Dislocated Kneecap, torn medial Patellar Retinaculum Ligament, Cartilage, etc

[comish]

Comish-

My leg did Atrophy quite a bit, and is currently 1.5 centimeters smaller. Doesn't sound like much, but it's more than you think.

I too hobble a bit when I walk. My leg just isn't strong enough to support my normal gait. A normal step will have a bit of a bend at the knee upon extension, but if I do that my leg wants to bend too far forward at the knee giving me that eerie feeling of 'giving out'.

The only strengthening I've done thus far is riding the bike. Currently I'm riding 10-12 miles outside about 3x a week. It's seemed to have helped.

I can also walk up stairs as long as their is a handrail. The only bothersome thing is that my kneecap likes to do a lot of clicking and seems as if it's 'floating' more than it should. Downstairs...not at home but at work their is a small set of stairs with only about a 5 inch drop. I can do those as long as I hold onto both rails. Running downstairs is a LONG ways away.

Hmm, interesting. Thanks again for sharing. My hobble is definitely getting better by the day which is reassuring. Any thoughts on doing more strengthening than just the bike? Were you advised not to do more? Leg lifts or various sorts as an example? I'm not quite there yet, but it seems to me like it would help.

The kneecap clicking is great eh. I figure that will go away with time, proper stretching, and especially strengthening. I can go up stairs, albeit super slowly. I can bend enough to do it, just don't have enough strength in the leg to pull me up. Down is tough. If holding onto hangrails and the down is small, ala 4 inches or so I can sorta do it. I think I need a few more degrees for that.

I'm very close to proving my Dr. right and the ever opinionated Dr. Mark wrong on the ROM issue. Technically I did it yesterday, but I want to blow it away before I declare victory. I also am confident based on how its progressing and feeling that I will get beyond the 115 degrees they achieved in the last surgery which Dr. Mark figured would be my max.

Its nice to be making progress.

[whisky]

After doing the cannonball stretch (letting my leg hang for about 5 minutes) I do leg lifts. I concentrate on pushing my knee down (negative flexion), and then up. The first few are painful after stretching but it quickly goes away. Leg lifts are good for beginning exercises, but your not going to build any real muscle.

I know everyone is against Dr. Mark but let's be honest. It's almost impossible to make an accurate diagnosis online. I think the benefit was that he would point out an 'option' and it were up to use to rule it out.

The excessive stiffness in our knees could be attributed to any number of things. You for example, during the second surgery did they loosen up the MPFL or did they just cut out scar tissue. Either one, or a combination of the two may have worked. Even if they only did one procedure doesn't negate the fact that the other could have had a similar outcome. There's more than one way to skin a cat.

Bottome line is that your making progress and that is ALL that matters!

[comish]

After doing the cannonball stretch (letting my leg hang for about 5 minutes) I do leg lifts. I concentrate on pushing my knee down (negative flexion), and then up. The first few are painful after stretching but it quickly goes away. Leg lifts are good for beginning exercises, but your not going to build any real muscle.

I know everyone is against Dr. Mark but let's be honest. It's almost impossible to make an accurate diagnosis online. I think the benefit was that he would point out an 'option' and it were up to use to rule it out.

The excessive stiffness in our knees could be attributed to any number of things. You for example, during the second surgery did they loosen up the MPFL or did they just cut out scar tissue. Either one, or a combination of the two may have worked. Even if they only did one procedure doesn't negate the fact that the other could have had a similar outcome. There's more than one way to skin a cat.

Bottome line is that your making progress and that is ALL that matters!

Agreed on all of the above. I'm not against Dr. Mark. Do I think he 1) is arrogant, 2) find it ironic he got his panties in a twist over words when he is so undiplomatic and imature in his choice of words, 3) unnecesarily alarmed some by the certainty of his assessments when having so little information on the situations being discussed, 4) provided a good source of information to think about and evaluate one's own condition, hell yes to all of the above.

