Recovering from Knee dislocation

[caddah]

Dr Mark....is it possible to get a quick over view on what exactly goes on during a big knee ligament reconstruction surgery with no tourniquet. I am starting to hear many things regarding options for my surgery, including stopping my blood flow further up in my body, however, I invision the same thing happening...that being the potential for blood to pool and clot where my bypass is due to the lack of blood circulation and therefore the possibility of bad things happening.

with a reconstruction with no tourniquet would you just keep cycling bags of blood through your patient throughout the length of the surgery? Do you make smaller or arthroscopic incisions. It must be hard to drill and place ligaments with a bleeding knee?

Hope that made sense.
Thank you for taking time out to offer your opinion

[drmark]

The first issue is what ligament (s) need to be repaired. Certainly the ACL needs to be fixed. Most of the time the PCL and the Medial Collateral will have healed well enough so it doesn't need any surgical attention.

Without a tourniquet, I would do the ACL and lateral complex through a lateral incision, after confirming the issues with a good physical exam under anesthesia and diagnostic arthroscopy.

The dissection has to be careful and hemostasis has to be meticulous. We do shoulder surgery without For me, this method of doing surgery is business as usual. I can't imagine loosing more than 100ccs of blood during such a case without a tourniquet. That is just a little more than you loose during the preop blood tests.

[caddah]

Some of you out there must have heard of this by now. Shaun Livingston Dislocating his knee in an akward fall. This is almost exactly what happened to me. just an akward landing with a fully extended knee. if you fall with your leg straight out like that, it can just collapse. his collapsed to the outside, mine was almost identical except it collapsed to the inside.

heres the link to the video

http://emuse.ebaumsworld.com/video/watch/14970

click it soon.
it just got yanked off youtube becuase its property of NBA

[here2day]

Arrghhh... I could feel that.

Mine went to the inside but fortunately the only "complete" rupture was my ACL. I had partial tears with my MCL and LCL's but no damage to my PCL.

The big difference when a skier has a total dislocation is the lever (ski) attached to the foot. Imagine something turning your foot 180 degrees after the ligaments have torn (are tearing)... Not a pretty picture.

So Caddah - what are your surgical plans? Are you flying to Texas?

[caddah]

so against most rational thought and advice i went skiing yesterday. I wasnt sure of myself or my descision seeing that i still have nothing holding my knee together, but i had to try. it was 50 degrees and sunny and i had the opportunity. ended up doing about 6 or 7 runs on the training hill which was empty mid week.

I CAN SKI.....carving presented a problem, knee just kinda gives away. suprisingly the easiest way for me to turn was kind of a quick short skidding type turn which i could bang out pretty decent. It wasnt the way i like to ski. but it was a beautiful thing. felt good.

anyway, i now know, 100 percent that my knee is totally f'ed up, and if i ever want to ski normally, let alone how i used to. im gonna need some serious work done on it. also i need more muscle mass, the bed leg is still alot smaller than the good one, partly from sitting in class all day. need to work on that more but been real busy.

surgical plans have not changed. it is nice to be able to walk and enjoy life right now, and i hate to go back under the knife again even though i need to. prolly gonna work on something for summer, and i am not sure about current ortho, as he is not comfortable with no tourniquet. i want someone who can do this shit in thier sleep and is more than comfortable with what thier doing. been really busy with college, jobs, shit, so doc visits have taken back seat, but hopefully i will know something new.

[drmark]

Caddah, what so hard?
I've done dozens of knee ligament repairs without a tourniquet. I have never done one in my sleep, but I have done dozens sick as a dog from the flu. If you go carefully with the electrocautery, you don't hardly loose any more blood without the tourniquet.

[caddah]

Caddah, what so hard?
I've done dozens of knee ligament repairs without a tourniquet. I have never done one in my sleep, but I have done dozens sick as a dog from the flu. If you go carefully with the electrocautery, you don't hardly loose any more blood without the tourniquet.

well first of all I don't have the money or anytime right now to fly to Texas. thats about it. thats all thats holding me back really. it sounds like you have the procedure down pretty well. speaking of....can you clear one thing up. you may have answered this but i am unclear.

my whole problem is my bypass on the popliteal (sp?) in your procedure, would blood be allowed to remain flowing through that bypass...and hence negating this risk of a clot or the bypass going down. my original surgery was scraped because they felt there was a risk of a clot forming becuase of blood pooling and sitting in my bypass due to the tourniquet.

