Second Daughter’s Knee Recovers Quickly – So Far

It’s been more than three weeks since Tessa’s surgery in which she had an allograft, or cadaver MPFL, placed in her left knee, and so far her recovery has gone very well.

While I suspected that her condition was largely genetic since my oldest daughter, Callie, required the same surgery a few years ago, now I am not so sure. You see, Callie’s knee was tilted towards the outside and her lateral ligament on the outside of her knee was tight. As a result, in addition to the allograft, Callie also had a lateral release performed as well as a bit more work to straighten her patella. Tessa, on the other hand, required just the allograft and no additional work was performed on her knee to stabilize it.

The same doctor performed the surgery on both of my daughters. He said Callie’s ligaments were very tight while Tessa’s were extremely loose, so much so that her knee could almost be hyper-extended.

As a result of having less work done on her knee, Tessa had less internal irritation initially and seemed to recover even quicker than her sister immediately after the operation. The nerve block she came home with for two additional days of numbness also helped. Tessa was only on her prescription pain medications through Monday or 4 to 5 days, while Callie took the medication for one full week. Beyond that, their recovery has been very similar.

Tessa did not return to school until Thursday, Sept. 13, which was one full week after her operation. I believe she could have returned a little sooner, but she was concerned about being able to keep her leg elevated during classes. And keeping her leg up was key to keeping her swelling down.

After seeing her orthopedic surgeon for her first follow-up appointment on Monday, Sept. 17, Tessa abandoned her crutches. That was just 11 days after her surgery. The next day her physical therapist began to open her brace to bend up to 60 degrees at the knee. She then had it opened up to 90 degrees, even as she walked, one week later starting on Tuesday, Sept. 25.

Tessa experienced some serious muscle memory loss. It was over a week before she could reliably and consistently flex her left quad muscle, and even a little longer before she could lift her left leg without assistance. But she has been diligent about her physical therapy exercises, and we continue to see improvement.

Tessa leaves the brace off once in a while when she is lounging around the house, but generally she continues to wear it. She experiences some discomfort after a long day on her feet or if she moves wrong, and she still applies ice to her knee at night. But overall, she is doing well. Her wounds are about closed, and she has begun applying Mederma to them to keep her scaring at a minimum.

Even though her initial recovery was faster than her sister’s, I don’t expect Tessa to be released for full activity any sooner. The allograft was the most invasive procedure for both girls, requiring the most rehabilitation.

I still suspect it will be five months or more before Tessa can resume any joint-intensive activity such as hard running, jumping, twisting, etc. And it will probably be a year or so before she’s back to full strength and regains confidence her left knee.

And that’s all right. At least the most intense part of the fix is over. Now we just need to have patience and remain committed to her recovery, even when she starts to feel almost normal.

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!

Knee holds up through basketball season

Sports Girl (35) grabs for the ball from an opponent. The poor girl holding the ball had broke her nose in a previous game. Playing sports can sure be dangerous!

Sports Girl’s first high school basketball season has gone fairly well. She hasn’t set any freshman scoring records or anything, but she has been consistently able to play at up to the junior varsity level.

And while the season hasn’t been completely without incident or injury, remarkably, nothing has involved her knee. And it’s not like she hasn’t taken more than one or two nasty spills onto her knee or knees on the hardwood or tile basketball courts across South Dakota.

The surgery she endured over a year ago where a cadaver ligament was attached to her left femur and patella to replace her MPFL has so far proven successful in stabilizing her knee. She has had no further subluxation or dislocation issues, and she has had very little discomfort in her knee.

She did, however, sprain her left ankle about a month ago, and she has had some pain from shin splints. The ankle sprain has continued to plague her, requiring constant taping during all practices and games to keep her ankle from rolling again, and continued icing afterwards. Now she has developed an allergic rash and a friction blister on her left heel from all of the taping.

These injuries are really incidental. At least I think they are. I say that because I find it odd that all of her weaknesses appear to be on her left side. She had the most trouble with the Achilles tendon pain during soccer on her left leg. And now her left ankle has given out, as well.

Sports Girl has been diligently strength training in the weight room, so I don’t think her left side can really be that much weaker than her right. Can it? Or could it all somehow be related to her knee surgery?

Either way, I still declare the knee surgery a success. At least so far. Sports Girl is gradually regaining her confidence, and she doesn’t seem to worry about her knee any more. The reward is seeing that competitive spark return to her eye … and when she grits her teeth, watch out!

Successful Surgery Sees Sports Girl Through Soccer Season

Sports Girl has finished her first post-operation soccer season without incident! She made it to every practice and played in all 10 junior varsity games for her high school.

Sports Girl (maroon) goes for the ball in a high school girls junior varsity soccer game.

If you look closely, you can see part of Sports Girl's scar on her left knee here.

