Sports Girl Is Recovering From Knee Surgery

All went well with Sports Girl’s knee surgery on Thursday. Things went so well, in fact, that the doctor said he wished he had been training a resident at the time; it seems she proved to be a textbook case for how and why to do this particular surgery.

I showed the doctor the diagrams I used to explain Sports Girl’s surgery in my previous post. Turns out I was spot on with my explanation — this is exactly what he did to Sports Girls. This and a “lateral release,” or the loosening of the lateral retinaculum, the tissue on the outside of the kneecap.

The surgery was done arthroscopically, so incision size was kept to a minimum. The doctor gave us some nice pictures of the inside of Sports Girl’s knee taken during the surgery. The good news is that her ACL and meniscus are in pristine condition. The bad news is that there was already some cartilage damage on the underside of her kneecap due to her kneecap sliding out of place. The doctor cleaned up the fraying and thankfully there weren’t any big  cartilage chunks floating around.

Besides pain and discomfort at the surgery site, Sports Girl struggles with nausea after taking her pain medications. She had a nerve block in her upper femur just prior to the surgery, and she 3+ days post operative, she is still experiencing some numbness and tingling in her leg and foot.

Sports Girls is wearing a long brace to keep her leg straight. She is to bend her leg 30 degrees during physical therapy exercises, but this isn’t much. She has her first outpatient physical therapy appointment tomorrow, and she has a follow-up doctor’s appointment next Monday.

Hopefully Sports Girl will write about her surgical experience from her point of view sometime soon. I’m sure her Christmas break from school is going to be quite boring as she spends the majority of her time either on the sofa or in bed with her left leg propped up on pillows and ice applied to her knee …

New Donor Ligament Will Support Sports Girl’s Knee

Sports Girl is not just having the surgery so she can continue to play sports. She is having the surgery for her quality of life and peace of mind. Each time the patella subluxes, cartilage damage occurs which eventually results in osteoarthritis. Cartilage cannot be replaced; knee replacement is used to correct the problem. We certainly don’t want Sports Girl to be looking at a knee replacement surgery at age 40.

Then there’s also the fact that each time her patella subluxes, it is very painful and frightening for Sports Girl.

Of course we are hopeful that Sports Girl will return to soccer and basketball and whatever else she wants to do in full force. We are told the recovery time will be 3 to 6 months, so we are planning for her to return in time for summer training. She starts high school next year, and the hope would be that she has a bright scholastic athletic career before her.

Why do kneecap dislocations become a recurrent problem?

Sports Girl’s left patella subluxes laterally – which means it slips out of place to the outside of her leg. Research I’ve found online explains that, “When the kneecap comes out of joint the first time, ligaments that were holding the kneecap in position are torn. The most commonly torn structure is called the medial patellofemoral ligament, or MPFL. This ligament secures the patella to the inside (medial) of the knee. When a kneecap dislocation occurs, something must fail to allow the kneecap out of the groove, and usually it is the MPFL.” I found this information on the Division of Pediatric Orthopaedics of Morgan Stanley Childrens Hospital of New York – Presbyterian web site.

So the doctor is going to go in and insert a cadaver/donor ligament to replace her MPFL – at least that’s how I understand it at this point. I should know a lot more about it after the surgery tomorrow, but the way he explained it last month in our office visit, I believe Sports Girl’s repair will looking something like the illustration below right. A normal MPFL is illustrated below left.

Normal MPFL Patellar LIgament

Normal MPFL Patellar Ligament

Reconstructed/Donor MPFL Ligament

Reconstructed/Donor MPFL Ligament

Sports Girl herself has contributed to my blog for the very first time. Read all about her pre-surgery anxiety here – from her point of view!

