Recovering from Knee dislocation

**caddah** · 01-04-2006, 12:40 PM

I injured myself pretty bad this september. completely dislocated my knee, ruptured my popliteal artery, and now have about 6 feet of scars and a laundry list of surgeries. I tore atleast 3 ligaments (still not sure which ones)....needed a bypass for my shredded vien and artery, developed compartment syndrome, so they had to cut my leg open. got a stylish external fixator on my leg, and needed a skin graft. ended up spending about a month in the hospital.

I'm now about 3 and half months out from the injury. still working on ROM and strength before i go under the knife for reconstruction. external fixator was on for about 8 or 9 weeks. im currently in a CPM machine (constant passive motion) to try to get my flexion back. after the fixator came off ive had 2 knee manipulaions becuase my flexion was so limited. lots of scar tissue build up after 2 months of being completely immobile. I'm now flexing up to about 120 degrees, but its taken a lot of pain and effort. now basically its more PT for strengthening rather than ROM... my hamstrings are so weak that i could probably pull harder with my pinky than my leg.

any way, i was wondering if anyone out there has gone through a knee injury similar to this and what their outcome was. If they returned to their previous level of skiing? any recomended books, vids (Kreitler's flick?), websites. Just tryin to find out anything about anyone who has done something like this.

-thanks alot

**Vinman** · 01-04-2006, 02:55 PM

1st thing that jumps into my mind is that I'm glad you still have your leg. IIRC about 50% of tibio-femoral dislocations end up in amputation due to vascualr injury, just as you mentioned.

I personally have never worked with someone with this injury, but from what I have read/heard it is possible to sik/resume cutting-twisting sports again. Weather or not you can get back to the level you were once at is highly dependant on how much stability you regain after reconstruction.

The thing that concerns me most about what you described in the amount of scar tissue you have. Arthrofibrosis (excessive scar formation in the joint) is possible after such a violent injury as this. Hopefully this can be avoided.

Good luck.

**Big E** · 01-06-2006, 11:13 AM

Wow. I have nothing to add other than wishing you good luck.

**caddah** · 01-07-2006, 01:57 PM

Originally Posted by Vinman

1st thing that jumps into my mind is that I'm glad you still have your leg. IIRC about 50% of tibio-femoral dislocations end up in amputation due to vascualr injury, just as you mentioned.

The thing that concerns me most about what you described in the amount of scar tissue you have. Arthrofibrosis (excessive scar formation in the joint) is possible after such a violent injury as this. Hopefully this can be avoided.

Good luck.

Yes, I do feel very lucky to still have my leg. From what the surgeons said, I was about 30 min from loosing it...6+ hours with out blood flow below my knee.

As for the athrofibrosis. my knee was so locked up with scar tissue after being taken out of the external fixator that I have been doing physical therapy, and light weight bearing with out any bracing....or ligaments. my doc said that the scar tissue was making my knee so stable that I did not need bracing. I have started to break up all those adheasions though, so hopefully this wont be a problem as I get more and more muscle strength back.

I guess another question I might have is the stability difference between using cadaver ligaments or patellar tendon/hamstring for ligament reconstruction. Has anyone had experience with multi ligament reconstructions? hopefully between a good reconstruction and a good bracing system i can get back.

The only skier i have found that has done something close to this and then come back is Kent Kreitler. has anyone seen his film? does it have any info on his crash and rehab? any other info would def help me out.

thanks

**Vinman** · 01-07-2006, 02:18 PM

There are a lot of thread on the board debating cadaver vs. auto graft. Do a search and I'm sure you'll find what you are looking for.

As far as stability goes either option is fine. it really comes down to failure rates and recovery time between the various choices.

And as for the scar tissue making your knee stable....while that would certainly be true in the short term before you get surgery it is not the kind of thing you want to have in your knee.

Without a doubt, you've already gone though some tough rehab and probably have more ahead of you. Keep your current positive attitude and take the gains and set backs as they come. Also read as much of the current research litureature about injury and your surgery as possible. Don't rely on anecdotal magazine articles and be wary of some of the stuff on the web. There is tons of good info on the web but there is also just as much bad info.

**here2day** · 01-09-2006, 06:33 PM

Chad Fliescher [sic] had a total knee dislocation. I think it was during downhill training in Europe. Someone sent me an article about his recovery that was pretty inspirational but I can't seem to find it. You may have luck searching on his name.

I just saw a good "fearless" segment on the Outdoor Life Network covering Picabo Street. She ruptured both ACLs and severly broke her fib in a race. This was after a successful recovery from an earlier ACL rupture. As I recall it took her three years to get back to World Cup form after the second accident (though she admitted not at 100%).

I'm 7 months post-op from an ACL, MCL, meniscus, tibia fracture, injury while skiing last April. Nothing compared to what you're dealing with. Hang in there and keep us posted.

**caddah** · 01-10-2006, 04:41 PM

Originally Posted by here2day

Chad Fliescher [sic] had a total knee dislocation. I think it was during downhill training in Europe. Someone sent me an article about his recovery that was pretty inspirational but I can't seem to find it. You may have luck searching on his name.

