Annie's MRI Results

Annie had an MRI of her knee on Monday, so today I took her to the orthopedist to get the results.  Sure enough, she ruptured the tendon graft that was placed to prevent her knee cap from dislocating.  The tendon had actually broken to two places, but was still securely fastened to her bones.  So it wasn't the result of the doctor's ability to make the tendon secure, the tendon just wasn't strong enough to hold her knee cap in place, especially when she has seizures that make her muscles want to yank her knee cap out of joint.

So we're back to square one--exactly where we were 4 months ago before she had her first knee surgery.  The doctor doesn't suggest repeating this same procedure to tether her knee cap in place with a tendon graft because he expects that it would just fail again because of her strong seizures and her lack of a deep groove for her knee cap to sit in.  So we're considering a patellectomy to completely remove her knee cap. 

We were more excited about this procedure after our appointment with the orthopedist last week, but today we learned more about possible risks.  There's always the risk that the tendons that will stretch over the space where her knee cap was will rupture, making the recovery period very long with Annie's leg in a straight-leg brace 24 hours a day for 6-8 weeks.  There's also the concern that sitting with her foot out straight for that long again might further worsen her scoliosis. But we also learned today that when the knee cap is removed, pressure gets distributed differently in that joint which can affect the growth plates.  Often after a patellectomy, the patient's leg will start growing sideways at an angle below the knee.  Surgery is then required to alter or modify the opposite growth plate to compensate for the uneven growth.  It's not positive that this problem will even occur, but it's definitely a possibility.  And when it would happen is unknown too--it could occur within a year of surgery or it might not happen until Annie hits another big growth spurt closer to puberty. 

Before we met with Annie's orthopedist today, he contacted a different pediatric orthopedist who has the most experience in patellectomies.  After hearing about Annie, this other doctor suggested that she might benefit from a hamstring lengthening procedure to help reduce the amount of tension and strain on her knee without the patella.  Because the orthopedist we saw today has very little experience with patellectomies, he is referring us to this other doctor who would ultimately do the surgery together with our current doctor.  So hopefully we'll be seeing the new doctor soon and get some more answers and information so we can make some better informed decisions on how to best treat Annie. 

We know that we could always elect to do nothing, but we fear that these repeated dislocations will start to cause more pain like they did before her first surgery.  We also know from her last knee scope that these dislocations are causing damage to her femur that will become more painful.  We also aren't too excited about the idea of her needing to wear a knee brace the rest of her life--which doesn't even completely prevent the dislocations.  So we're really praying for inspiration on how to best treat Annie, keeping in mind that our goals for her are to be as happy and comfortable as possible and be able to enjoy her life to the fullest.  The big question... How do we do that when we can't see the future?  We obviously wouldn't have put her through the first knee surgery if we would have known it was going to fail, but we felt like that was the best thing to do at the time.  So please pray that we'll be able to know what will be best for Annie and help her to have the happiest life that she can.

It's amazing to me that in the short year that we've lived here, we've managed to now have 3 different orthopedists for Annie.  Our first is Dr. Scherl who has been helping to monitor Annie's scoliosis, dislocated hip, tight heel cords, and now her dislocated knee.  For such an involved knee surgery, Dr. Scherl then referred us to our second orthopedist Dr. Dietrich (considered to be a sports medicine doctor) who reconstructed her knee last December and who we met with today.  Dr. Dietrich is now referring us to our third orthopedist Dr. Esposito (who is also in Dr. Scherl's practice), who is known to be the best pediatric orthopedist in Omaha.

Now that we've been here a year, we counted to see how many doctor appointments Annie has had since we moved.  In just the past year Annie has had 66 doctor appointments, an average of one every 5 days.  How come it seems like we've had a lot more than that?

We appreciate all our friends and family who show such a genuine concern for Annie. Please continue to keep her in your thoughts and prayers as we make decisions in her behalf.