I suppose I should start at the beginning with this knee stuff.
Some of you might remember I dislocated my knee in 2002, while working at a veterinary clinic. I tore my Medial Patellar-Femoral Ligament (the ligament that keeps your kneecap from being pulled out of alignment to the outside) and since that first trauma, it would go out (sublux) spontaneously from regular activity until I got it repaired in 2007. I waited so long because I was travelling and working with Leslie and didn't want to take time off from that, and riding, and training. In 2007 I was living in the US for a few years already and attending ASU and so could spare some months to recover. Dr Yaccobucci in AZ did an MPFL repair (used my own ligament, just tightened it and reattached it) and a Lateral Retinacular Release (severed the opposing ligament on the outside that was pulling the kneecap off center to the outside). He also cleaned up some torn cartilage. The recovery was unbelievably devastating. I had only 5 PT sessions and used them all for manual manipulation to break up surgical adhesions after being locked in an immobilizer for 4 weeks post op and the leg healing straight.
Now, you guys know I have a very high pain tolerance. I mean, I broke my back in three places and kept riding for a week before I even went in for radiographs. I didn't even take tylenol. I have had 3 back surgeries, multiple procedures...
And this knee recovery is THE WORST EXPERIENCE I have ever had in my life. I start to get anxious just remembering it. I promised myself no matter what, I would NEVER do it again.
Well, because The surgical site happened to be on the inside of the knee, exactly where our dressage saddles contact our kneecap, and my doctors never told me I had "Ligament Laxity" to a very high degree, I have ruined the repair over the past 8 years by continuing to ride.
The saddles, constantly pushing against the knee, have overstretched the ligament, and now, as there is no ligament on the outside (it was severed during the first surgery) my kneecap has no lateral structures to keep it stable. It is now a "floating patella".
Since the surgery in 2007, and after I recovered (took 14 months to get back 100% ROM and strength) it was completely perfect. Never swelled, never hurt, never felt unstable. EVER! it was wonderful! I was so pleased.
Last year, Around October, it subluxed and reduced on its own, was swollen and sore for 24 ours and then was fine. I didn't worry too much because I couldn't manually push my kneecap out of place like I could before the repair. Then, This summer, it went out again. I found this time, that the mobility of the kneecap was again to the point where I could dislocate my knee laterally (to the outside) 100%. My heart basically sank at that moment. I went to my GP and she got me a consult to my Ortho Dr, Scott Hughes, who I had already been seen for my right shoulder in the summer and was awaiting an MRI for pain and loss of motion (long history).
After I got the appointment scheduled, D'Jango ran into me, my left leg (the bad one) and knocked the knee out. The kneecap dislocated medially (to the inside) and I ended up so painful I had to use crutches for 3 weeks. It felt like it was freezing with bending motion, worze with load bearing, especially going downstairs. It never felt that painful, EVER, before the first surgery.
When I saw him, he and I decided I would pay for my own MRI ( I didn't want to wait) and we would tentatively schedule a MPFL Reconstruction because of my Ligament Laxity (obviously my lax ligaments were no good if they would stretch out again). and he could do the surgery. It was pretty devastating for me, I did not tell him my knee is what caused all my spine problems (my discs herniated 5 weeks post op in 2008) or that since I saw him for my shoulder I broke my back). I also didn't think to tell him the kneecap was dislocating medially. Why Would I? I didn't think it was a big deal.
So, here's a tidbit of juiciness, Scott is a wonderful guy, very good bedside manner, excellent references. (And hello, handsome!) but his receptionist, OMG. Since day one, she's been rude to me. Short, cranky, disinterested. I asked my GP to send me to Robert McCormack, head of UBC Orthopedics, and a world renowned knee surgeon. I was recommended my several high performance athletes (friends) to see him as a second opinion as he is the Team Canada surgeon. Well, Receptionist gets wind of this and phones me to tell me if I go see anyone else, she "will cancel all my appointments with Dr. Hughes". WHOA. apparently I have no right to get a second opinion about my career ending, major surgery?! wtf. so I cancelled my second opinion because it took me months to get into Dr Hughes already.
After my MRI, I saw Dr Hughes to go over it and book surgery.. (2 weeks ago) This time I showed him how my knee could dislocate from my fingers pushing it both ways, laterally and medially. He was shocked..basically said the MPFL repair would not work. And why would it? I never thought of that, Of course tightening the ligament on the inside would just pull the kneecap off the rails (aka trochlear groove)to the inside. Damnit. I didn't tell him about his receptionist's threats or attitude. Or my spine or anything. We just started thinking about possible procedures that could be done. There isn't a set "flow sheet" to this type of problem. There aren't enough of us medial dislocators to have the protocol set in stone. I suggested a Trochleoplasty (deepening the Trochlear Groove) and he said that the outcomes from that procedure are absolutely awful, they all cause pain, arthritis, and patients are worse off than before the procedure, comfort wise. He left to look at my radiographs, and was back 5 minutes later, saying it may be a good idea. What?! Also said I might be looking at a "Tibial Tuberal Ostoeotomy with Distal Transfer" which is a fancy way of saying cutting the part of my Femur that has the patellar tendon attached and reattaching it at a lower spot on my leg so that my patella sits lower and will advance into the trochlear groove sooner during flexion. My patella sits very high, higher than it should, so that's partially why it subluxes so easily.
So, because he isn't a Patellar Femoral specialist, and he said only 1% of patellar instability patients sublux medially, he needs to send me to another specialist. His friend, Laurie Hiemstra of Banff Sport Medicine.
So, He sent the referral, I had to go get a new set of special view radiographs for her, and am now waiting for a consultation appointment. In Banff. 5 hours away. In the winter.
Oh, here's a cute little video,