I'm 7 months post-op from an ACL, MCL, meniscus, tibia fracture, injury while skiing last April. Nothing compared to what you're dealing with. Hang in there and keep us posted.

Thanks for the suggestion. I did find some good info on him on the web. Sorry to hear about your injury. hope your rehab has been going well. I still dont know exactly what ligaments i have destroyed. I cant get an MRI (MAGNETIC resonance image) becuase the magnet will tear the metal clips I have holding my artery together right off. I also fractured my tibia plateau and have 2 screws pinning that. so we do have some unfortunate similarities. Maybe ill try to get some gory pics and x rays up here for anyone who wants to see them.

Just had a PT session. I've maxed out the CPM machine at 120 flex. but with a little help and pain I can get to about 125/130. Im still having alot of trouble with my dorsi flexion (ankle). wondering if anyone has had trouble with this becuase of a knee injury. I actually bruised my poroneal nerve in this injury, so when they put the external fixator on they put an extra pin in my foot to prevent foot drop. (I regained functionality and did not tear that nerve) but becuase of edema and prolonged immobilization my ankle is real stiff.

I go to see my ortho on 1/17. Could use some good news. its startin to get rough hearin stories from all my buds commin off the mountain...but it also fuel to work harder to get back.

**creaker** · 01-11-2006, 01:43 PM

I know how much it sucks to hear the stories when you're gimped up. I had a mtb crash a few years back and landed right on my f'ing head. Got a great concussion. When I went to shower the next morning I could barely raise my arms to wash my hair. I had bruised my spinal cord and was losing function and feeling in my arms. I've never been so freaked out in my life. Facing that prospect really changed my perspective on a lot of things. Yeah, you are well and truly gimped up, but you're going to be ok. Work your ass off and good luck to you. That's one hell of an injury you've got, truly spectacular. Kick its ass.

**caddah** · 01-12-2006, 06:15 PM

Just had another PT session today. went very well. worked on strength and felxibiliy in the knee and ankle. started walkin with one crutch which was a great feeling. Was able to ride the bike for about 20 minutes. I can feel myself getting closer to finally actually walking. quite the improvement from 4 weeks ago. the picture i attached was from about 4 to 6 weeks ago...not exactly sure. not for the faint of heart, but for any one wondering what this injury looked like....heres a pretty good shot of the external fixator and skin graft, the other stiches are for the screws and other fasciotomy cuts that were able to be stitched back together.

I'm lookin forward to seein the orho on tuesday. I'll update with news and throw up some xrays for anyone who wants to see them. Even tho i have a long way to go, feels real good to be makin progress from where I was.

**stompinlines** · 01-12-2006, 08:52 PM

How long will you have the ex fix on?

**snowdreamer** · 01-12-2006, 10:18 PM

Wow, this is pretty scary. Was this a skiing injury?

I wish you the best with your recovery.

**caddah** · 01-13-2006, 11:06 AM

Originally Posted by stompinlines

How long will you have the ex fix on?

ex fix is off. its been off for about 4 weeks. i had it on for about 9 weeks.

I wish this was from a skiing accident. after doing countless stupid things on skis it really pisses me off that all of this came from tripping and falling off the front porch of a friends house right before ski season. doesnt take much to do a lot of damage.

**Redskea** · 01-13-2006, 03:18 PM

In 5 years patrol I have only seen a similar injury to that once. A snowboarder landed a jump, board (can't remember if it was nose or tail) dove into the snow and they guy kept rotating and dislocated a knee.

**caddah** · 01-17-2006, 10:17 PM

saw ortho today. finally starting to feel better and participate in daily activities with out being in extreme pain. this took me the best part of 4 months since the accident due to all of the complications that come with a knee dislocation.

did a bunch of pulling and prying on my knee. def have no acl, pcl....mcl, lcl are questionable....there was actually some stability there which may be some good news. probably just scar tissue but the ortho said u might have some ligaments here. which was a good sign. ive been told to start walkin with one crutch tryin to get a normal gait back. and 2 hours a day on the bike. dont go to see him for a while (about 3 months) I need to gain alot of stregth. all of this with out any bracing still. does this sound like the norm to any of u guys out there?

anyway...he was pleased with the ROM that i got. 125-130 right now. he said i would be lucky with 90 after he saw me in the hospitol and we would take it if it was all we could get. feels good to have a free hand when getting around now. no more one handed crutching/holding the other crutch in the armpit while transporting a drink to the nearest place to sit down.................i'll be on the bike

**here2day** · 01-19-2006, 03:25 PM

caddah - found the link to the Chad Fleischer story.

http://www.skimag.com/skimag/feature...561042,00.html

**caddah** · 01-26-2006, 09:38 PM

I've been hobblin around for the last week or two. i can quazi walk with no crutches with a very bad limp. mostly still one crutch though. the knee is popping alot especially on quad extensions. I had my first outpatient PT. did some strength testing . my right (good) leg is consistently 4 to 5 times stronger in all tests. my flexibility is also very bad. i had some work done on the ankle that for some reason has become a big prolem becuase of the knee dislocation. for the past 2 days after they worked on it it has been swollen. i have a serious case of cankle on my bad leg for some reason. very sore and stiff. the swelling is pretty bad where my fasciotomies were...two big bulges on my leg. is this something i should worry about?