Agreed on all your points really. I haven't even started to do the leg lifts and I realize thats a baby step to doing real strengthening. They are/were so focused on ROM for me that we didn't want to piss anything off through strengthening until I got a bit further on ROM. Oh ya, they cleared the scar tissue out and did a further Lateral Release, which I'm sure are both having an effect although the scar tissue removal I'm sure is what is helping me most at this point in the game.

There are always many ways to skin the cat which is what makes this so tough, frustrating, and endless in terms of the search for information. Then its a case of filtering and analyzing for one's self.

[whisky]

Went to PT yesterday for the first time in ohhhh about 8 weeks. When I left PT the last time the so-called 'expert' said "Sorry, wish there was something I could do for ya" as I was stuck at 90 degrees.

Well, after doing PT at home I gained 55 degrees and am now at 145. He says at this point we can now begin to strengthen it. Really, ya think?? I think the guy has been spending too much time rehabing the elderly.

First thing he wants me to try is hopping on one leg...my BAD leg. I looked at him and asked him if he was crazy! He said "nope, in order for me to release you, you're going to have to perform certain tasks". That's when my blood pressure started to rise. I said, "first I don't need you to release me for anything." "I'm not a city, state, or federal employee nor am I here for any type of workmans compensation". "I am self-employed and here for suggestions and ideas on how to best get my knee back into shape".

Needless to say, we didn't start out too good.

Things did improve however. I explained to him that my kneecap seems to "float" a bit and it takes more effort than it should for it to tighten up when I flex it. For example: Standing with your legs shoulder width apart and with your hand on your kneecap, shift your weight to your good leg. You can feel how quickly the knee cap tightens up. Try and pull up or down on it. You can't. Doing the same thing on my bad leg...kneecap still goes up and down untill I really flex the leg.

He showed me some other exercises, and afterwards I asked him what these exercises were supposed to accomplish besides strengthening my knee. He said he wanted my knee to get used to "absorbing the load" and "firing" like it should.

These include:

-Shifting your weight from side to side on the balls of your feet. Kinda like dancing back and forth. Wants me to bounce back and forth.

-Jogging in place. Just get your legs up and down as much as your comfortable with

-Facing stairs, step forward with your bad leg catching the edge of the second step. Bend the knee forward and push back. Repeat.

I'm going to incorportate those along with more taditional exercises.

Stand at ease...

[Woodlandclown]

i'd get a new PT and quick

[splat]

No shit. If there's one thing I have taken away from all the posts here, it's that you need to do the PT and to get ROM. Sounds like you're lagging and that person is not the kind of inspiring spirit you need. I'd hate to see you not get the ROM you'll need for the long haul.

[whisky]

Funny the two of your mention that. When I left the office I didn't reschedule any more appointments. I see my OS near the end of July and I think I'll just wait and see what he thinks.

My ROM is almost there as I need another 10 degrees to equal my other leg. Had I had gained my ROM back in a more timely matter I'm sure I would've just skipped going to a physical therapist all together. I've been thru lots of rehab with both knee and shoulder injuries during my playing days, however this is the first time I've had a patella dislocation associated with an injury like this and it concerned me.

Physical therapy for most people involves going to a physical therapist 3-4 times a week for 30 minutes. They don't have the means to do it on their own. I'm lucky enough to have a full gym in my basement and I certainly don't lack motivation...in anything.

As a matter of fact, I don't think anyone on this site lacks motivation!

[splat]

Funny the two of your mention that. When I left the office I didn't reschedule any more appointments. I see my OS near the end of July and I think I'll just wait and see what he thinks.

My ROM is almost there as I need another 10 degrees to equal my other leg. Had I had gained my ROM back in a more timely matter I'm sure I would've just skipped going to a physical therapist all together. I've been thru lots of rehab with both knee and shoulder injuries during my playing days, however this is the first time I've had a patella dislocation associated with an injury like this and it concerned me.

Physical therapy for most people involves going to a physical therapist 3-4 times a week for 30 minutes. They don't have the means to do it on their own. I'm lucky enough to have a full gym in my basement and I certainly don't lack motivation...in anything.

