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.

Advertisements

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 …