2 Questions for Dr Mark

[anytimefitpro]

I recently had ACL reconstruction and meniscal repair. I've had 4 orthopedic surgeries in my life, this was by far the most painful. I seriously considered flying out to Texas to have you do the surgery; in the end, I had it done by a sports medicine ortho out of San Francisco. I live here so it was easier.

I've watched the videos of your patients, squatting, walking, pressing the day after surgery. I was in bed for almost a week, living on percocets. I don't doubt that you achieve the results you claim, you're obviously incredibly successful. What I am curious about is what is so different about your technique that your patients seem light years beyond other doctors in terms of functional ability immediately after surgery.

Fortunately, it's now 4 weeks post-surgery and I am progressing well. I expect a full recovery.

Second question. I had my patellar tendon reattached in December of last year after the accident that caused both of my knee injuries. I am now 5 months post-surgery and still have ENORMOUS challenges with this leg. Examples:

1) Extreme pain through the medial retinaculum during terminal extension
2) The leg is incredibly unstable, when I walk each step requires contant thought and manual contraction of the quad
3) I have severe edema STILL. The knee is constantly swollen, and is ridiculously huge after exercise.
4) I have a fairly large sulcus right above my quadricep tendon that impacts the aesthetic of my quad.

I was a national level bodybuilder and manage health clubs for a living. Recovering full function in this leg is not a desire, it is a NEED for me to make a living. At what point do I consider having this leg operated on again, and what kind of results can I expect in a second surgery? The first surgeon said the tear was clean and expected a good result; obviously this has not been the case.

[drmark]

Asking my why my results are so different from other guys is a little hard as I have a different approach for almost everything.
In short:

Patients are fully prepared for surgey, physically by a comprehensive exercise program, and mentally, but a lot to talking

We typically do the surgery through a mini arthrotomy, rather than arthroscopically assisted, so blood can easily egress through the sutures into the dressing. This keeps the swelling down.

We start on full motion and full weight bearing gait in the recovery room, rather than wait a few weeks for it to stiffen up.

We use the highest strength graft, and the most durable fixation methods, that avoids excessive tightness of the graft that will capture the knee. (In my opinion, there is only one thing in the human condition that can't ever be too tight, and the knee isn't it)

We typically take the graft from the opposite knee, so the trouble is divided between both legs. Remember you are only as good as your worst leg.

Your patella tendon issue defies me. You should post a photograph of the knee.

[anytimefitpro]

Ok, I am posting a plethora of pics. By the way, I get more questions answered by you then I do my own physicians. If it is at all possible to get this leg repaired, I will be having you do the second surgery......





Above is a pic of my legs currently. Both are extremely atrophied, but the right is far more than the left, despite the fact that I had surgery on the left just 4 weeks ago and have been rehabbing my right for the last 4 months. You can see the severe sulcus above the patella that impacts the quad. Also evident is how much edema is on the knee.



Above is a photo of me just prior to injury. This is what I am striving to get back to in terms of leg function, aesthetic, and muscularity.



Above is a lateral view of the right leg immediately after the accident that caused the patellar tendon tear and dislocation of the patella. You can see how much the patella is out of position in this photo



Above is a photo taken laterally of my left knee, the leg which just had ACL reconstruction and a partial menisectomy. My normal anatomy of patella, patellar tendon, and quadricep tendon can be seen.



And above is a photo of the lateral aspect of my right knee. You can see how the kneecap is still EXTREMELY superior to its normal position. The patellar tendon seems to be lengthened as a result, I am guessing part of the reason why my leg has such a sulcus is that the tissue simply isn't being pulled down as far as it is on my opposite leg since the patella is so far out of its normal anatomical position. Additionally, you can see the difference around the tibial tuberosity, how much more prominent it is in my right leg. I have no idea why this would be impacted by my surgical repair....but I am guessing you might.

Taking a look at these pics, is this an issue that can be rectified? Or am I simply f'd?

[drmark]

I would like to see a lateral X-ray of both knees. If in fact the patella is riding high, then the repair pulled out and it has to be redone.

[anytimefitpro]

Well, these pretty much tell the tale don't they? Here are the x-rays I had taken today, we measured the position of the patella and it's about 7 cm superior to its normal (or perhaps pre-accident) anatomical position.



Above is a lateral aspect shot of the left knee, showing the normal anatomical position of my patella. And the enormous screw they used to hold my allograft in place!



And the right knee above.



Taken from an anterior aspect with the knee in flexion. This is the left knee...



Same aspect, this one of right knee. You can see the holes drilled in the patella used to anchor the sutures.



Left knee, shot taken from anterior aspect with leg in extension



And finally, the right knee from the same perspective. Not only moved superiorly, but laterally as well.

[drmark]

The knee with the patella alta (high riding patella) needs surgical correction.