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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Winter Weather Leaves Thousands Without Power or Water

Even though the winter of 2009-10 isn’t yet half over, it has already been one to remember in South Dakota. Temperatures have been even colder than usual, inches and inches of snow have fallen, and even when the snow hasn’t fallen, fierce winds have blown around what was already on the ground. There is something seriously frustrating about shoveling the same snow more than once!

We traveled across our great state this weekend and got a belated glimpse of some of the havoc our extreme winter weather has caused.

There were livestock fences and wind shelters entirely covered in snow. Many large fields of corn stood unharvested after an unusually wet fall followed by the early arrival of winter. And even while there were areas of brown ground exposed in some places, just a short distance away there were mature shelter belts of trees with only branches poking out of enormous snowdrifts.

Repairing Power PoleBut perhaps the most striking blow the weather dealt was the large ice accumulations on power lines and poles, leaving thousands of people all across the Northern Plains without electricity for days, even weeks. The picture at right was borrowed from AberdeenNews.com.

We saw some of these downed power poles first hand. They looked like splintered toothpicks lying on the ground with lines sagging toward the ground or even snapped completely apart. And fixing these poles was obviously a daunting task. First crews needed to plow away the snow just to access the area for repair.

Entire communities have suffered from these extended power outages, and in these cases another problem has also arisen – a shortage of water. The community water towers drained quickly. And with no electricity to pump water or to run water treatment plants, residents were left without water not only for drinking and cooking, but also for flushing toilets, taking showers, or washing dishes and clothes.

Those living in the country have added challenges – they often have livestock to feed and water, and the power lines leading to their single-family homes are generally fixed only after those serving entire communities have already been repaired.

But country folks sometimes have it easier, too. Most have their own well and their own septic systems, making them more self-sufficient and generally taking care of any water shortage issue. Many also own standby generators to cover when the power goes out, so they are better prepared for the wrath of Mother Nature.

The plight of South Dakotans has gained some national news attention. An article will appear in tomorrow’s New York Times, for example. But generally our rural weather hardships are being rightfully overshadowed by the earthquake devastation in Haiti.

My ranching in-laws say this winter must compare to that of 1949, which has gone down in history as the worst winter of the 20th century for South Dakota. The only difference, they say, is that farmers and ranchers today have four-wheel drive tractors so they can still get the snow cleared to get out and take care of their animals in spite of the weather. Thank goodness for that!

Calving and lambing starts soon here, so hopefully we will at least get a break from the blustery weather. Even just a couple weeks of 40+ degree temperatures would help us better cope!

Ignoring my Pathfinder’s ‘Service Engine Soon’ Light

Three years ago I swapped my trusty 1996 Dodge Grand Caravan for a 2006 Nissan Pathfinder. I thought the Pathfinder would be better suited for driving our gravel roads and rough driveway. While I have appreciated the all-wheel-drive function on several occasions, I haven’t exactly been happy with my Pathfinder.

I’ve written about my struggle to find the perfect vehicle for country life once before. What I didn’t detail then was the service issues I’ve had with my Pathfinder – all supposedly caused by the six miles of gravel I drive on each time I travel to and from my home. It seems the gravel kicks up dust that gets sucked up into the vehicle’s engine and exhaust systems.

As a result, my “Service Engine Soon” light has been on almost perpetually for two years. The light first came on just two months after we purchased the vehicle, but thankfully the Pathfinder was still under factory warranty.

Initially, the light really bugged me; I promptly took the vehicle in for diagnosis and repair. Eventually my warranty expired, and I submitted a formal complaint to Nissan. Nissan tried two more times to fix my issue even without a warranty, but the light still came back on soon after every service. The last time I tried to have the dust issue fixed about a year ago, the service light came back on before I even made it home from the shop!

For those of you who are mechanically inclined, most of the issues I’ve had that required service involved the PCV valve and the oxygen sensors. And both issues are a direct result of the dust wreaking havoc with the emissions standards established to maintain clean air.

So now I just live with the “Service Engine Soon” light on all the time. The mechanics tell me the light will blink if there is anything seriously wrong with the vehicle. That’s sort of reassuring.

While I have my oil changed regularly, I have my tires rotated, and I’ve replaced my front brake pads, I continue to ignore my engine light. Speaking as the daughter of a diesel mechanic, this seems wrong. But constantly having the light checked and attempting to have the issue repaired was obviously a waste of time and money.

If only vehicle engineers would realize that some people still live in the country and that vehicles – especially SUVs and pickups – should be built to withstand this type of driving. Perhaps I should submit a formal complaint to them, as well … There’s probably too many of them to do that; so I guess this blog post will have to do.

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.

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!