Annie's Follow-Up with the Orthopedist

We got in to Annie's orthopedist. Her knee is very swollen from having so much trauma to it for so long, so Annie will need to wear an immobilizing knee brace to hold her leg straight for 3 weeks while her knee recovers. After that, she will need to wear a flexible knee brace that will provide pressure and support to her kneecap to prevent it from dislocating when she bends her knee.



They suspect the reason her kneecap is dislocating so frequently is because her quads and thigh muscles are so weak and atrophied from not standing or using her legs. Because those muscles are so weak, they are not working to hold her kneecap in place. It also doesn't help that she's on baclofen for muscle tightness for her tight ankle and arm. The baclofen has most likely loosened her already weakened thigh muscles.

So for treatment Annie will wear the flexible knee brace after her knee has healed. At that point we will start more specific physical therapy to help strengthen her thigh muscles, hoping that that will help hold her kneecap in place. We're skeptical about Annie's abilities to strenghten her legs because that's a choice she has to make to flex those muscles, but being in her stander will be good exercise. She hasn't been able to be in her stander for about 8 months now because of the muscle contracture in her right ankle. So after she has surgery on her ankle this fall, she'll need to be standing a lot to strengthen her thighs.

If physical therapy doesn't work to help hold the kneecap in place by strengthening her thighs, there are always surgical options, but our doctor uses those as a last resort. That kind of knee surgery is relatively rare, but definitely an option we might be facing. So for now, they will just be operating on her tight right ankle and releasing that heel cord.