Left Kneecap Dislocations
For over a year, my left kneecap dislocated medially (very rare) and laterally everyday. It even took up new residence on the medial aspect of my knee. Bracing and taping did not help, and my kneecap dislocated despite both. I could hardly flex (bend) beyond 20-30 degrees before it jumped out of position. It was incredibly painful.
In 2010, I previously underwent an MPFL reconstruction with a cadaver graft for lateral dislocations. That surgery seemed to work for 7+ years before the dislocations occurred again. This time, when it began dislocating medially as well, my surgeons were a bit more confused as this is really should not be possible. There are very few reported cases of true medial kneecap instability and as a result, the treatment options are even more scarce. But I am blessed with a team that researches and contacts other specialists to determine the best path moving forward.
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| The kneecap should be positioned in the center of the black line. |
Left Knee Surgery
In December, I underwent reconstructive left knee surgery to reposition my kneecap centrally (with a TTT osteotomy), and to provide stabilizing forces to the medial and lateral aspects of my kneecap (MPFL and LPFL*). Due to EDS, cadaver grafts were used. I was inpatient for 6 days. The drain was removed the following day. Because this surgery increases the risk of compartment syndrome, a fasciotomy was performed. This involves cutting the fascia (tissue) to reduce pressure in the tissue (which can result in tissue death). Unfortunately, I still ended up with mild compartment issues and for the first 48 hours I had no feeling in my left foot (which was not expected). The fasciotomy also resulted in a large muscle hernia.
During my hospitalization, I received a visit from my beloved Bruins. Words cannot even begin to describe how excited I was and thankful for their visit. I have had surgery nearly every December for 10 years at Children's and I have missed the Boston Bruins visit by 2-3 days every year until this time.
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| A bright spot during a painful week in the hospital. |
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| Post-op |
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| Muscle hernia and hematoma |
It has been a very slow recovery. I had post-op x-rays at 4 and 8 weeks. My osteotomy site has healed well and I am allowed to fully weight bear through the left knee as long as my brace is locked in extension. I still have no active quad function, though this really is not unusual for me. My quad tends to shut down for an extended amount of time postoperatively. I will need to remain in the post-op knee brace until I have sufficient quad strength, otherwise my leg will give out on me and I will fall on my face (which I do anyway because of my right hip). It has also been a struggle to get my knee to bend; however, we continue to work on this in physical therapy.
Making recovery even more challenging is the fact that my right hip is severely unstable and that has led to quite a few falls. The falls have resulted in more damage to my right shoulder as it dislocates nearly every time.
CRPS Relapse
Leading up to the surgery I was dealing with a significant CRPS flare in my left foot. This was triggered by an avulsion fracture after I rolled my ankle for the millionth time. I was unable to tolerate a sock on my left foot, so went without a left shoe for awhile. It was decided just prior to being put under anesthesia for my knee surgery, that we would try ketamine as part of my anesthesia cocktail. Ketamine has been used for CRPS successfully in studies and I am thrilled that it worked for me as well! I have not had CRPS pain since December.
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| My foot would swell and turn red daily. |
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| Some days my foot would turn purple. |
I will post more about my right hip instability in another post. For now, I will continue to work in physical therapy on regaining strength and flexion in my left knee.
*We don't have an LPFL as part of our anatomy...
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