[drmark]

Maybe I don't understand the question, but if the operation occurs without a tourniquet, then blood flows through the bypassed area down to the foot, and then back through the venus system as usual.

[caddah]

Havnt been here in a while, schools been real busy.

any way, since the last update, i took my first run down stowe since the injury. knee performed....mediocre in slushy heavy spring snow. I can do most of my normal activities, but have no where near the finess and control i once had. knee gives out in to many directions. skiing felt especially painful. had a dr. appointment. got x rays for the first time in a while. cool to see my artery show up on xrays, it can be traced from above to below the knee becuase of about 15 metal clips holding it in place. doctor went over ligamets again. i tore acl, lcl, pcl, politeal ligament, and popliteus ? ligament. on the outside of the knee. he wants to replace 4, everything except the pcl, too difficult especially with limited tourniquet use.

some observation i made of my own based on looking at the xrays which i will try to get for you medical mags soon. when looking at xray comparing both legs slightly bent, it seems that the top of my femur on the bad leg was rough compared to the good one. the condyle this is called i think, where the acl should be. just very rough. also the head of the fibula seems rough. this concerned me becuase this is where he wants to drill alot of holes for ligaments. and its close to a very important nerve. also it seems like while both legs were bent at the same angle, my knee cap on the bad leg was further up, and to the side. this may be due to my ankle still giving me trouble.

rough plan for now is to go through with a 4 lig reconstruction, but am weary of the risks from both blood clot tourniquet issues as well as the close proximity to nerves when doing an open knee on the outside of the leg.

still planning on 2nd/3rd opinions before completely commiting, however it is time to start strengthening even more

[drmark]

I have serious doubts that all that needs to be fixed. But on the chance that it did, the PCL would be the cornerstone of the repair.

This can easily be done all at one time.

[caddah]

Haven't updated here in a while. I guess I am closing in on 2 years since i hurt myself (September is the anniversary)

My leg is still no where near as muscular as the good one, but i can walk, and get around fine these days. hiking is ok. going up is fine...going down hurts. and my ankle move is still slightly limited.

anyway.......on to the work in progress of getting this fixed. spoke with Dr. Hershman in NYC...(Ortho for NY Jets and Islanders)...he said to go with what the vascular team said. much more important to have a leg with good blood flow, and sloppy knee, then tight knee and bad vascular. so...he advised me not to do surgery unless vascular writes off on it.

I am basically in the same situation as before. my bypasses are making a knee surgery difficult. I meet with vascular soon to see if anything is different. I am kind of reluctant to go under the knife just because I am in no pain right now, and can walk with out pain. the possibility of stuff going wrong in surgery scares me.

my plan as of right now is to see what vascular says, and take it from there. my knee is a little sloppy and skiing like a i used to is out of the question i think. what i want to do is train really hard to try to build up some muscles around the knee, and then invest in a real nice custom brace and try to come back to some form of aggressive skiing.

right now the knee seems to be popping more than normal, after a pretty decent hike i did. sometimes it will feel almost out of joint, then if i contract the right muscles, there is a very loud audible pop, and it goes back into place. but it seems like the crunching sounds and popping from underneath my knee cap have gotten worse.

anybody have a link or know of some good routines to strengthen the leg and knee. because i cant do alot of excersizes due to the stress it puts on the knee its hard to get a good work out. my inner quad muscles have come back nicely, but the outside of the quad is barely there. also hamstrings are still pretty weak.

maybe ill post pictures soon of how things look after this long.

[caddah]

Updating my injury thread here. latest news is that I am going back to physical therapy to strengthen the leg which I am real excited about. I thought I would post some pictures of what everything looks like now, 2 years later for anyone following this thread. beware, my bad leg had to get shaved from the knee down because I wear compression stockings on them now, so it looks pretty special.
















I also just got this, still working out the fit issues, it is rubbing against a bone on the outside of my leg where the tibia and fibula meet, making it painful to wear, but once i get it dialed in I am hoping to start skiing a little bit.

[nancie2k]

lucky you thinking about going skiing!!!!
hope it all works out for you!!!

