Second Daughter Experiences Patellar Subluxation, MPFL Surgery

I still can’t believe it happened. It was the last basketball game of the season at the end of March, and she fell to the floor grabbing her knee.

Those of you who have followed my blog are probably thinking my oldest daughter Sports Girl – Callie – hurt her knee again. But it wasn’t Callie this time; it was my middle daughter, Tessa.

It took us a while to accept the fact that Tessa has just experienced patellar subluxation in her left knee just as Callie had at about the same age.  We even encouraged Tessa to go back into the game to keep playing. She tried, but she promptly came back out explaining that her knee started to give out again. She was in pain, and she was scared.

We continued with our denial. Since it was the end of the basketball season, we thought perhaps Tessa could recuperate and do some exercises and light weight training on her own to get past it. But her knee slid out two more times during physical education classes during April and May.

Then Tessa attended a week long basketball camp in early June. While the knee didn’t actually sublux during the camp, it did swell considerably. And so we dug out her sister’s old pre-surgery knee brace for her to use and scheduled an appointment with the orthopedic surgeon later that month.

Handsome Hubby was ready to schedule surgery right away. But even with her sister’s history, the surgeon approached Tessa’s issue conservatively.

Unfortunately, it was a familiar routine with a familiar ending. Tessa completed six weeks of physical therapy, and she performed the exercises faithfully. But when we went back to the doctor late in July, he wasn’t satisfied with the results. When he started to wiggle her kneecap with her leg extended straight, Tessa experienced extreme apprehension. To be honest, she about came up off the table.

So today I am sitting at the hospital waiting for Tessa to come out of surgery  – the same surgery Callie had done almost three years ago. Tessa is having a cadaver ligament inserted in place of her MPFL to stabilize her knee. She will also most likely have a lateral release performed and any other maintenance necessary to allow her knee to track better.

Callie hasn’t been completely without issues. She has had some discomfort and mild swelling around the ligament when she resumes a new strenuous activity, such as when soccer practices started twice a day in early August. There’s also the scars which will always be present on her young skin around her knee. Callie has some general tightness in her knee, as well, and cannot always easily bend her knee far enough to touch the back of her foot to the inside of her thigh. But I can’t do that either!

But we do know from Callie’s experience that the surgery works; it leaves the patient in better shape than before. And so we are going through it again with our second daughter at an even slightly younger age. Callie had surgery shortly after she turned 14; Tessa just turned 13 in May. Both girls had the surgery as eighth graders in school. The goal is to save precious cartilage that is damaged with each subluxation.

I always thought that Callie’s initial injury was primarily due to some sort of unusual blow to the knee she received during physical education class. But after Tessa has had the same injury, it’s hard to deny that the issue might be due in part to genetics.

Rylie is only five, and we know that this surgery cannot be performed until the patient has finished growing. But we have joked that perhaps if we get Rylie’s knee fixed now, we might be given a buy two, get one free offer. But we are only kidding. We are hopeful Rylie can somehow avoid the same fate. Besides, we know the health care industry doesn’t offer any such discounts anyway!

12 thoughts on “Second Daughter Experiences Patellar Subluxation, MPFL Surgery

  1. Good luck to your dear daughter as your family navigates, once again, thru this trail. Keep us posted on Tessa’s recovery and know that somewhere across the country, we are saying a silent prayer for a successful recovery.

  2. Can you give us a rundown of her recovery like you did with Sports Girl? Maybe the highlights? I know your blog has helped a lot of people feel more comfortable with the idea of MPFLr!! Me included! Hope Sports Girl 2.0 is doing ok 🙂

    • I will absolutely provide updates on Tessa’s progress. So far I must say that she has rebounded from the surgery even quicker than Callie, aka Sports Girl, did. I attribute that largely to the nerve block which remained in place for two days post-op; Callie did not have that. It could also be because Tessa did not require as much work on her knee. She only had the MPFL allograft; she did not require a lateral release nor any cartilage clean up or other structural straightening of her patella.

      • I was looking up my sons surgery online this morning and stumbled on your page..really not much info out there on a personal level with children’s knees. So thank you for your postings. My son is 10 and will be having double MPFL transplants. The first surgery will be performed in a couple weeks on his left knee and the second a few months after. His dislocations are daily every time he bends his knee to a certain degree. He’s in pain every day and his muscles aren’t developing in his legs because he can’t use them properly. My sons growth plates are still open and he’s far from finished growing but this surgery is necessary for him. He’s a patient at The Shriner’s Hospital, no where else can treat him. His surgeon has performed many transplants on children his age and younger with great success…granted he sees the worst cases with not much choice, the benefits for his patients far out weigh the risks. My daughter is 18 and spent her entire early teen years battling dislocations as well but not nearly as serious as her brothers. In her case she gave up her sport which she was without a doubt headed for college scholarships in and focused on personal training and will be heading to medical school for her doctorate in physical therapy…inspired by her own experience and her little brothers. It was definitely an emotional road when you have a kid who is extremely talented in their sport to give it up. Lots of lessons on there being more to life than competition. My biggest concern with my son is pain management after surgery and his recovery with both knees being weak. So ready for his activity not to be dictated by his knees. I’m also unsure if I should put him on home bound education for awhile rather than try to force him back to school two weeks after surgery.