Sports Girl Reports on Pre-Surgery Anxiety

I am very nervous and scared about the surgery. I won’t be able to eat after midnight and I am always very hungry in the morning, so that should be interesting. Also, I don’t get any liquids after midnight except clear liquids, and I can only have those until 7 A.M. I am also really worried about the I.V. Does it hurt? What about the mask that puts you out? How long are you out? What happens if you keep sleeping for a while longer? How do you feel when it’s all over? Will the pain medications make me sick then making me not be able to take them anymore causing intense pain all the time? Yikes! It’s all so scary, and I have no idea what is going to happen to me! Just thinking about all of the medicine TV shows that I’ve seen makes me woozy. Is that what they are doing to me?

Some other things I have to be aware of is that I have to make sure that all of my nail polish is off. I just got done taking it all off and it took me forever because I had to get in all the nook and crannies and get all of the little bits of nail polish off, what a bother! Also, I didn’t get to have any ibuprofen starting about Sunday. That wasn’t too bad, but it was still a restriction, and another thing to worry about. I am always being constantly reminded of it through those restrictions.

I am also being constantly reminded by the homework I have and by all of my friends telling me good luck and to text them as soon as I could and all. Then there also are all of those people who always ask you where you are going and when you tell them they ask why and yadda yadda yadda.

Then there is the fact that I still have to buy Christmas presents for my dad and Busy Toddler. I have ideas for both of them, but when am I going to get to the store? Also, even though I get to miss school, I still have a Christmas 4-H Program thing that Horse Lover and some of my other club members are participating in three days after my surgery. Then there is an early Christmas my whole family is having with my Great Grandma before she goes to visit other family four days after my surgery and also five days after my surgery my cousins have invited me to a hockey game and I really want to go! I really hope I am feeling good enough to go to those things!

As I mentioned before, I get to miss school through all of this. The good part of it is that I am only missing three and a half days until Christmas vacation making my vacation almost a whole week longer than it should be! But missing school always means one thing, homework. The only okay part in it is that since it almost being Christmas vacation, I am not missing much since in my middle school there are no finals. I also got most of it done in study hall the past few days.

Anyways, all in all I am pretty scared and nervous about it. In fact, I even started having dreams about it last night! That was pretty freaky. I dreamt that a lady was putting an IV in my hand and while she was doing that I asked her what the odds were of me waking up during the surgery. She said that that had happened only like 1/6 of the time. Boy, that really freaked me out! That still meant that people did wake up! But before I could think much of it I started feeling woozy. Just when I was starting to fall asleep, I woke up because I had even started feeling woozy in real life! When I looked at my clock it was 5 A.M. and so then I just sat in bed and worried for an hour and a half until my dad and mom came in to wake me up.

I will report more after the surgery, but for now I need to get to sleep so that my mom can wake me up for some more spaghetti before it is to late to eat anymore! Good night!

Sports Girl Prepares for Knee Surgery

This doesn’t really fit in with the “country life” angle of my blog, but my oldest daughter who recently turned 14 is scheduled for knee surgery next week and it’s a big event for our family. I couldn’t find much information online covering her affliction and impending surgery, so I thought I would go ahead and detail the experience.

Sports Girl Wears Knee Brace While Playing Soccer

Sports Girl wore this special knee brace for the entire fall soccer season. It helped her feel a bit more secure, but ultimately it didn't keep her knee cap from subluxing again.

Sports Girl first dislocated her left patella or knee cap following a collision during a physical education class in April. I say “dislocated” because most people will understand what that means, but her patella actually “subluxed.” That means it went out of place and then shortly after went back into place on its own. A truly dislocated patella must be manipulated to be put back into place. (Slammed back into place is probably a more accurate description, but we’ll go with “manipulated.”) The full, proper term for the temporary dislocation which Sports Girl experienced is “patellar subluxation.”

At first I thought the episode was nothing but a fluke. Sports Girl took a few days off from P.E. and spring soccer practices; she also missed one Saturday soccer game which was a huge sacrifice for her. She returned to soccer practice on Monday, and her left patella promptly subluxed again – this time just as she planted her left foot to kick with her right, without anyone touching her.