And while she may not be quite as strong competitively as she was before her knee issues began, she was mostly without pain and without worry that her knee would pop out of place throughout the intense, 7-week season. And she didn’t wear a knee brace at all!

So as we approach the one-year anniversary of her surgery coming in mid-December, I am almost ready to declare it a complete success. My only hesitation is seeing how things go on the basketball court.

You see, it was the first week of middle school basketball practice that delivered the final blow to Sports Girl’s knee issues at the end of October last year. Basketball involves more jumping and quick turning than soccer, and the hard indoor court is actually harder on Sports Girl’s knee than the soft grass soccer field even if it is sometimes uneven. Basketball shoes do provide more support and shock absorption than soccer cleats, thankfully, and we will soon be shopping for Sports Girl’s new high tops.

High school girl’s basketball won’t actually start until around Thanksgiving. Between now and then Sports Girl plans to keep running and lifting weights a few times each week at the local recreation center to stay strong and ready to play.

Sports Girl has worked hard the past 10 months to recover with physical therapy, performance training and other practices and workouts. She can’t quit now or the results of all her hard work could all but disappear in the six or seven weeks she has off in between soccer and basketball. So while Sports Girl is looking forward to a break from regular team practices these next several weeks, I know she has no intention of giving up on her physical progress.

Ortho Releases Sports Girl for Sports, Physical Activities

It’s been a long time since I have posted, and I know many of you are following Sports Girl’s progress as she recovers from her MPFL replacement surgery. To you I apologize.

I hope you assumed that no news was good news, because things continue to go well. Sports Girl steadily cut her times in both the 800k and 1600k in track through mid-May. She went back to her orthopedic surgeon on June 2, and – as we had anticipated – was fully released to resume all of her former physical activities and sports. It was a great day, and barring any future complications or other issues, it was our last visit to this doctor. While we would recommend this physician to anyone without hesitation, for reasons that should be obvious, we are grateful that Sports Girl doesn’t have any future appointments scheduled with him.

Since then, Sports Girl has been strength training and conditioning three times a week in a summer training program offered by the local high school athletic trainer/physical therapist. She has also participated in open gyms twice a week in preparation for basketball; she has even played in a few summer league basketball games.

She had some discomfort in her left knee during the first basketball she played, but subsequent games seemed to go better. I am sure my knees would hurt if I tried to play a basketball game in my out-of-shape state, so hopefully her pain was due more to her lack of recent activity than to the surgery itself.

It’s been a little over 6 months since Sports Girl had her surgery. While we had hoped her recovery would progress much faster, all her caregivers have said she has done remarkably well.

Just yesterday I took Sports Girl to our local family practitioner for her annual sports physical examination. This is the same doctor who referred us to the orthopedic surgeon at almost exactly this time last year. Since Sports Girl has not had cause to see a doctor this past year other than for her knee surgery, our family doctor hadn’t known how his referral had turned out. He was genuinely interested, and we were thankful that he knew of a doctor who took a proactive approach to frequent patellar subluxation issues. I know of a couple of middle-aged women who have just lived with this problem and the pain and discomfort that goes with it for much of their lives.

It seems we have come full circle, and Sports Girl is looking forward to a successful year playing soccer and basketball as a freshman in high school. I’ll have to post pictures …

Sports Girl Runs Track to Strengthen Quads

Sports Girl running relay after MPFL surgerySports Girl continues to rehabilitate from her MPFL reconstruction surgery. She is now strengthening on her own rather than attending regular physical therapy sessions. She still has a ways to go to get her left leg as strong as it was before the surgery, or ideally, even stronger.

The doctor gave her the green light at the end of March to run some mid-distance races in spring middle school track, but he told her not to expect to have a stellar season. So her goal at meets has been not to finish last – which is a strange twist for my ultra-competitive Sports Girl. But I’m proud of her for knowing her limitations and pushing herself right up to them.

She is running the 800k and the 1600k and a couple of various legs in relay races. She is pictured above right getting ready to take the baton from a team mate in one of these races.

Overall, she’s had minimal problems other than a little muscle fatigue (which is actually a good thing), and a few instances of strange rubbing sensations and minor discomfort in her left knee while running. Sometimes she said both knees were actually bothering her, so I could chalk up those instances to being out of practice physically.

At first I was concerned when she said her left knee was bothering her, but when she actually fell on her knee recently while roller skating, I saw how worried she became when her knee was causing real pain. Thankfully, the knee felt just fine the next morning – so the pain was not unlike what any knee might feel after colliding with a tile floor.

I think she might just have to get used to some of these new feelings and learn how to read them. My hope is that she can grow confident on this newly stabilized knee and get back to her old aggressive self during competition.