As a matter of fact, I don't think anyone on this site lacks motivation!

Good for you, mang. My PT starts this week after a couple false starts. Right now I am downloading movies to watch while I lay on my bed alternating between an infrasonic wavelength machine, a cryocuff, a cpm machine (0-100 ROM) and leg lifts. I am just waiting for the day I walk again and get to the gym - and with two weeks to go to start weight bearing - I cannot fukking wait!~

[whisky]

My point about PT is that if a person only does it while they are physically at the appointment, it's going to be a long f*cking time before they ever get back on track!

Splat- Hopefully you respond well and make a fast recovery.

Comish- What's up with you bro??

[comish]

Got my road bike around while on a trainer today without cheating or moving my hips. Officially up to 119 degrees at PT on Wednesday so things are rolling, slowly. Knee still looks like a frankenknee and is pretty dang swollen, but ROM is getting there... My walk is even improving. Concentrating on really trying to walk normal, lift the leg, bend the knee (even though I get all these great clicks when it bends past a certain point)

[SLSki]

My point about PT is that if a person only does it while they are physically at the appointment, it's going to be a long f*cking time before they ever get back on track!

Splat- Hopefully you respond well and make a fast recovery.

Comish- What's up with you bro??

Doing PT at home is about the most boring and arduous task I can imagine, no matter how much I know it will help my knee. I really need to find a better way to motivate myself.

[fallin]

[whisky]

Doing PT at home is about the most boring and arduous task I can imagine, no matter how much I know it will help my knee. I really need to find a better way to motivate myself.

I just incorporated it into my workout. Instead of waiting a minute or so between sets, I just work on the knee. Stand along side the bike and pedal, stretch.

If you don't currently workout, now might be the time to start!

[comish]

Hit 130 degrees today. Yeah!

[splat]

FKNA! Dude!

I know how major that is. I felt funky the last week and slacked back on my mehab a bit. Working into 110 and closing in on weight bearing, prolly a couple more weeks. 4 weeks post op and if I'm up on crutches for too long, the swelling goes all the way into my toes. Is that typical?

[fallin]

Score. I can't wait till I can hit that.

[SponsoredByDuctTape]

Hit 130 degrees today. Yeah!

Damn it! You have surpased me, my friend. Mine is going slowly - like 1-2 degrees every couple of weeks at this point. Still increasing, but very slowly. Congrats on that, mang. What do you feel like your time frame is for being on snow again? Beginning of the season? After New Year? End of next season?

[comish]

Damn it! You have surpased me, my friend. Mine is going slowly - like 1-2 degrees every couple of weeks at this point. Still increasing, but very slowly. Congrats on that, mang. What do you feel like your time frame is for being on snow again? Beginning of the season? After New Year? End of next season?

Thanks doods. Its nice to finally be moving, almost 6 months after I messed it up. This has seriously been a lot longer of a road than I ever imagined...

Regarding on snow again, I have no idea. I have been behind on everything to date, so haven't even asked about "real" sports. I'm sorta targeting new years and my PT guy thinks that should fly as we are planning our bi-annual Euro trip to Austria so it damn well better be good to go. The good news is my repair is totally healed, so I don't have to worry about that, its just flexibility and strength. My knee is still huge and totally swollen which is kinda weird, but hey, everything about this one has been weird.

SBDT, what ROM you at? You walking/limping? What is your target for skiing?

[Woodlandclown]

the swelling goes all the way into my toes. Is that typical?

yes! My entire leg.ankle, toes swelled up ridiculously by the end of the day if i was up and on my feet a lot. it'll gradually go away.

[Purveyor of Slack]

If the calf is warmer to touch than the other leg and have signif calf pain when flexing ankle upward (+Homans sign) you need to rule out the possibility of a deep vein thrombosis in the leg that is swollen.

Probably not a DVT, but impossible to tell over the internet.



Heal up fast, everybody!!

