16 year old with recurrent knee dislocation

[Silkncardcrafts]

Hi there,

It sounds like you are making some real progress. Don't like the sound of the first two, but do like the sound of the OS your daughter has just seen. Sounds more in tune with what is happening and has better attention to detail. I'm so pleased he's not keen to rush into anything and will hopefully make the right decision for your daughter.

Can't wait to hear the next instalment.

[datapopp]

Well, after 5 doctors evaluations - 2 Sports medicine (1 who conferred with a well-known Patella Femoral Specialist , 2 knee specialists(1 who conferred with the same well-known Patella Femoral Specialist, which by the way that was a little embarrasing) , and one quack who thought we should start with a lateral release.

My daughters knee surgery has finally been scheduled for Tuesday September 16. She is afraid but happy to have something finally be done about it. From my limited understanding she will have a MPFL reconstruction and a distal re-alignment procedure.

[adlottis]

It does pay to have multiple opinions, I hope your daughter will do well, I am 41 and had the same procedure done 18 months ago, along with a chondroplasty (for I ignored my problem for years) My Dr. said he usually does this procedure on 18 year olds. I started dislocating at age 10.

The surgery is a tough one, but she's young, make sure she does all of her exercises. It's key to the success.

Good Luck
Annette

[datapopp]

Thanks Annette.

[Leentje]

Hey!

Just want to share my story...

I was 13 when I had my first dislocation, it came out of the blue... Slipped on ice when returning from gym class.. BANG!
Was out for a few minutes but once I got up and extened my leg it went back in. OS told me I would grow out of it...
In the years after that I dislocated frequently but OS still told me and my parents "she will grow out of it!"... Did not happen (read further on, don't let this discourage you kust yet! It gets better)
Fast forward to the time i was in nursing school, during an ortho college I recognized my problem and realized I would not grow out of it : recurrent patella dislocations... Treatment... PT, bracing, taping, surgery... OMG!
I had to do clinicals and my knee got worse, started to work and knees... worse and worse... When I switched from neurology to ortho ward, I decided to see one of the OS. Xrays and CTscan showed : severely subluxed patella, no femoral groove, malformed patella, chondromalacia grade III even IV,... all those years I did play recreatative (sp?) badminton without too much problems, needed bracing from time to time, more for pain.
As years passed by the subluxing got worse, I could feel the patella sublux with every move and I dislocated just moving my leg... OS decided to perfom a LR with a warning it would probably fail, still I had it (and don't really regret it) but yeps it did fail... 1?5 years later I had the TTT 2002, I was 25). Rehab wasn't easy, but I told my OS I would give it 300% as I would NOT : give up my job and give up badminton!
Didn't have much pain post-op, was in cast 3 weeks, had 3 weeks of PT in wich I regained full ROM, but it took me up to a year to have a normal knee again, good strenght and reliable feeling... 6 months post TTT I started running again, shortly after that i was playing badminton again, carefully and easy but I was back on the court and it felt like... heaven!
I braced my knee for over a year playing sports, then gradually played without it. Knee felt fine. I started to jog again (4 km runs) and switched ortho for ER/ambulance services which is not alwyas knee-positive. Since last year I am playing competiteve badminton (am 31 now) and play a minimum of 8 hours a week. I run every other day 4km and on sept 20th I will be running a marathon with 7 collegues (I will run 7km). Knee is fine, no more dislocations, have my moments of pain when I wear my brace (donjoy tru-pull) but this sin't very often I can asure that!

Just want to add that my OS is a very good one but doesn't do much TTTs. He was kinda afraid to go through with it, as I was working with him and when something goes wrong it's always with surgery in collegues/nurses you work with, I had to beg him to do it,!

Hope this gives you a thought about how it can be! Most people on here are still here because they had failed TTTs and seek further advice/actions, I am still here because I want to show TTTErs how active one can still be post TTT.

Hope this helps!

Helena

[adlottis]

Helena,

Your story sounds similar to mine, except i'm 10 years older than you. I too have had good success with the TTT, i'm running and working out, unfortuantely I have developed tendonitis, and because of so many dislocations over the years I had to have a chondroplasty and although we feel it has been successful, OS already sees wear and tear 18 mo. PO. My advice to anyone who has had this recurring problem with dislocations, don't let it go and don't let the dr's say you'll grow out of it or in my case they only looked for injury not the reason i kept doing it. YOu will regret it and it is a problem that doesn't get fixed. You mention failed LR, my OS concurs the same thing, that is why he wouldn't do it on me, instead he did it in conjunction with the TTT and medial reefing and chondroplasty.

Annette

[datapopp]

Thank you Helena for such an uplifting story, my fingers are crossed that it will turn out the same way with my daughter.
It has been and still is very frustrating for both her and I....I had started out just to get a second opinion and ended up going to 4-5 different doctors because their opinions were all different. One of the doctors told my daughter that she should pretty much give up on sports....as he did not believe that the dislocations could be fixed....WOW, was she bummed...I hope he is not right, though I appreciated his honesty. But really really hope he is wrong.

Luckily the OS we chose is a great OS Dr. Steve Shoemaker and is collaberating with Dr. Fithian who is an expert in the patella-femoral joint...we don't have Kaiser so can't go to him directly.
Currently she is still scheduled for a TTT and MPFL reconstruction on Tuesday.

