially because you have had an ACL tear in the past. Did that get fixed during your surgery in 98?

Good luck, and please keep us posted!

Angela


OOOOps, sorry! I ought to pay more attention! I just re-read your post and realized the ACL tear was on your OTHER knee... never mind!
That being the case, if I were you I would definitely try to find a very good patellofemoral specialist, to see if there is any chance the problem stems from a bad LR, or if not, they would be still much better equipped to diagnose your current problem (if it is related to your patella).
Are all these symptoms you mention new since your left knee LR in 2004?
Is the 'pop' you feel actually your patella jumping back into the groove after subluxing? Or is a different structure involved?

[WorkinWings]

Hello to all of my patella-pals!

How have you guys been? I missed yous!


I've been away on two trips in the last two weeks, and come back bearing news:

I saw a new OS last week my fifth, and the second patellofemoral specialist I've seen, now!

OS#5 is amazing. Of course I knew going in that he is very knowledgeable, but he is also very thoughtful, very sensitive, and extremely good at explaining everything in a way I could understand he has a dry erase board in the examining room, which he used over and over to illustrate his points.

He said that, unfortunately, my OS did indeed over-release into my vastus lateralis tendon. He could feel the defect where the VL tendon was cut. After he showed me this, it is easy for me, for my husband, and my PT to feel it as well.

So the surgical option he proposes is to just repair the tendon, and not try to reconstruct any other structures as he put it, reconstructions would involve 'robbing Peter to pay Paul' which he does not like to do.

I really liked the fact that, as surgical options could go for this problem, that is as conservative as it gets, as far as I know.

Even so, I will continue attempting to gain some function back through exercise. He endorsed that as my next step, especially given that just two weeks ago I finally found a brace that has been enormously helpful my 5th brace, the (drum roll, please…)[glow=red,2,300] Tru-Pull Lite[/glow].

The good doc#5 did say, though, that it is not possible to strengthen a muscle that now has nothing to pull on... We'll see, maybe other muscles being stronger could help... He has offered to ask around about a knowledgeable PT in my area, which I was also grateful for. My current PT is a lovely person, but understandably doesn't have too much of a clue when it comes to medial subluxations...

Is there ANYONE out there who also had a confirmed overzealous lateral release??

Has anyone actually been successful with a non-surgical approach?

I would love some input from you fellow medially-subluxing-Geeks.


Anyway, I thought I'd share the good news with you all, and say that I so appreciate the fact that KneeGuru site and you KneeGeeks were among the ones to first steer me in OS#5's direction.

Thank you so very much!

(((Hugs))) & *!*Cheers*!*

Angela


'BIG' PS -

MANY, MANY THANKS to all of you who wrote in recommending the Tru-Pull Lite!!!!!!!!!!!

Yes, Kirstin, that includes especially you!

[align=center]That little guy is a virtual MIRACLE![/align]

[Silkncardcrafts]

Hi Angela,

So pleased to hear that OS no. 5 was so helpful. It is great that the Tru Pull Lite brace is working so well. I tried it for a while, but my medial subluxations and dislocations were so bad that I needed additional support. My OS referred me back to my orthotist to get a hinged brace as my knee was feeling really unstable. I was hyperextending a lot, so the hinged brace really helps. It doesn't come out as much either.

I didn't have an over-zealous lateral release, but have had a lot of problems with medial instability, especially with my left knee. It is one of the risks of a lateral release. The first step you talk about is called a lateral release repair. My OS did one on my right knee, which worked fantastically but unfortunately didn't work on my left knee. So, that's why I am scheduled to have a trochleoplasty next Thursday. I am worried that I've also torn my MPFL and will need it to be revised. I think I may have some cartilage damage as well. Will be interesting to see what my OS finds.

When are you scheduled for surgery ?

Carol, what you describe sounds like medial instability. My OS said for medial instability that surgery is really the only option, but most likely you will have to try physio first.

Good luck !!

[tanyap]

Hi Angela,
wow - thats great news! There IS someone else around here who had a confirmed over zealous lateral release, cant remember who just now - was it Laura, (austinknee)? I definitely spoke to someone who had that happen though.
I like that the most conservative surgery option is the one to go for - the simpler the procedure the better the chance of success eh?
I need to read the rest of this thread for a catch up.
xxx

[WorkinWings]

Hi All!

Kirsty and Tanya--Thanks so much for your notes! I really appreciate them.

Tanya, please don't bother with the rest of this thread... It'll bore you to tears! LOL! At least the parts I wrote!

So WHERE is that Laura, anyway?? I am soooo worried about her! And I could really use her help right now... But really, I sure hope she is all right.


Anyway, I have not scheduled surgery. We decided I'd first attempt to see how much function I'd be able to gain back through exercises. The surgical option that was explained to me sounded terrific! I've really been on cloud nine for since my appointment with OS #5 on May 9!


