Just What I Kneeded

What happens after a life-altering knee injury?

Summary

I thought, now that I’ve gone off on random tangents about random life happenings, I’d gather the most pertinent information about my knee surgery here to make it easier to find specific information.

In March 2010, I fractured my right lateral tibial plateau. It was like I’d broken off a wedge-shaped piece at the top of my tibia. It was non-displaced and healed uneventfully. I had persistent pain, especially when bearing weight on a bent knee (like when I’d go up or down stairs), so I revisited the knee problem with a new orthopedic surgeon (OS) in March 2011. I was diagnosed with Hoffa’s fat pad impingement. The fat pad sits inferiorly to the patella, and my OS figures it was pinched when I had my initial injury and was scarred. You can read more about the backstory here and here.

After the initial surgery, injections and continuous physical therapy over the course of nearly a year failed. My OS recommended doing a reconstructive knee surgery that required slicing my knee open from just above the patella to below my tibial tubercle. In September 2012, he resurfaced the back of my patella with DeNovo NT tissue graft and performed a tibial tubercle osteotomy (where he cut the bone and realigned it so that my patella would track correctly). Recovery has been a roller coaster, and patience is an absolute must.

Recovery room after TTT and DeNovo NT.

This was my view when I woke up from surgery.

To date, I am more than 18 months out from the DeNovo NT cartilage graft and TTT. I regained full range of motion within the first 10-12 weeks, and I typically don’t have much swelling. I have no limp when I walk. I’ve done countless straight leg raises and other PT exercises designed to help me regain my range of motion and strength in my leg. The hardest part has been getting my vastus medialis oblique (VMO) to fire correctly.

I’m still experiencing pain on the lateral side of my knee and through the middle of the joint. It comes on when I’m bearing weight on a bent knee. OS and PT originally chalked it up to soft tissue inflammation, but the topical compound medication (part anti-inflammatory, part pain medicine, and part muscle relaxer) didn’t work. So I went back to my pain doctor to see if he could help me find a solution to take away enough of the pain to allow me to work through my physical therapy exercises. The only solution was to take narcotic pain medicine, and I cycled through six different drugs before finding one that I could stomach (with a side of Zofran) and would take the edge off the pain.

I stopped formal physical therapy in March 2013 (six months post-op) because the pain was unmanageable. I sought a second opinion at the recommendation of my surgeon and was told that I need another extensive surgery. I wasn’t excited to hear that, so I instead received another round of Euflexxa injections and started another round of PT in July that I finished in early December 2013. Thanks to my PT’s ability to think outside the box, I was able to strengthen my leg and get the VMO started in the right direction. But the pain, unfortunately, will not go away. I’m no longer taking any narcotic pain medication, so that’s at least a step in the right direction.

In January 2014, I had my third surgery on the knee–a scope to clean up scar tissue and deride some cartilage, as well as hardware removal. This surgery was successful in that I’m now able to sleep through the night (I’d been waking up with an aching pain a couple times a night), my VMO finally has some sort of definition, and the spot where the screws were is much less tender. I’m still trying to figure out how to manage the pain I experience when bearing weight on a bent knee or during a number of different daily activities and exercise. So it’s still a work in progress!

Tibial Tubercle Transfer (aka Tibial Tubercle Osteotomy)

I get quite a bit of search traffic from folks looking for information about the tibial tubercle osteotomy (sometimes known as the Fulkerson osteotomy or the Elmslie-Trillat osteotomy), so I thought it might be good to separate some of the info about the TTT. I explained the Elmslie-Trillat TTT in an early, pre-surgery post. This type of tibial osteotomy moves the tibial tubercle medially; it does not tip it out in an anterior direction as the Fulkerson osteotomy does.