i've been on the bike a lot and the knee is moving pretty well with exeption to the popping cracking, and weakness.

does any one know of any information about total knee dislocations with vascular compromise and external fixation. i had read many medical journals about knee dislocations with no complications, but there seems to be nothing out there about this injury if u shred ur artery and dont have surgery with in the first couple weeks. I feel like im just passing time here with no ligaments in my leg. if anyone who knows anything about this please let me know

i'll update again after a few more PT visits

**Vinman** · 01-27-2006, 07:27 AM

unfortunately, I don't really have any more info that I already posted since I have never actually worked with this kid of injury in the past.

As for the bulges where the fasciotomys were, maybe just call your doc and ask. I'm sure he won't mind you asking. Which doc did your surgery and where are you doing rehab? I know a few ATCs and PTs in the Burlington area.

**caddah** · 01-27-2006, 10:44 AM

Originally Posted by Vinman

unfortunately, I don't really have any more info that I already posted since I have never actually worked with this kid of injury in the past.

As for the bulges where the fasciotomys were, maybe just call your doc and ask. I'm sure he won't mind you asking. Which doc did your surgery and where are you doing rehab? I know a few ATCs and PTs in the Burlington area.

Dr. Slauterbeck for surgury
Rehab Gym in Williston for PT

my cankle problem seemed to go down over the night, but it will prolly flame right up again after bein on my feet. woke up and ankle is so sore that i cant even put pressure on it...

**Redskea** · 01-27-2006, 11:00 AM

If your ankle is getting worse I would definitely ask your doc. I got an infection in the damaged tissue/fluid in my ankle,after surgery for a fracture, that needed antibiotics, it was red and throbbing especially when I was standing. Hope it's not that though.

**Vinman** · 01-27-2006, 11:43 AM

Redskea is right, definitely call.

I have been at a couple places Dr. Slauterbeck has spoken. I liked his talks and have heard great things about him. I also know one or two fo the guys at Rehabgym, good people.

Sounds like you have a good team working for you.

**caddah** · 02-07-2006, 10:36 PM

I'm about 4.5 months out from destroying my knee now....the leg is slowly getting better. i've been at outpatient rehab for about 2 weeks now. ive moved to walking with out any crutches when i can, but I still use them a bit to get around. I still have a noticable limp. I do alot of biking. I try to do about 2hrs a day if i can. bend is past 130. 126 degrees when i am lying on my stomach, stretching a very tight quad. I'm also doing lots of balance, strength excersizes. today was the first day i tried balancing on my bad leg and throwing a ball at a trampoline. I could only do it three times, but its better than last week. I'm slowly starting to feel a little strength comming back to the leg. squats with no weight are hard, and i do favor my good leg quite a bit still. Lots and Lots of cracking and popping comming from the knee, but i guess this is to be expected??

heres so pics of before and now.....

here's basically what they did after reducing the knee, and reconnecting my artery..

and now in real life ...before

and now...

the donorsite before

and now

**caddah** · 02-07-2006, 10:45 PM

heres a couple more pics that i couldnt fit in to the last message

right(good, and much bigger) leg

heres a shot of my lumpy left leg next to my right

and my ankle that constanly blows up still....

**caddah** · 02-09-2006, 02:28 PM

PT today
single leg press 30lbs with bad leg
2 days ago, balance on floor with bad leg while catching a ball thrown at a tramp. best i could do was 3 throws
today 16 throws on solid floor. 18 throws on foam cushion.
bridging with bad leg on excersize ball
first attempts at walking up stairs normally, quad was shakin real bad

3hr vascular check up/lab scheduled for next wed.

**caddah** · 02-16-2006, 05:19 PM

Well the 18th will be 5 months since i dislocated my knee. I just finished my 3rd week of outpatient rehab.

did 22 throws of a heavier 6lb ball at the tramp today on the foam pad on my bad leg. so i moved up to a circular balancing disc to stand on. I could only get off one throw. It was considerably harder.
3 sets of 15 single leg presses with bad leg at 35 lbs.
things are improving everyday. but my leg is still far far far from normal. I really started out here with NO muscle from being immobilized for 2+ months.

I've got a question. the perscription for PT from my doc was to increase mobility, and try to get a normal gait. at PT i have been doing many strength and balance drills. the strengthening of muscles definately tightens them up. last week i was able to lay on my stomach and have my PT stretch my quad till i was at about 127 flexion....today after working quads etc...could only get 123 flexion. should i be focusing more on mobility than strength right now. is this something i should bring up with my PT??

also had a vascular lab done yesterday. both bypasses on the leg are open and have 100% flow. so good news.

**Vinman** · 02-16-2006, 05:25 PM

you are bound ot have some days when your knee won't be as mobile as others so don't sweat the 4 degree difference.

You have enough ROM now to be able to walk without a limp once things get stronger.

Keep plugging away and working to maintain your ROM while you build some strength back.