[Injured Roster]

Well, your injury makes mine look like kids stuff. I tore my patella tendon below the knee and relocated my patella to the top of my thigh. Hurt like a motherfucker and I was reasonably close to medical attention. They wired my tendon back together in surgery and I can only hope that it healed. No circulation cut off or anything as serious as what you experienced. About 1.5 years later I was having some discomfort and started picking at what I thought was a pimple on my knee. I grabbed that pimple and ended up pulling 2" of stainless steel wire out of my knee that had been in there to hold things together during recovery. There's more of it in there and I have to wonder when the rest of it is comming out. I made a full recovery from this injury though I did quit playing soccer and ultimate for fear of tearing it again. I also tore my ACL at the same time and was told that the recovery process was counterintuitive so I could either have another surgery or live without an ACL, I chose the latter though I will probably have it fixed sometime later in life.

Stay positive!

[caddah]

had my first session of PT in a while. 2+ years later, my bad leg is still atrophied and about 2 inches small than the good leg measured 4 inches above the knee. when looked at by a professional my weaknesses became very apparent. I am very weak on the outside of my knee/leg. makes since since this is the side with the most ligament/nervous/artery/vein damage. only the hamstring on my inside has recovered, and is now almost super human, as it is providing all my hamstring strength. this could also be why i have some serious instability as my knee is not completely surrounded with strong muscle.

Went back to the basics and did some exercises to work on the hip and outer hamstring. by the end of the session I felt amazing. I was shaking doing some of the exercises and can definitely tell that with some serious work, I think I may have a pretty strong knee, nothing like it used to be, but definitely solid. So the PT continues hopefully. I'll update again after a few visits

[BigKuba]

Caddah, I've been following your thread and others where you chime in, and it's really good to hear that you're making progress and staying stoked on getting back into skiing. Definitely uplifting to read fellow gimp recovery stories here.

I'm just briefly hijacking the thread to give a shoutout to Injured Roster as a fellow patella tendon gimp. Sunday will be a year since injury, and I totally agree that this is child's play compared to you. Thinking about the kneecap shooting up my thigh brought back vivid memories, which thankfully cut off soon after thanks to a healthy morphine regimen administered by the hospital staff. Haven't picked out any wires yet (don't think I have any in there, at least they haven't shown up on x-rays) and I avoided ligament damage, but I'm a shadow of my former skiing self, and can't jog more than 100 yards. Leg is way smaller than the good one, but every day I ski noticeably better than the previous. Stay positive and plow through this bitch[/Mexican-food-coma-fueled ramble]

[Pat_rick]

to: Caddah
My names pat and I ran into your thread just today. I'm pulling for you buddy. I just recently dislocated my knee playing for lake forest college. It's been about 5 months and the strengthening is the toughest part of the ordeal. Just keep a positive attitude buddy I know you can do it. I've had schoulder and wrist surgeries in the past and swimming helped for both. The knee sucks but trust in your bodies ability to heal man. a good success story to mine is that i will be back and playing hockey in about a month and I'm sure you will get to do the same.

Oh and did that lateral skating workout help with you vmo at all? I might just preasure my dad to buy me one

I'll post back soon just keep your head up buddy and you can DO IT! tell your self that no matter what

[owwee]

I'm speechless. I'm just doing some research on meniscus as I seem to have messed mine up. But seeing this really blows my mind and makes me thankful that "all" I have is a meniscus tear.

I hope you'll continue to share your story and recovery here.

If it is any help, I coincidentally came across this blog post yesterday from a skiier with a nasty sounding knee dislocation:
http://www.michelle-parker.com/2009_03_01_archive.html

[BlechMan]

Hmmm... Are you sure that youve copied the whole content of the offline folder including the zarafa folder from one system to your system?

Best regards

Andreas

[beaterdit]

^^^
WTF?

Damn, haven't see this thread in a while or heard from you Caddah. How are things? Any updates?

Well, hope they found a way to get you fixed up and your living a more 'normal' life these days.

-Sam

[caddah]

Whelp haven't been here in quite a while. Unfortunately I am gimped up again so I'll be here for a while.

This will continue to basically be a documentary journal of my recovery.

after my dislocation which is more than 5 years ago now, and lots of PT I had regained almost 100 percent of my pre injury ability with no ligament reconstruction. between building up surrounding muscle and ligament scarring with in the knee I was able to cope pretty well and have a very stable knee. Skiing remained painful and not at the level I was at before, but I could make some pretty good turns. I was able to hike and ski tuckerman's ravine etc. A ski is just too big of a lever for a knee with no ligaments, but with the aid of a donjoy I could ski pretty well. Also got back to playing hockey competitively too. hiking walking and jogging were all do able.

fast forward to this past december. I was hit head on in a car accident. Some jackass woman from CT who didnt know how to drive on snow packed roads lost it and fish tailed in to my lane. There was no where to go. collided head on with her lincoln Navigator (a battle which I lost). was only going about 20 mph but still smashed my bad knee off of the dash. I wasnt wearing a belt.

