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DoctorGZ
DoctorGZ, Board Certified MD
Category: Orthopedics
Satisfied Customers: 208
Experience:  Board Certified in Orthopedics
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I am a 30 yr old female, horse trainer. Originally suffered

Customer Question

I am a 30 yr old female, horse trainer. Originally suffered recurring patellar instability and my kneecap would luxate fewquently starting in 2005. I had a lateral release and mPFL plication in December 2007. I have very lax ligaments and I continued to train horses so now the repair has reverted and my knee is once again very unstable and subluxating again. I can manually dislocate it both medially and laterally. It is very painful and swollen every day, and I have to use a brace and KT tape. my OS says I need an MPFL reconstruction using an allograft. I can't find any reference to this being done twice on the same knee, ever. What is the recovery and my prognosis? Do I have to quit my sport? I am an international competitor. The saddle pushes directly against the repair spot against the medial edge of my kneecap. TIA
Submitted: 1 year ago.
Category: Orthopedics
Expert:  DrDon replied 1 year ago.

Jamie:

You really should see a high-level specialist in knee problems for a new analysis of your issue. Best would be one with a sports-medicine practice and a history of dealing with difficult problems in professional competitors. If you tell me the general area of the country where you live, I can see if there is a good choice or two you might go see.

Customer: replied 1 year ago.
I have, I referenced my orthopaedic surgeon in my original question here. I just paid for a private MRI this Monday and have a follow up appt with my OS (board certified sports medicine) next Monday. I am looking for answers to my specific questions. But thank you for your help so far :)
Expert:  DrDon replied 1 year ago.

Jamie:

There is very little in the way of documented answers in the medical literature, so I don't think I can provide much insight. However, to the "big" question "Do I have to quit my sport?" I don't think so. But what might give you the best chance for that outcome? For one, you might consider finding the very best physician for your specific problem.

Yes, you have a board-certified sports medicine doctor, and that is great. He (or she) may be excellent. But here is what I would do, if in your position. I'd find the very best doctor (in the world) for this problem, and I'd go see him/her. I'm talking about someone who does many of these, preferably in the 100's every year, and is not only deeply interested in the problem, but is highly technically skilled for your particular issue.

To give you an example, a former partner of mine and I love to ski. He lives in Colorado, and I live the NE US. When his knee started going bad, it soon became apparent he needed a knee replacement. Now what. Well we researched and found a surgeon with incredible results, and he went to see him and his staff. The team had an incredible program that promised (not kidding) he would be walking up steps in an hour-and-a-half after total knee replacement. I did not believe it. Well, he travelled the 1500 miles and had the surgery done there. And in an hour-and-a-half he was walking up steps! My mouth dropped open. That was in November, two years ago, and by the end of December, he was skiing...and skiing well, just like he did in his teen years.

Don't know if you got the "gist" of what I am saying to try to help, but your questions to anyone who is to operate on you should include 1) how many of these (including repeats) have you done? 2) how many do you do a year? 3) Can you give me some statistics on your results? 3) what can I truthfully expect as an outcome.

Hope this helps, Jamie. My intent was to help provide you with some direction Tthough I do not have more specific answers for you, someone does. Wanted to help as best I could, and can't spend more time, though I found a doctor to whom I would go, if I had your problem: NR Howells, Nuffield Orthopaedic Center, Oxford, England. Look him up. Problems of your specific type are his lifelong interest. Yes, I would call, write, then be prepared to get on a plane, and go.

Best wishes,

DrDonMD

Customer: replied 1 year ago.
Thank you, ***** ***** what I should be doing and the questions I should be asking. I was told by my surgeons receptionist that if I were to request a second opinion (I had already requested one with the Canadian Olympic team surgeon and my GP office had asked for my surgeons notes to be sent over) that they would not tolerate it and my appointments and surgery would be cancelled immediately. Apparently I have no right to get a second opinion. I believe this all comes from the receptionist and not my surgeon but either way it was very upsetting for me to get yelled at over the phone. My first mpfl repair and recovery caused 3-level recurring lumbar herniations resulting in two open discectomies and multiple procedures and steroid injections and now chronic pain which I deal with and ride with anyways, and I am afraid this second surgery will cause the same thing as I still have two herniations at the moment. So, it's a difficult thing, facing all this. The surgery and recovery alone is hard, I wish it were as simple as a knee repair or ACL repair. Mpfl reconstruction and lateral release is devastating to recover from.Thank you for your help :)
Expert:  DrDon replied 1 year ago.

Jamie: thank you for the additional information. It makes it harder when, in addition to your primary issue, you have to deal with the complexities of medical care systems, as well as complications. I do not know much about the Canadian system, in practical terms, only what is learned by second hand sources. Still I have to give you an "If I were you" type of suggestion, and some encouragement. Sometimes, in special circumstances, one has to do "battle" to get optimimum care. Your athleticism and your wish to remain in your sport on an international level, seems quite special. So, at minimum, I would call Dr. Howell in England, and see if you can get to speak with him. Perhaps he might have some suggestions for you. Not entirely impossible is that he might know someone in Canada who deals specifically with your problem. Then, you would have not only a goal practitioner, but a reference from which to engage the system. Best wishes, keep fighting for your career.. Dr.Don MD

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