Thank you for your support!

[3Diggersmom]

Hi there, I am new, but posted my 15 year-old son's story today. I am so happy your daughter will have a surgery to correct her problems. We were told our son could not have a corrective surgery due to his growth plates being open. Did you have this discussion? Best of luck to you. I will be eager to hear how she is doing. I too hope she will return to play sports.

[datapopp]

I read your post about your son. I am really sorry..it is so difficult on these teens who love sports and then have something like this happens. I am very ignorant about these things and learning as I am going..Dr. Elizabeth Arendt specializes in female athletes and in one of her abstracts says she has alot of success with MPFL reconstructions for the dislocations of the knee without doing a TTT even if there is a shallow trochlear involved...my understanding is this is a procedure that can be done without the growth plates closing yet....of course I have no idea why your sons knee goes out but at least this might be something to ask about???

My daughters growth plates are closed so it is not a worry for her...good luck!!!!

[3Diggersmom]

Thank you so much. I will definitely ask about this when we go back to the OS on the 29th. We have tried to learn everything we can as we have gone through this, but there seems to be so much out there. There are so many terms and names for the surgeries. Early on the first OS we saw suggested a lateral release, but when we looked into this it didn't seem to have many positive outcomes.
We switched to our current OS after doing some research and talking to people. We are very pleased with him, but continue to feel frustrated and helpless in our quest to end these troubles for our son. I think a lot of it is that he is continuing to grow, so his instability continues to exist. The best that I can tell his patella alta, shallow trochelar groove and growth spurt are the reasons he subluxes. Can you tell me what the difference is between the Fulkerson surgery and the TTT...are people talking about the same thing? Are these the same as the distal realignment surgery? Our OS talked about a surgery that would realign the patellar tendon and it would be screwed into the tibia....is this the TTT,etc.? This was the surgery he said he couldn't do until he was done growing. It is so nice to talk to another parent in this situation. How has your daughter's mood been? It has been a roller coaster here. Thanks again!

[datapopp]

My understanding is the Fulkerson Osteotomy is a type of TTT, it is when the Tibia Tubercle the bump below the knee where the patella tendon? is connected is cut and then screwed back in at anotherr area to change the patella's alignment. I may not have gotten this exactly right but this is my understanding. And yes it has been an emotional roller coaster....one of the competative cheer teams she was on was just chosen to be on the Movie "Bring it on 5". It is one of my daughters favorite movies....and she is out for the season....big, big, huge disappointment. Along with the fact that these teens who are really competative athletes have been in the sport for years(as you know)....alot of their peer group are on the teams.....she will go to practice to watch, be with her friends and then come home very depressed.....it is very sad...
She has done much better since the surgery has been scheduled.

Let me know what happens with your son.

[datapopp]

Well we went a saw the specialist in the patella femoral joint today, Dr. Fithian, my daughter's OS had asked him to take a look at her...I feel like she is very well taken care of at this point . Dr. Fithian used the MRI and took measurements of where the kneecap rides, etc. Their main concern is that she dislocates both lateral and medially. They decided to hold off on the TTT and do a MPFL Reconstruction at this point. And to complicate it a little more...the growth plate on the tibia is closed which would allow for the TTT without a problem but....the growth plate on the femoral is not closed which means they are going to perform an MPFL Recon with whatever method is used on pediatric patients. Well at least we have a plan and Tuesdays the big day! My daughter was a little worried as this will take care of the lateral dislocations but may not do anything for the Medial... but we have to start somewhere.

Does anyone know what type of brace she will probably be in and how long she will need to stay home from school??

[3Diggersmom]

Wow, I can totally identify with your situation...just sitting by and watching your daughter observe from the sidelines is soooo heartbreaking. I can't even drop my son off at soccer games without totally losing it when I'm driving away . I know that sounds silly, but its more than just having him on crutches. It's the years of watching him and enjoying his success and growth and then having it all snatched away in an instant. I know he will grow as a person having gone through this, but sometimes its just plain hard.
I am glad that your daughter has such excellent care, that has to be comforting. I will be thinking of you both and will keep you in my prayers.

[FormerlyActive]

Sorry I'm late catching onto this post.

Wondering how your daughter is?

Agree with the other posts, sounds like you still needed more information (as of one month ago). Have to agree with the other posters, your knee is never the same after surgery so its wise to sufficiently try the other options. You can research the LR, there are certain conditions under which it applies. With the TTT surgery you mentioned, Fulkerson is one variation I think. I know my PF doctor told me she does 50 per year, apparently the skill of the OS on that surgery is significant. Sounds like your risk is with the shallow groove, which sometimes requires a different surgery the other posters mention.

Good luck and let us know.

[datapopp]

My d had her surgery today. The doctor said the surgery went well. He did an Arthroscopic first, Medial Reefing, and then a MPFL Reconstruction with a graft from her hamstring. He said there was quite a bit of avulsion or avulsion tears on the medial side of the knee when he went in so he did the Medial Reefing. She has 3 2" incisions for the MPFL. She woke in recovery and started crying because of the pain they gave her some meds in the IV and a shot. She also has a tube going into her joint with pain medicine which will be in there until Saturday when I am suppose to pull it out.....
She is currently asleep and some of her friends came by with candy and flowers which was very sweet.