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.
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.