Post-OP Day 17: Follow Up Appt.

Yesterday morning, I had my first follow-up since surgery. It went fairly well. My OS had set a goal for my knee to be able to bend 90º. Despite me keeping up with my exercises, I was not able to reach this goal. My knee was only able to bend 52º. They also ran another set of X-rays to check out how things were healing. It looked good!

I wish I had a picture of the X-rays to show. He showed me comparison images of my patella and the overall bend of the knee. The operation successfully aligned my patella into its groove (before, it had rested over the outer edge of the groove). The second image showed the rest of my knee and the bolts in my tibial tubercle. My shin looks bizarre due to the distal lateral release - the segment of my shin holding the bolts doesn't even look connected to the rest of my shin.

Since I was not able to meet my flexion goal, the doctor decided I would need out-patient physical therapy. I was fully expecting that either way. So, just a few hours after my appointment with the doctor, I started my first round of physical therapy. When the PTA tested my flexion, I was able to bend my knee a whopping two degrees more than at my earlier appointment!

The PTA did some heat therapy while I practiced tightening my quadriceps for probably ten or fifteen minutes. After that, she placed a rolled up washcloth under my knee and had me work on sliding exercises. I also worked on flexing my calf muscle at therapy and keeping my foot upright. It was a relatively easy therapy session but my knee killed after that!

Future Prospects:
- Go to PT 3x/week for the next few weeks
- In 2 weeks, I can start walking with crutches or a walker
- In 3 weeks, I will have my next appointment with the doctor

Attached are new pictures with the surgical tape taken off of my knee. Top knee view shows the whole shebang. Side knee view shows the incision from the scope. 

Post-OP Days Two through Twelve

Wow, the past ten days have gone by fast! Sorry for not keeping you all up-to-date regularly.

The next three days after surgery seemed to blur together. I couldn’t get a full night of sleep. Monday night (1/14/2013) in the hospital, my sleep pattern cycled from 30 minutes to an hour or two of sleep, waking up, needing to use the bathroom, staying up for a while, then drifting back into nap mode for another short while. I tried so hard to keep up with my post-operation diary each day, but during this period, I would start to drift a sentence or two into my next entry update. My apologies!

My pain remained constant during these few days, some points worse than others. More notably, my foot swelled up more and more each day. It practically became a balloon! I could not see my ankle. By Day 4 (January 17^th), the swelling was painful and prohibited me from doing the few exercises I had been able to do.

Fortunately, the 18th was a different story. The swelling in my foot had gone down enough to move it again. Even better, I was able to take off my dressings, check out my knee, and shower! Boy, did it feel good to freshen up a little bit! My knee did not look nearly as bad as I had expected. There was no drainage, the incision was nice and clean-cut (it is 10 inches long), and there wasn’t nearly as much bruising as I thought there would be.

My ankle, however, is (still) a different story. Presently, the swelling is still prominent in my foot/ankle and the bruising is really busting out down there. I am also struggling with the few exercises I am allowed to do because of this issue. Has anyone else who has undergone an AMZ/TTT/Fulkerson osteotomy had this problem?  

I am hoping the next few days will get better in terms of swelling and mobility. The pain knee pain had a noticeable decrease during the second week following surgery. The first week, though … yikes, did it hurt! There were numerous points where it would be about time to take my next round of pain meds and the pain would be so tremendous, it sounded like I was going through childbirth. I’m not a mother, but holy cow, the pain felt truly awful during week one! I’m just glad that is getting under control now.

Tuesday, January 29^th will be my first post-op follow-up appointment with my OS. At the rate I am going, I doubt I will be able to bend my knee a full 90 degrees by then. As of now, it looks to be at 45 degrees when I bend it. 

Photos Following the Fulkerson Osteotomy

Here are a few pictures following the operation. 

The photo above shows the images from the athroscope before the OS cut open the rest of my knee. During this part of the operation, my surgeon shaved/smoothed damaged cartilage from the back of my patella; removed a free-floating piece of cartilage in the joint; and mended the tear in my hyaline cartilage. Thankfully, my ACL looked good, considering I strained that back in 2008. 

The three photos above are from January 18th, after I got to unwrap my knee for the first time four days after the anteromedialization/TTT. 

And last, here is my new cyborg leg! Hehe. I'll be wearing this brace for awhile. On Tuesday morning (January 29th), I will have my first follow-up appointment. 

Day One Post-OP

I had my surgery Monday, January 14th in the early afternoon. My OS said the operation was successful in fixing the problems going on in my left knee. Overall, it took an hour and a half. My surgeon first did a scope to double-check for any unseen damage, removed a loose piece of cartilage, and shaved the damaged cartilage under my patella. He then went ahead with the full anteromedialization of the tibial tubercle (Fulkerson Osteotomy).