Honestly, I believe the biggest risk facing her right now is incurring an injury unrelated to her previous patellar dislocation issues. With one weak leg, she is predisposed to injuries such as ACL and MCL tears.

As I’ve mentioned before, one key thing we’ve learned about how to protect the knee is to have strong muscles in the quads, but also in the hamstring, hips and abs.  So Sports Girl will spend much of her summer strengthening and conditioning.

After spending well over $100 a week on physical therapy, the fees involved for multi-week training programs in our area now seem like a bargain! I recommend all physically active teens should attend performance training as an insurance policy against a more expensive and time-consuming potential injury.

Sports Girl goes back to the doctor for hopefully the last time on June 2, and at that time she should get approval to start summer training/practicing for soccer and basketball, which start in the fall and winter respectively and require more sudden stops, turns and jumps. So there will be open gyms, skills camps and city leagues to attend this summer, as well. We’re looking forward to being busy with these activities – it sure beats being sidelined from them!

Sports Girl Needs to Strengthen Quads to Protect Knee

Monday was D-Day for Sports Girl – Doctor Day that is. She went back for her third follow-up exam following her MPFL reconstruction surgery back in mid December.

Except for being told she could immediately resume all her former activities without risk, the appointment couldn’t have gone better. The doctor did say that her left patella (kneecap) is now completely stable with less shifting than even her right. And the x-ray showed that the kneecap now sits straight on her joint rather than presenting with an outward tilt as it did before. The x-ray did, however, highlight the two metal screws she now has permanently implanted in her left kneecap, but these have left no lingering effects, thank goodness. If we hadn’t seen them on the x-ray, we might not have believed they were there!

Sports Girls’ quadriceps, however, are still obviously smaller on her left leg than her right in spite of undergoing more than 15 30-minute physical therapy sessions over the past two months and completing exercises on her own almost daily. Rebuilding and toning muscle takes time, and the doctor says resuming physical activity now would put her at risk for other injuries such as an ACL tear. He recommends another four weeks of physical therapy and exercises to further strengthen her leg and better protect her knee before she starts working out or competing in any sports.

The doctor wants to see her again on March 29 after she completes four more weeks of strength training, so running in spring track is off the table at least until then. And we are all OK with that, including Sports Girls. She’s been through too much already to risk any unplanned setback. It’s more important that she get back into shape over the summer, so she’s ready to play high school soccer come August and high school basketball after that starting in November.

It will be equally important, I think, for her to strengthen her right leg, as well as her left. While the doctor says he doesn’t personally know of anyone who has required the same MPFL surgery on both knees, he has known patients who’ve had subluxation or dislocation issues with both knees. So Sports Girls needs to prevent this from happening on her right knee as much as she needs to rebuild her left.

Besides doing her exercises, these days Sports Girl applies Mederma to her scars daily and looks forward to the day when she can run and play ball without even wearing a knee brace and with no fear of her kneecap sliding out of place. That day isn’t too far off …

Sports Girl Recovers Quickly From MPFL Surgery

Knee After MPFL Reconstruction Surgery

Sports Girl's left knee is no longer swollen but shows some signs of scarring.

My posts about my 14-year-old daughter’s knee surgery where surgeons used a cadaver ligament to replace her MPFL and a lateral release have attracted lots of readers and several comments. I am happy to report that Sports Girl continues to have a quick and painless recovery.

She goes back to her orthopedic surgeon for a follow-up appointment on Monday, March 1, where the doctor plans to x-ray her knee and give her a post-operative evaluation. We should know more then about how well she is progressing, but by all indications, she seems to be healing as well or better than we could possibly have expected.

Sports Girl has regained almost complete range of motion in her left knee, and she continues with aggressive closed-chain physical therapy weekly with the therapist and daily on her own. This means she does weight-bearing exercises on her leg while her foot is planted on the floor, but no jumping or running or anything where she picks up her leg.

It is amazing to me how quickly her left quadriceps atrophied, and she still has work to do to get them built back up. But she is working hard at her therapy, and while hurdles and the long jump are out of the question, according to her physical therapist, running distance in spring track may be a possibility for Sports Girl at this point. We plan to discuss this with the doctor next week as track will start almost exactly 3 months after the surgery, and this was the short end of the 3- to 6-month recovery time frame we were given.

While she is doing very well now, the surgery wasn’t entirely easy. Sports Girl spent one week taking the narcotic pain reliever, Oxycodone. The little white pills made her queasy and light headed, but she needed them – especially at night when the busyness of the day didn’t keep her mind off the throbbing pain. She had many pills leftover at the end of that first week, but she gradually weaned herself solely to Tylenol. She found that she didn’t actually need the potent pain pills to be comfortable. She didn’t like the way they made her feel in her head and her stomach, and she didn’t like knowing that they are classified as habit-forming drugs.