THEN...


Last night I got this BOMB of an email! You should see the mess it made of my spirit...
It was from the person who probably has done the greatest number of surgeries to fix bad lateral releases... Probably more than anyone else in the world... He TOTALLY trashed the suggestions given by the other PF specialists I have seen...

THANKFULLY I have not used anybody's names anywhere!


I'm feeling really down, right now. This guy was a bit rude in his email. BUT, when it comes to surgical procedures, we want to go with whoever gives us the best chances of a successful outcome, right? Sometimes that might mean ignoring some not so likable personalities…



But how am I going to figure this all out?? I really feel vulnerable.

I LOVED the last doctor I saw. Everything he said made sense to me. All of his attitudes were just beyond perfect...

BUT WHAT DO I KNOW??


.
.
.


nothing

[arkitect06]

Angela, what did you ask this other OS? Is there any way you can post his response to you? I am just curious as to how it all went down. I hope you are doing okay. My knee locked up about 15 minutes ago and I stood up forgetting about it and it straightened out and hurt really bad. Now I can't move it or bear any weight at all. I am so tired of this crap!! Well I hope you are doing well.

Farrah

[tanyap]

Angela,
Has this OS you got the email off actually examined you knee and looked at your x-rays, mri's etc.... Or did you just email him for advice?

Can you bring the content of his email (no names) to the OS you DO like and ask him for his opinion and ask him why he thinks itll work and this guy doesnt? You need to get to the bottom of all of this - sometimes doctors assess risk differently you know? And the email guy may be taking the conservative approach without looking at the bigger picture (ie, something needs to be done) but the other guy may be taking the approach of 'lets try it anyway' - so you need to find that out.

I feel for you - its awful to have conflicting opinions - my last horrible OS had pretty much no opinon and the new guy is totally different, but what the new guy says makes sense in terms of my problems whereas what the old guy said didnt so Im listening to the new one.
xx
Tanya

[Silkncardcrafts]

Hi Angela,

Sorry to hear you got that horrible email.

Feel free to PM me. I'd love to know more.

Just go with the OS that you trust. It sounds like you had a lot of faith in the one you saw on the 9th of May.

Sometimes that's the problem when you get lots of opinions.

Keep your chin up !!!

[WorkinWings]

Aaaw, my dear, dear fellow Geeks,

Thank you for your words. Boy, that stuff hit me hard over the weekend, and I can't tell you how much it helps to have you guys here for me.

I am feeling better now… Acute part of crisis OVER… Moving on to thinking more calmly over what to do.

I will work on explaining what happened more clearly. I think it has been a little confusing what with trying to preserve everyone's identity, and attempting to relay complex issues with as few words as possible, so as not to lose you guys forever in endless posts…

Add to that all the emotions swirling 'round… You got the picture!

I'll PM you guys thanks for your interest, and for trying to think this through with me!




(But, for the record, I don't transcribe private emails, or reveal names. It's not needed, and I don't think it's ethical. I know that is not what you guys have asked of me, but I just wanted to make it clear here in case anyone reading this thinks that's what I will do in my PMs... )




On a different note:

Farrah,

Sorry about the way you unlocked your knee in such a painful way… It sounds like everything in there is just so inflamed, and then everything sets off a much bigger reaction for you. I'm so sorry, and hope that by the end of this week you will be in a much better place. Hang in there just a little longer!

Tanya and Kirsty,

I started getting butterflies in MY stomach now for you guys! Maybe we should try PUP-therapy again…

I cannot wait to hear that you guys have come out of surgery Thursday all fixed up and ready for that elusive 'road to recovery'! It may have some nasty bumps along it, but what a DREAM of a destination! Wishing you both all the best!

Talk to yous soon!


Many hugs,
Angela

Ooops! PT in a little over an hour! Better get those wheaties in me ASAP, otherwise there ain't no way I'll 'perform' well!!

[tanyap]

Awww!! I LOVE pup-therapy!!!!! why didnt they prescribe that for me years ago!!!
heres my theraputic offering of the day:

[WorkinWings]

[align=center]Oooooh, GEEZ!! Squeezy is cUte!!

Yeeeeeeeah!!

MORE PUP-therapy to all!!!



Thanks!!



(yiiiipes! late late late )[/align]

[Silkncardcrafts]

I love those puppies. They make me feel really relaxed !!!

In late August I am getting a Basset Hound pup. I can't wait !!!

[tanyap]

I cant WAIT for the Basset Hound Puppy Pics!!!

[WorkinWings]

Oh, my!! A Bassett Hound puppy!! Angela is envious!

No, seriously, that is seriously cute! What a wonderful thing to look forward to!

You guys, I am getting really anxious for you both--in a good way! But it does keep requiring pup-therapy...

Here's a visual to hold in your hearts for Thursday... And she's bringing you both a little gift from me...