This part of my surgery, the tibial tubercle transfer, went off without a hitch. It is not what’s causing my current issues. After surgery, I was placed in a ROM brace that was locked in full extension. I was allowed to bear weight as tolerated, and I managed to ditch the crutches completely in 15 days. I was down to one crutch at nine days or so and then off completely less than a week later. I would still take one with me in public for another week, just to be safe, but I didn’t use the crutches at home or when going to PT after 15 days. This was fairly fast. I’ve heard most people take a bit longer to ditch the crutches, and some surgeons don’t allow weight-bearing at all or restrict patients to toe touch weight-bearing. I appreciated my surgeon’s approach, and I healed uneventfully.

The worst part of the TTT was the “blood rushes.” I don’t know how else to describe the feeling. This started about two to three days after surgery and would happen every time that I moved my leg from an elevated position to the floor to stand up. They were so bad at times that I’d just have to stand up and not move. Just breathe through the pain. The feeling is like everything in your leg just rushes down to the foot, and it hurts like a beast when moving through the knee. These lasted until about 10 or 11 days post-op. They were the worst for the first few days and then gradually got better.

I had the screws from the tibial tubercle transfer removed because the area under my knee where they were located was very sensitive, and I couldn’t kneel at all. This sensitivity is not the pain that keeps me from doing anything. I had sclerotic bone grow around the inferior (the lowest) screw, so this is likely the problem. My surgeon indicated that these wouldn’t have to come out, if there were no issues, so some people live with the screws forever. I’m glad I had mine removed because the spot is much less tender, and I’ve actually started to work on kneeling. I do better on a thick, soft pad, but it’s coming along. I’m working on it so that I can get into some of the yoga positions I used to have to avoid or modify.

Advertisements

20 thoughts on “Summary

  1. I, too, had the De Novo Juvenile chondrocyte implantation and anteromedialization tibial tuberosity almost 3 weeks ago. It has been challenging. I wanted to see if anyone went through the same procedure and shed some light on recovery ahead.

    • Hi Theresa,

      Sorry to hear that you’ve joined the club. How is recovery going so far? I’m now more than a year out, and it’s still challenging some days. But I have more than just kneecap problems; I have other degenerative issues in my knee, so my experience is likely not typical. The best advice I can give, no matter how glib it might sound, is simply to keep your chin up. There are days that will be harder to do than others, but it’s important to maintain a positive outlook. Let me know if you have any specific questions, and I’ll answer them as best I can.

      Good luck in your recovery!

      Laura

      • Hi Laura! Glad you’re doing well. Your blog helps me out a lot since this also has been a long recovery for myself. I know Physical Therapy takes a lot out of you. I am always so wiped out, but I love the place I go to and my PT is fantastic. I am 6 months out right now. I’ve had my episodes of flare ups over these past few months. Right now, I am doing fairly well, however, I have this crepitus with every single exercise I do in PT. Did you experience that crunching and popping sensation? I was wondering if it would be possible to talk to you since it’s so hard to find someone who has had the same surgery as I have and going through the same thing.

        Let me know. Take care.

        Theresa

        • Sure! I’d be happy to connect. Why don’t you shoot me an email at blueboots08@gmail.com?

          Also, I definitely have some crepitus. Had a lot before surgery and still have some residual crunching and crackling even now, more than 18 months after the DeNovo NT surgery. My surgeon has said that it’s normal, to be expected and not something that I should worry about. I don’t typically have a lot of popping going on in my knee though, and I don’t have the crunching on all my exercises. I mostly have straight leg exercises, or some with a minimal ROM, so perhaps that’s why.

          There’s a lot of two steps forward one step back with this recovery, isn’t there? I am very glad to hear you’re in a good spot right now, and I hope that you continue to improve as you work through PT!

          Cheers,
          Laura

      • I just found this blog after searching for something random like fat numb 3rd and 4th toes after Tibial Plateau fracture. Then I saw life altering knee injury and kept looking for the type of injury you had. Great writing. I am bookmarking it! I had a Type V Bicondylar TPF in 2014 and life has not even come close to the same. I find that the only people who get it are the people at the Trauma Survivors Network and people who have had them. My doc told me that I really needed a total knee replacement but that the break was too jagged to do it and I’m thinking it’s about time now. Thanks for writing!