[SkiBrain]

That's great. Congrats Comish.

if I'm up on crutches for too long, the swelling goes all the way into my toes. Is that typical?

The couple of weeks after surgery my ankle and foot would be so swollen that they would tingle and feel really uncomfortable. In fact, that often bothered me more than knee pain. I couldn't fit into any of my shoes and have only been able to comfortably wear them in the past week or so. Found that wrapping an ace bandage around the foot, ankle, and calf would help for a bit, but as soon as that was off everything would flow down and get really swollen again. Things should also improve significantly once you're off the crutches because that'll get things moving and circulating right again.

[SponsoredByDuctTape]

SBDT, what ROM you at? You walking/limping? What is your target for skiing?

I'm at 120-122 right now. It's going slowly, but steadily. The PT says he thinks this is surprising because most people gain ROM in chunks. On the other hand, the doc told me last week "you can expect to see small increments in ROM." My PT guy is great and has a ton of experience, but I don't think he's handled anything quite as extensive as what I have going on, which leads me to trust what the doc is saying in regards to ROM.

Very little/no hobbling. No crutch, no cane. They've been upping the strenuousness of the rehab lately, which is helping me get up and down stairs a lot easier - kind of a metering rod for me.

Target for any serious physical activity was set at 1 year from the time of surgery. I thought I might be able to do some backpacking at the end of August, but I don't see that happening. Light hiking, maybe - backpacking, no. If I get back on skis next winter, it wouldn't be until probably April. That's assuming I don't need any other minor/cleanup surgery between now and then.

[comish]

Interesting. I'm still hobbling around. No crutch or cane, but definitely not smooth and can't walk too far. No way could I even contemplate hiking / backpacking in August. I'm just hoping maybe a little bike riding and maybe hopefully a few easy waves? I also still can't get down stairs normally and up is difficult...

Good luck mang! I think we are both in the kill the rehad phase.

[SponsoredByDuctTape]

Interesting. I'm still hobbling around. No crutch or cane, but definitely not smooth and can't walk too far. No way could I even contemplate hiking / backpacking in August. I'm just hoping maybe a little bike riding and maybe hopefully a few easy waves? I also still can't get down stairs normally and up is difficult...

Good luck mang! I think we are both in the kill the rehad phase.

That's all about where I was roughly a month ago.

Rehab will be much more aggressive/frequent when the bar exam is over (14 fucking days - this is killing me).

[splat]

If the calf is warmer to touch than the other leg and have signif calf pain when flexing ankle upward (+Homans sign) you need to rule out the possibility of a deep vein thrombosis in the leg that is swollen.

Probably not a DVT, but impossible to tell over the internet.



Heal up fast, everybody!!

I asked my pt if there was a possibility of a clot and he gave my calf a good squeeze and said it there was a clot, I woulda hit the ceiling.
....
I just paused to refamilarize myself with dvt. Here's what I found. I see the tenderness issue is addressed.

Deep-vein thrombosis (also known as deep-venous thrombosis or DVT and colloquially as economy class syndrome) is the formation of a blood clot ("thrombus") in a deep vein. It commonly affects the leg veins, such as the femoral vein or the popliteal vein or the deep veins of the pelvis. Occasionally the veins of the arm are affected (known as Paget-Schrötter disease). Thrombophlebitis is the more general class of pathologies of this kind. There is a significant risk of the thrombus embolizing and traveling to the lungs causing a pulmonary embolism.

Signs and symptoms
There may be no symptoms referrable to the location of the DVT, but the classical symptoms of DVT include pain, swelling and redness of the leg and dilation of the surface veins. In up to 25% of all hospitalized patients, there may be some form of DVT, which often remains clinically inapparent (unless pulmonary embolism develops).
There are several techniques during physical examination to increase the detection of DVT, such as measuring the circumference of the affected and the contralateral limb at a fixed point (to objectivate edema), and palpating the venous tract, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis.

Scott and Doug - I'm closing in you guys!