Sports Girl’s knee swelled to at least twice its normal size, but we diligently kept it elevated and iced almost non-stop for at least the first week, maybe longer. As someone who normally sleeps curled up in a ball, I know Sports Girl didn’t adapt well to being forced to sleep lying flat on her back. There was just no other way for her keep her knee stable and elevated.

Sports Girl also struggled with the lingering numbness she felt in her leg, probably a prolonged effect of the nerve block she had for surgery and also a possible side effect of the long hours she had her leg elevated. But after a couple of weeks, she finally regained complete feeling in all of her left leg and foot.

I think some of Sports Girls struggles involved getting past her own fears. For example, my fashion-conscious teenage daughter wore the absolutely ugly white TED compression hose/leggings even longer than instructed. She also continued to bandage her incisions long after anything was draining, and she covered them with plastic wrap before taking a shower much longer than the doctor ordered. I believe she actually dreaded losing the pieces of tape that covered the incisions.

And while Sports Girl was quick to ditch her crutches, she wasn’t as eager to leave her large black leg brace behind. She wore the brace for a few days longer than necessary, but that was fine with Handsome Hubby and I.  The roads, sidewalks and walkways around here have been covered in ice for much of this winter, and the brace served as a small insurance policy in case she fell.

The surgeon attached the cadaver ligament to Sports Girl’s femur with one dissolvable screw and to her patella with two screws that will not dissolve. According to the doctor, the dissolvable screws are too soft to be driven into the kneecap. The fact that the ligament will eventually be naturally attached to Sports Girl is reassuring and weird at the same time.

The surgeon could have used a piece of Sports Girl’s hamstring to replace the MPFL, but he wanted to leave the hamstring intact in case Sports Girl ever needed an ACL repair. Evidently the hamstring is the preferred tissue of choice for this type of repair. The surgeon assured us there was no risk of rejection using a cadaver ligament, and the recovery time is a bit less as the hamstring is not further weakened.

Sports Girl applies lotion with vitamin E on her incision sites daily as well as Mederma to reduce scaring. She will also need to wear sunscreen faithfully all summer as the surgeon said sun exposure in the first year makes scare appear more pronounced. I am picturing a tanned teenager with a white knee — similiar to how she looked last summer when she was wearing the black knee brace while playing sports.

The initial news of being sidelined from basketball and spring soccer was devastating for Sports Girl. But as she watches her former teammates wind down this basketball season, I think she has actually gotten a bit accustomed to her free time and has actually somewhat enjoyed this break from her sporting activities.

I believe Sports Girl’s biggest obstacles from this point forward could be overcoming her own internal fears as she regains trust in her knee – that and finding the strength and time to recommit to the sports she loves. So now we hope and pray that Sports Girl has the drive and dedication necessary to get ready this summer for high school sports in the fall. But first we need the surgeon to release her for full participation. I don’t think this will happen next Monday, but it might happen in March or April …

Knee Recovery Goes Well So Far

Sports Girl's Knee 5 Days Post-Op

Sports Girl's left knee was still fairly swollen just 5 days post-op. It's still a little swollen even now, but not as much as this. Notice, too, how she wrote on her good knee with permanent market to ensure the doctor didn't make any mistakes.

Now at nearly 3 weeks post-op, Sports Girl is recovering quite nicely from her knee surgery. She has almost no pain, even when she’s worked hard twice a week by her physical therapist.

Her doctor told us that females tend to recover from these types of surgeries quicker than males and that young people tend to recover quicker than older people. So with two positive attributes on her side, Sports Girl seems to be bouncing back especially fast.

She still struggles a bit with mobility. She can just bend her left knee to almost a 70-degree angle; she says she feels a pulling sensation when she tries to go more than that. And she still wears the long brace to keep her leg straight almost all of the time. On the plus side, she actually can completely straighten her leg, which folks who’ve had this type of surgery often struggle to do.

Sports Girl is also able to support her weight on her left knee. She actually ditches her crutches quite regularly around the house and sometimes even forgets where she left them!

We had a fairly casual follow-up appointment with the orthopedic surgeon’s physicians assistant 10 days after the surgery. I think “casual” and “uneventful” are good qualities when it comes to describing doctor’s appointments. We go back to see the actual surgeon in 2 more weeks.

The original estimate for complete recovery was 3 to 6 months, so at only 3 weeks, it’s really too soon to tell much. I won’t prematurely declare that Sports Girl will be running hurdles in track this spring or that she’ll be playing striker for spring soccer, but we are feeling cautiously optimistic.

And even though this surgery has left Sports Girl sidelined from sports for most of her eighth grade year, we are at peace with our decision to have it done. Our hope is that she will recover better than she was before, that she will have a fun and successful scholastic athletic career and that she will lead a long and active life.

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!