  2. Hi! Would you be up for talking with me about your Denovo experience? I had a patellar graft in Oct 2013. Not sure how to contact you via the blog. Hope this works. :)

    • Hi Elise! How’s your recovery going? Hope you’re doing well. Feel free to shoot me an email at blueboots08@gmail.com, if you want to connect privately. Otherwise, I try to respond to comments here.

      Cheers,
      Laura

      • Hi Laura!

        Thanks! Recovery is going slowly. I’m in the midst of a setback. Some activity-related pain and swelling for a couple of weeks. I’m resting it and hoping for the best. I shot you an email yesterday. Thanks so much for responding so quickly.

        Best,
        Elise

  3. I had the samething done September 2014 . I am also having lots of pain where my screws are. Sometimes I wish i never had it done. I still walk with a limp. I cant even sleep all night cause the pain wakes me up. If i stand or walk on my leg for very long it swells like a balloon. I keep hoping it will get better its been 4 months for me.

    • Hi Mary Jo,

      Sorry that you’ve joined the ranks. All I can say is hang in there! Four months was not a particularly good time for me after the DeNovo and TTT. It was pretty rough. Are you in PT now? I would not have been able to make any progress at all without a lot of help/guidance from my PT at the time.

      Do you know if the bones are healing? Will they take the screws out for you in the future?

      I wish I had more to offer than just encouragement. Best of luck with your recovery moving forward!

      Take care,
      Laura

  4. Thank you for taking time to write this. I am searching for patient views on the TTT. My orthopedic surgeon has suggested a TTT and a lateral release because I have 2 forms of malalignment in right knee- my knee cap is tilted and tracks laterally. I have decided to go through with surgery, but we are holding off until fall because of the work that I do is seasonal. This way I will have time to go through surgery and most of my physical therapy before the spring season begins for work. I have a question, was the trouble kneeling due to the TTT or more because of the other procedures? My work requires lots of kneeling and twisting, as does my life at home with 2 active children.

    • Hi Laura,

      Sorry to hear that you’ll be headed for knee surgery. I did have a lateral release with my TTT and DeNovo, so it sounds like a similar procedure.

      My problems kneeling were a direct result of the TTT, unfortunately. I had trouble with the screws that held my knee together after the surgery. I had the screws taken out about 16 months after the TTT, and my ability to kneel improved slightly after that. I can kneel now if I have some kind of padding under my knee. I do not kneel directly on the floor because that’s still painful. I can kneel enough to do yoga poses now, so I’m ok with it.

      I can squat all the way down though, so that’s been a decent compromise.

      I have no trouble using my knee in any normal way. Doesn’t really hurt to twist or pivot. That’s good news!

      Good luck with your surgery!

      Cheers,
      lk

  5. Hi everyone,

    Thank you for this wonderful blog, Laura!

    A little background about me: I was struck by a car on my left knee while walking 5 years ago (it was a little old granny, and also a hit-and-run….she was never found, and by now she is probably dead….or at least hopefully no longer driving)! I initially was diagnosed with internal derangement, a torn meniscus, sprained MCL/PCL, and severe bruising.

    5 knee arthroscopic surgeries later, I was told I have Grade 4 chondromalcia with deep fissures on the back of my patella. My new orthopedic surgeon has recommended the Denovo procedure to help with this. The decision to go ahead with surgery was pretty simple for me (I just want my life back)! However, insurance coverage has been a nightmare! My doctor wrote an appeal letter, and the insurance company will have to give a response in 3 days.

    I’m 33 years old and sick of feeling like I’m 93 years old! A year ago we moved from Wisconsin to Colorado to be able to do more outdoor activities, such as hiking, biking, fishing, etc. and I just want to be able to do these things! I also work as a pre-op/PACU nurse, and this darn knee makes my job difficult.

    Please keep your fingers crossed that my insurance company approves the Denovo surgery!

    Thanks!

