Knee realignment surgery

Ouuuch! You have all of my sympathy. I haven't had any surgery on my knees but man am I glad I persuaded the specialist otherwise. I was stuck in a closed reduction cast for two month's last year to reallign my left knee after a dislocation and even after that, the recovery time was 6 months before the chondromalatial pain went back to normal and my knee felt stable again.

I can't imagine what the recovery is like for surgery.

What is the problem with your knees?

I have bilatteral patella alta from Osgood-Schlatters when I was a child. So far, even though I have dislocated my knee's easily 10-12 times during my life, I have been able to persuade doctors not to opperate as I have heard things about people having had surgery and never being the same and having to go back again and again and again...

Let me know how things turn out and feel free to send me a pm if you want to talk...I know how painfull it is and I know how much support one needs when going through something like this.

Hi Nina,

You need to ask your OS what procedure he/she intends to do. You don't say what your symptoms are. Is your patella grinding, subluxing, or dislocating? Or, is there an issue with the Q angle?

There are a number of realignment procedures currently being performed, and many with good results.

Proximal realignment procedures include -
lateral release, medial reefing, medial plication, Galleazzi procedure (hamstrings tenodesis). The most common of these proximal realignment procedures is the 'lateral release' (also called 'lateral retinacular release'). Lateral release, done for the right indications, and done in the correct way, may offer patients a significant improvement in their symptoms. But done the wrong way or, more importantly, for the wrong reasons - and the procedure can be the beginning of a nightmare scenario for the patient, the physiotherapist and the surgeon.

If proximal realignment procedures such as lateral release and medial reefing fail to correct the alignment of the patella, the surgeon may progress to a distal realignment procedure. A word of warning here - distal realignment is a specialist area. Be sure that your surgeon is experienced in this field.

There are a number of different procedures - some involve moving the tibial tubercle (the bony lump on the shinbone (tibia) a couple of inches below the kneecap - the bony point at which the kneecap tendon (patellar tendon) joins onto the tibia) and some involve pulling the kneecap itself by changing the forces through the patellar tendon.

The different procedures generally carry the names of the surgeons who first described and promoted them:
Maquet procedure, Elmslie-Trillat procedure, Fulkerson procedure, Hauser procedure, Roux-Goldthwait procedure, many variants and modifications (mostly involving 'tibial tuberosity transfer').

Derotation osteotomy
This procedure is rarely performed, and only in those rare cases where the tibial tubercle is in a bad position and the patient dislocates or subluxes because of the tibia bone (or even the femur) being rotated (see 'malignant malalignment').

In this procedure the bone is cut through and rotated, and fixed into a new position, in order to properly realign the tibial tubercle.

Please keep in mind, each situation is unique, and a well-qualified patellofemoral specialist should be able to explain how/why a procedure will benefit you.

Please be certain to ask your OS about your concerns, and be sure you feel confident about his/her surgical decisions before A second and third opinion is nearly always in order.

Wishing you the best.

L1zz1e

Sorry to butt into your post nina0706 but seeing as we are allready on topic.

L1zz1e, seeing as you seem to know quite a bit about these kind of procedures, would you mind answering a question?

What are the options in relation to patella-alta?

Is maintaining my muscles, by regular visits to the biokineticist, sufficient or should I at some stage consider surgery? If so, when would be the best time to do so?

I allready have some degree of chondromalatial-osteoarthritis...espetiall y in my left knee. Picking up heavy objects...and sometimes even lightish abnormally sized objects...is an absolute no no but at least climbing stairs is much less painfull now that my leg muscles is coping with my ligaments job. I have also been informed to avoid cycling like the plague.

Would surgery make my situation bettor or worste and best kept for when mobility in my knee fails due to osteoarthritis?