      • Hello SCmom,
        Wow! I certainly feel for your son and his situation, although at least there is a fix for the problem. I feel like in the past, most people chose to just live with the issue — like your daughter. But it interferes with their quality of life and I believe it must contribute to other knee issues later in life due to a potential loss of cartilage with each subluxation/dislocation.
        I will post an update regarding my second daughter’s surgery recover soon, but so far I must say that things are going very well. She missed only one week of school. She actually probably could have gone back sooner, but not being able to bend her knee and trying to keep her leg elevated to prevent swelling kept her home a couple of extra days. Your son’s risk of his other knee giving out may require extra consideration, however.
        As for pain management, the nerve block/drip lasted for two full days after the surgery and that really helped control the pain through the worst of it.
        Best of luck to your son and to you as you navigate through the surgeries and recoveries!
        ~ Country Mom

  3. It’s very encouraging to read how your girls have handled surgery and recovery and how you’ve handled it too. You seem to have a calm, lets do this approach. I haven’t met anyone else who has more than one child with genetic type knee issues. I’ve met a few parents whose kids have had injuries that required surgery however. Dealing with knee’s on a daily basis for my kids is just our normal and everyday life. I honestly can’t remember when activity in our house wasn’t dictated by knees. And, yes…I would love to hear an update on your daughters healing and recovery. My son will be having his surgery October 8th. It’s funny too….my husband and I don’t have knee problems but 2 out of 3 of our children do.

  4. My son had his surgery yesterday he is seventeen and lost alot of cartilge. We have a family history of this problem he was the first to have surgery. I wish I would have requested the nerve block for him.

  5. My son had a cadaver ligament put in his left knee on the 8th. We are having MPFL transplant surgery on his 2nd knee when this one is fully recovered. He had the nerve block and we thought it was amazing the first two days by the 4th day post surgery he was in extreme pain. The Shriner’s is 4 hours from out home so we were really concerned. We literally did not sleep for 3 days round the clock due to pain and that was with pain meds and valium for his muscle spasms. It turned out that the nerve block can cause irritation and inflammation around the nerve in some cases. The pain was in my son’s foot, not his knee. His foot was also having spasms. Now the question will be do we risk the same side effect on the second knee. It was that awful. We are in week 3 and my son will not be returning to school for another two weeks. Our son has some other joint issues and has struggled a bit with mobility, we expected that. His other joints are struggling with the added stress of his knee being in a brace. Our son is in a brace that is adjusted weekly to increase his degree of bend. He has to lock the knee brace straight when he walks. No physical therapy. We are at 30 degrees. We’ve also had some issues with his blood pressure dropping with walking, doctor said that should go away as he’s up more. No regrets with surgery and he’s doing well now, seems to be healing and getting around.

  6. My daughter (14) has experienced 3 episodes of subluxation between November 2012-January 2013 while playing basketball. After the first episode the doctor gave her 4 weeks off with exercises to do at home to strengthen muscles surrounding knee. As soon as she was released, her knee subluxed again. She was then sent to formal PT. I took her back for a follow up after about 3-4 weeks and he allowed her to try playing again. Second game in her knee popped out again. Doctor ordered 6 more weeks of PT. We’re coming up on week 6. Her doctor mentioned lateral release surgery, but wants to exhaust PT first. I kind of want to push for the surgery because I just don’t feel like PT is going to be enough to prevent it from happening again. She missed nearly the entire season in her Freshman year of high school and I’m afraid she will miss next year as well. Thanks for your posts about your daughters. I hope they are doing well.

    • Hello Jeanette,

      You are probably right — therapy may not be enough for your daughter. Please note that research shows a lateral release by itself is only about 20 percent effective. My oldest daughter had the lateral release along with the alograft. My middle daughter had just the alograft. I am taking my middle daughter back to the doctor for her six-month check up later today, and I hope to add another post to the blog. Do note that it takes about six months after surgery before they can resume full activity.

      Best of luck!
      Country Mom

  7. Hi County mom, I just found your blog when I was googling for articles about mpfl injuries. My 13 year old daughter had the same patella dislocation as both your daughter’s did in 8th grade. So much research has been done to show the many reasons adolescent girls are more prone to knee injuries. We are most likely going to have her do the surgery and then rehab. I’m very, very nervous about her returning to basketball next year but she absolutely loves sports and is determined to get back in to basketball and volleyball in high school. My question for you is, now that it’s been several years since your daughters’s experiences with MPFL repair and returning to sports, how are they doing now? Do they have any lingering knee issues as adults? Do they have osteoarthritis? Have you found any information about treatments for rebuilding the cartilage lost when the patella dislocated?

    • Hello Susan,

      My daughters aren’t really having any lingering knee issues as adults and don’t have any osteoarthritis. They do experience some stiffness in their repaired knees from time to time, but I believe that’s about it.

      I really need to write an updated post on my site as I don’t believe I’ve fully covered my middle daughter’s situation. The surgery was quite successful for my oldest daughter as she was able to play high school basketball and soccer afterwards with no real issues. But my middle daughter wasn’t so lucky. She actually had a second procedure (different fix) done on her knee after repeated issues when she attempted to return to cross country running. She hasn’t had any problems since, but she hasn’t really pushed herself too much physically, either. But I do believe her knee is good now for general lifetime activities.

      I don’t believe there’s any way to rebuild cartilage once it is lost, but I think we caught my daughters’ knees soon enough that while they lost some, they didn’t lose too much.

      I hope this is helpful for you. I remember well the agony of deciding what to do. The second surgery for my middle daughter was exceptionally difficult. Her initial doctor wanted to repeat the same surgery a second time, but we weren’t comfortable with that. So we saw a different doctor who recommended the alternate fix.

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