    Ann

  6. Thank u all for your post, has gave me hope. I had the elmslie trillat in my left knee,I also need it in my right knee. I’m 4 months out, PT for 19 weeks now. I can’t walk for very long or my knee gives out and swells. If I sit too long or stand too long my leg swells. My swelling has only went down 2 cm n 4 mos. I have pain that wakes me up at night and foot cramping always. Some nerve pain and numbness still, if anyone has any advise it would b greatly appreciated. Very hard to stay positive and definitely not wanting to do my right knee! Plus it’s swelling and giving out cause it has had enough.

  7. I just had a TTT Thursday morning and am still in a significant amount of pain. I can’t imagine being crutchless in 15 days. Way to go! I also experience the blood rushes…no fun! So far Percocet isn’t really doing anything for the pain, and I got dizzy and fell crutching out of the bathroom. I’m looking forward to calling my surgeon tomorrow for something a bit stronger. Hope your recovery is still progressing!

  8. Hi, I hope each and everyone of you are doing well in your recovery’s.

    I had my operation ( Tibial Tubercle Transfer) on Monday 8th November 2016. It’s nearly been one whole week YAY. I’m at that stage where you said about the “blood rushes” Deary me, how I hate them. I’ve been trying to explain it for what it seems ‘forever’ but, never really knew what to say but ‘ouch’.

    This blog helped me out and put my mind at ease, that I’m not the only one who has / is suffering with it. I’m currently lying in bed with agonising pain taking my tablets wishing it was day 60, not day 6!

    Another day closer to recovery hay! x

  9. Let me start by saying that I truly never post comments on articles! I wanted to reach out though because I really enjoyed reading this and it helped me immensely.
    I have knock knees and, due to this, have dislocated my kneecap twice. This last time it never went back into place and remains on the far left of my knee where it has sat and scraped for the last year. I have had the benefit of having actually visited Dr. Fulkerson (as he is practicing here in CT) and he is truly amazing. He is so knowledgeable and understanding. I went to him recently because the grinding and crunching hasn’t stopped and my knee is getting worse. He recommended the TTT surgery.
    Since I have scheduled this I have read so many mixed reviews of it..people on crutches for months…people with an array of problems…not able to resume activity for almost a year…
    I know this surgery is right for me and essentially the ONLY option and I fully trust the doctor who recommended it but of course as with any time I’m facing being CUT OPEN I’m scared!!
    With a 9 month old at home – it’s painful enough to imagine being on crutches for 6-8 weeks NEVERMIND the rest of the horror stories!
    I read your story, however, and was filled with hope. Off crutches after 15 days? Weight baring to tolerance? FULL extentsion of the leg and ability to do yoga restored?? These are all of the things that I am desperate for…
    Even if my post-op instructions (or final results) vary slightly from yours (since everyone is different) I want to thank you anyway for sharing your success. It’s so daunting – the idea of being incapacitated, inactive, essentially useless – for what seems like SO long but after reading your story I feel like…I can do this. I can go through with this and, in the future, maybe even run with my daughter through the part or something (who knows!)
    Thanks
    :)

  10. Hi. I had a tibial tubercle osteotomy, MPFL reconstruction, lateral release, and meniscus repair. I wanted to know now the recovery is after getting your screws out. Was it worth getting your screws out and how long was your recovery? I was on crutches for 3 months after my osteotomy and it was a very long recovery. So, I wanted to know how it is, I’m only 20 years old and am in college. Hoping to hear from you soon!! Thank you so much!

    Shivali

    • Hi! My hardware removal was super easy. It was done with the second scope (about 18 mos after osteotomy), and I was up and walking the next day. Never used crutches that time. Three days after the surgery, both my PT and surgeon were audibly impressed (the surgeon saw me and said, “Wow!”).

      Hope you’re doing well in your recovery!

      lk

  11. Hi
    Had my right leg done(TTO) Jan 2013 took 8 months before I was up and about due to delayed bone healing.Still have pain and swelling every day .

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s