Now I knew we needed to look into this issue further. I took Sports Girl to see a local physician’s assistant; she recommended Sports Girl wear a neoprene knee brace, exercise to build up her muscles and perhaps undergo physical therapy. We decided to wait to see how Sports Girl’s knee would heal before starting physical therapy – perhaps she just hadn’t given it enough time before going back to sports. But we did pick up a basic knee brace at our local sporting goods store.

I first wrote about Sports Girl’s knee troubles about this time. You can see my post relating to bike riding as exercising here.

Summer was fast approaching, and she would be able to take more time off to recover. The thing was, it was becoming obvious that the patellar subluxation experiences had left their mark on Sports Girl’s body and mind. She was continuing to experience discomfort, and she was extremely anxious about her knee whenever she did any physical activity. So I decided to get another medical opinion. This time we went to a full-fledged medical doctor and used the appointment to also conduct a physical examination to meet school athletic requirements for the next year. This two-for-one approach helped me convince Handsome Hubby that we should spend the money on another office visit even though he was personally convinced that Sports Girl would eventually just grow out of this problem.

Second Doctor Refers Us to Orthopedic Surgeon

But this doctor had other thoughts. He paid special attention to Sports Girl’s bone structure and build and to how generously loose her joints presented. He thought she was a prime candidate for surgery to correct her problem and he referred us to an orthopedic surgeon who specialized in sports medicine and who was utilizing new surgical methods to correct this particular issue.

Unfortunately, we couldn’t get in to see this sports med/ortho for about 6 weeks; it was already late June, and the fall soccer season was fast approaching. In the mean time, we tried to get in to see our local orthopedic surgeon, but we had to start by seeing his physican’s assistant. This P.A. also recommended physical therapy, so with two written orders on file with the physical therapy department, we decided to go ahead and get started with that before seeing the other orthopedic surgeon.

Sports Girl Starts Physical Therapy

The physical therapy seemed to make Sports Girl’s knee hurt more before it got better, but she did make progress. Her exercises called for strengthening not just her VMO , quads and hamstrings, but also her hip flexers, glutes and abdomen. Since girls have a wider core, research has shown the important of strengthening the whole package to heal and prevent injuries. Prior to this I thought a 13-year-old girl was much too young to be introduced to the weight room, but now I’m convinced that with proper training and a proper approach of lifting a lighter amount of weight for more repetitions, weight training or strength training in general may well be crucial to keeping teenage girls physically healthy.

When we finally got in to see the sports med ortho, he ordered x-rays of Sports Girl’s knee and confirmed that her patella sat at an outward tilt, which became more pronounced when her leg was bent at a slight angle. That combined with her loose joints made her very susceptible to patellar subluxation and dislocation. And once the patella slides out of place, the ligaments attached to it become stretched or torn, resulting in subsequent subluxations. He prescribed a special knee brace which cradled her knee cap with a horseshoe-shaped support and urged her to continue with the physical therapy.

She plugged along with PT through the summer, faithfully wore her new knee brace and started fall soccer. But she still seemed cautious; she just wasn’t her usual aggressive self. Those subluxation episodes were very painful and she definitely was scared it was going to happen again. A couple of times she told me, “I felt it almost go today.” But thankfully it didn’t. So while she continued doing her exercises, we ended our visits to the physical therapist who had offered these prophetic words, “The real test will be basketball.”

Sports Girl took three weeks off between soccer and basketball, but continued her PT exercises. She really did. I reminded her and pressured her regularly. That’s what moms do, right?

During the first week of basketball her patella subluxed again – this time as she pivoted on her left leg while running a ladder for conditioning. Again, no one touched her, and she was wearing the special knee brace at the time. The episode dropped her to the floor in a crying heap. I got the emergency call from the coach that I might want to come get her early from practice.

Surgery Is Scheduled for Dec. 17

We called the sports med ortho doctor a couple of days later and he said she should not play basketball if she was experiencing pain and that he wanted to see her again. Somehow this time we managed to get an appointment for the very next Monday. That’s when he showed us how fluid had pooled up in her knee. I hadn’t noticed her knee looking bruised or swollen following any of the subluxation incidents, but there was definitely fluid there. And then the doctor uttered those dreaded words. “The last thing I want to do is put a 14-year-old girl on the operating table, but I think we are looking at surgery.”