Had the ortho look at the knee and he made me aware that the knee was no where near as stable as it was pre car accident. He felt it would be almost impossible to regain stability with just PT so he recommended that I finally have the ligaments repaired/reconstructed.

I am now far enough out from my original vascular injury that he felt it would be less of a risk. Also he felt that he could perform the procedure with out a tourniquet.

Now here I am today 2.5 weeks out from a 5 ligament reconstruction performed on 6/24

acl/pcl/lcl/lateral complex reconstructed with cadaver Achilles tendon. First picture is at week one, second picture is at week 2.





Surgery went very well. I am in a brace with a cryo cuff with instructions to only bend 10 degrees a week for the first 6 weeks. PT has been just quad sets and ankle pumps, which actually sometime give me flairing nerve pain which i do not like. In the surgery he had to actually move my poroneal nerve out of the way to do the work and then put it back in place. So this pain is worrying me.

Right now the waiting game is killing me, as well as the not knowing if these ligaments are taking well. every time I move the leg I cringe because I do not want to disturb these ligaments before they attach.

I am looking forward to being able to do PT on a larger scale. I respond well to it, and work my ass off. I have no problem putting 150 percent in to it, but right now i mostly just have to wait for things to take.

I'll continue to update. I am hoping that after this is all said and done I will has as close to a normal healthy knee as I have ever had. more stable and ready for an active lifestyle.

[tone capone]

Caddah you are the man! So sorry to hear about your second round of severe misfortune, but after all you have been through, I know you can do it. Those cuts look really painful, I hope you are able to manage the pain. I have wondered what happened to you after those missing years, but after hearing about what you were doing, I just know that you will have a good outcome from this. Maybe the car accident is the final catalyst for you to have a fully functioning and safe knee again. Of course it's gonna be hard, but it seems to me if there is anyone that has what it takes to recover again, it's you. Best wishes dude, you are an inspiration to all us gimps. Keep us updated, we'll be thinking of you.

[caddah]

DAY 29 POST-OP

Hey thanks for words. This place has been an awesome spot to not only keep a journal to look back on - But a real great place for Positive motivation when your getting down sometimes. I remember when I first injured myself that there was very little information floating around the web in terms of personal experience with an injury like this so I want to keep posting up what I've been going through for anyone else out there who might come across it, and it looks like many have.

back to the recovery. 4 weeks out from a 5 Ligament reconstruction....At 4 weeks out I am still braced up in a locked position for most of the time. I can unlock the brace to 40 degrees following my protocol of 10 degrees per week. PT has been mostly stim to get my quad going, ankle pumps, and gentle bending. some very light weight bearing. I originally had a script for weight bearing as tolerated but that has been downgraded to toe touching even though i feel comfortable putting about half my weight on this leg. the doctor is very concerned about the LCL and PCL reconstructions and wants to be conservative and make sure they take.

This has been hard for me - it is tough being patient and watching the knee just deteriorate....but hopefully will be able to go harder in PT very soon. most fragile time for these grafts is from 6-9 weeks.

My swelling has gone down alot, I have lost 4cm circumference since day 4 at the center of my knee. and I have full extension with no pain which is a good start. Its tough seeing regular acl reconstruction patients walking around after a month and a half, but I'm dealing with a different animal. Gonna keep on doing what I can to get this thing back into shape.

[tone capone]

Well, I would say keep that attitude about patience. almost 5 months since acl recon alone and still a skinny little chicken leg compared to the other for me. Just take lots of baby steps and worry about the real strengthening later.

[caddah]

5 WEEKS POST OP

Leg is feeling better this week. swelling is down and incisions look good. PT consisted of more isometric exercises. I am cleared to bend to 50 degrees. I can get to around 45 before I feel tightness on the medial side with is starting to limit bending. I am going to try and break through that this week. All bending is done with the brace on and after that the brace is locked back in extension to protect the ligaments. I am hoping that by week 9 when the ligaments are past their most fragile stage I will be able to start walking around and unlocking the brace. We'll see what the doc has to say on the 11th.