Upon waking from surgery, I did not feel as bad as I expected to. Granted, that was due to the nerve block plus the anesthesia given to me. Despite the amount of pain medicine in my system, my leg still hurt a good deal. My ankle was (and still is) incredibly swollen and sore, in addition to the knee. Is this common with osteotomy?

Throughout the rest of the day after waking from surgery, I continued to doze off and on. My parents were there with me until visiting hours ended. It was nice to have their company for a while. As midnight approached, I could feel the nerve block wearing off. My pain got progressively worse in a short amount of time. I could not sleep for longer than 45 minutes to an hour at a time my first night post-op. I cycled from short naps to being awake for an hour or so at a time, then I would drift again for a short while. Three or four times throughout the night, I had to call the nurse for a bed pan. This is the first time I’ve ever used a bed pan in my life. I cracked a couple jokes with the nurses about it to relieve how awkward I felt about having a nurse wipe my bottom.  Thankfully, my nurses were easygoing and we shared a couple of laughs.

Ready & Waiting

The OS got my knee marked up and explained the procedure to me one more time before I go in at 1:30. Ready to get this thing done!

Pre-Operation Musings

In approximately 10 hours, I will endure my first knee surgery. The past two weeks have been long and trying with the latest knee injury, doctor's appointments, X-rays, MRI's, and ortho consultations. I have spent hours researching various treatment options, from physical therapy (PT) to athroscopies to various open knee procedures, in an effort to mentally prepare myself. I will undergo an anteriomedialization of the tibial tubercle (or, the Fulkerson knee osteotomy). The road to recovery will be challenging and difficult, but I have high hopes. 

Over the past nine years, I have sustained a number of injuries to my left knee. Starting in 2004, at age 14, I buckled my knee during a game of dodgeball in P.E. for the first time. I felt my patella shift with a "snap, crackle, pop" sensation and I fell to the floor. The pain was so horrendous that I had to leave school early. It was then that I first began physical therapy. PT was a helpful, yet temporary fix. 

Following freshman year of high school, my left knee continued to slip, buckle, and cause varying degrees of pain on a fairly regular basis. I spent my second stint in PT fall of my junior year, just a few weeks short of the State Cross Country Meet in Iowa. My varsity running career as I knew it was over. This time, I buckled my knee dancing at the Homecoming dance in October 2005. Literally, within five minutes of my arrival, I sustained the injury. Much like the first time, my kneecap slipped inwards, shifted around a bit, popped, and settled back into its groove. I spent the next hour sitting on the linoleum floor outside of the gymnasium icing my knee off and on while I watched the rest of my friends and classmates arrive at the homecoming dance. 

My second round in PT seemed to work wonders for me. This time, however, I exhibited much more caution with my left knee. The reality of having a bum knee was setting in and I began to accept my misfortune. By this point, the subluxation of my patella was an ever-present worry. Tasks as simple as walking, dancing, and running had caused my knee to buckle. I had to atune my senses to the environment, the ground I moved upon, and  the particular motions of my knee in an effort to ensure patellar stability. 

During Fall 2007, I ran through a season of college cross country successfully (in terms of my knee, that is). I was quite proud to be injury-free for once. Confidence in my physical capabilities began to rise after that. Surely enough, I was caught by surprise in 2008 during sophomore year of college. I was a dancer in an improv group and we were practicing late one night. Literally, on our last run-through of the evening, my knee went out during a spin. This time, I couldn't bear any weight on my knee after the injury, nor bend it without agonizing pain. I returned to PT and discovered I had strained my ACL. I had to use crutches for a week and suffice with an immobilizer knee brace for a couple of weeks until my knee had regained strength. During physical therapy, my knee seemed to regain strength surprisingly quickly despite the rough fall. 

I made it a little over four years from my last stint in PT before my left knee buckled bad enough to necessitate medical attention again. Ergo, New Year's Eve 2012. Go figure, I was dancing again when I sustained my present injury. After seeing a number of medical professionals over the course of the past two weeks, it has come to light how messed up my left knee really is. Nine years after it first buckled, my knee now looks as such:  

• 1 cm tear of the inner hyaline cartilage
• free-floating piece of cartilage in the joint
• scarring from prior subluxation
• missing cartilage behind the patella
• outer lateralization of the patella
• shallow-angled knee groove

After a second set of X-rays this past week, my OS (orthopedic surgeon) obtained the view he needed most to determine the course of treatment. The images showed how shallow my left knee groove is compared to the right knee groove. This also showed the displacement of my patella over the outer edge of the groove. My OS said that the angle of the left knee groove is 12-15 degrees more shallow than the right knee. Due to this, I am naturally at a predisposition for patellar subluxation. That explains why I've had such a trick knee over the years. 

Knowing all this, I am (now) comfortable with undergoing the Fulkerson osteotomy. My hopes for recovery are high, even if I only go another five years before having a serious episode with my knee again. Here's to recovery, rehab, and renewal!