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!

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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!