He also recommended that she quit playing basketball until the problem was corrected. It was a heart-wrenching appointment for Sports Girl, yet she didn’t argue with any of his recommendations. She promptly notified her coach that she would be out for the season but that she would like to serve as team manager. And she started mentally preparing herself for the surgery. That was mid-November. The surgery has been scheduled for Thursday, Dec. 17. I think the five-week wait has been the hardest on Sports Girl – that and watching her basketball teammates lose a couple of very close games while she’s sidelined keeping the stats book.

I’ll post more about her situation and the type of surgery she is having done in the next couple of days. Subscribe using Feedburner to receive e-mail notifications of my posts or keep checking back!

A Tom Cat Named Ginger (Or, Gender Confusion on the Ranch)

Back in August, Busy Toddler and Sports Girl bamboozled Handsome Hubby into adopting a kitten from their cousins. She was a sweet little orange kitten the cousins had already named Ginger.

Tom Cat Named Ginger

George (aka "Ginger") lounges while Busy Toddler starts the day watching cartoons.

Now, this kitty was born and bred as a “ranch” kitty, but that doesn’t mean anything at our house. It was well understood that this would become a house kitten, mostly because we do not have any outbuildings close by that would enable us to officially have “barn” cats. There’s also the issue of our male Welsh Corgi, Archie, who has already successfully chased off one cat, and then there’s the fact that my girls want their pets to be inside, so they can spend more time with the animals for their own personal comfort and convenience.

But I digress … back to the kitty.

A couple of weeks ago I took Ginger to the vet to be spayed. I opted not to pay extra to see if she might have any issues with the anesthesia, and I left my cell phone number with the receptionist in case of an emergency. A couple of hours later, I got what I thought was the dreaded emergency call from the vet clinic, but the lady sounded far too cheerful for there to have been any crisis.

“Ginger’s fine,” she said. “But Ginger’s a boy.”

That was one strange phone call. I didn’t laugh at the time, but I have gotten a good belly laugh out of the conversation since then and thinking about it even now makes me smile. Turns out both of Ginger’s male protrusions failed to protrude at all and were still up inside his abdomen. The worst part was that getting him neutered actually cost more than a normal spaying would have cost because the vet had to search and dig for the goods. Just my luck …

Before you think we’re all crazy, I should emphasize that even the vet tech that prepared poor Ginger for his eventual castration did not notice the gender mix-up until after the kitten was opened up on the operating table and things didn’t present as they should.

My oldest niece says she noticed Ginger was a boy before we picked him up. After examining dozens of litters of kittens, those lifelong teenage ranch girls don’t miss much. And she thought she told us – she probably did. We acquired this kitten right after the county fair, and who’s thinking straight after helping the girls finish dozens of craft, food and sewing exhibits, helping them prepare and show five sheep, and spending three relatively sleepless nights in a tent in the heat at the fairgrounds?!

Speaking of the fair, we had another funny gender issue come up there – this time with Sports Girl’s mini lop rabbit. She purchased the best overall mini lop doe from another 4-Her at our county fair last year specifically to breed with her buck. Well, we didn’t have any luck getting bunnies and for good reason. Turns out last year’s champion doe is actually a buck! Now, it can be tricky to tell the difference between male and female rabbits, especially when they are younger as this rabbit was last year, but still … more than one set of rabbit expert eyes looked at this critter and didn’t catch the mistake!

It’s really no big deal that Ginger is a boy. After all, he’s officially an “it” now. The hard part is convincing a 2-year-old that Ginger should now be called George. Heck, I’m having a hard enough time getting used to the idea myself. I find myself telling Busy Toddler something like, “Be nice. Ginger just had surgery and she has an owie on his tummy. Just scratch George’s head.”

Who wouldn’t be confused after that?