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 …

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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!

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!