Two Knees Better, Two More to Go

Annie's knees are healing nicely since her surgery, so we've moved on to considering my painful knees again.  First, about Annie...

Annie had another follow-up with the orthopedist since her kneecap removal 2 months ago.  She's in dramatically less pain with those kneecaps gone, but has still been struggling to sleep through the night since she's not able to straight out her legs on her own anymore.  The orthopedist had us consult with our orthotist about getting some custom knee immobilizing braces made for Annie to wear at night, but the options shown to us looked much worse than the ones she's been currently using.  The doctor still anticipates another month before her recovery is complete, so we'll just wait to see how she does then.  Just in the past week, Annie has been sleeping a little better, and not requiring her leg braces at night, so I think things are headed in the right direction and she'll soon be completely recovered.

She does have some unusual bone growth that has occurred where the crater in her bone was in her left knee.  But it's purely cosmetic and not causing any issues, so we'll just let it be.

As for my knees, the pain has improved quite a bit since last fall, but I'm still fairly limited in certain activities.  I still can't kneel and any kind of squatting motion is pretty painful, but I'm getting better at stairs without using the rails as a crutch. After 8 months of physical therapy now, I can tell that the physical therapy is helping, but the problems have not been resolved.  So I went to a different orthopedist this week with the recommendation of a friend here in Omaha who just had knee surgery and loved her doctor--and he's a Mormon!

The news from him was the same as from my other doctor I saw last fall.  It's not looking good for my knees.  But at least I was able to find a doctor that I like much better and that I'd feel much more comfortable with doing surgery eventually down the road.

Here are just two of the x-rays they took of my knees:

These are my knees.  This x-ray was taken skimming the tips of my bent knees.  You can see here that I really don't have a groove for the kneecaps to track in, especially medially (on the inside).  This bone deformity is causing my kneecaps to slide all over the place and causes pain from the rubbing on the femur, outside of their proper track.

For comparison purposes, this is a picture of a normal knee (obviously not mine) with a proper groove for the kneecap to track in.

These are my knees again, standing up.  You can see, especially on my left knee (on the right in the image), how the kneecap is pulled in medially (to the inside) and not properly aligned, even when I'm standing.

So the problems with my knees are:

-lack of groove for the kneecaps to glide in
-kneecaps track in a sideways "V" shape rather than in a straight line
-loose tendons surrounding the kneecaps which also allows them to drift
-offset angle of the patellar tendon coming down from the kneecap causing an un-natural pull on the kneecap
-smaller space than usual (3mm instead of 5-7mm) between the femur and the tibia--officially diagnosing me with arthritis

The doctor was so surprised at how strangely my kneecaps were tracking as I'd bend my legs, that he actually asked to video tape me doing it.  He said he's never seen knees like this in someone as young and slim as me, and explained that it's simply a congenital malformation.

So, he agreed with my last doctor that the tibial tuberosity transfer surgery (a bone realignment) would be my best option.  I more thoroughly explained that procedure in a previous post here.  And here's a video animation of the procedure.  But basically, they would cut out a chunk of bone from my tibia where my patellar tendon connects to it, shift that bone over and screw it back in to the tibia, all in order to straighten out the offset angle of that tendon that is pulling on my kneecaps wrong.  Then they might also tighten up some more of the tendons surrounding my kneecaps.  Before I ever have the surgery, they would require a dynamic CT scan of my knees at various angles so see more clearly exactly how my knees track and where to tighten the tendons.

So there is a potential surgical fix, but it is so invasive and requires such a long recovery (8 weeks on crutches with no weight-bearing, and no heavy lifting for 6 months) that it just is not feasible for me to undergo that kind of a surgery (twice, since they only do one knee at a time) and still be able to take care of Annie at all.  And there's no guarantee that it would resolve my issues.

Justin asked if I could get a knee replacement, and the doctor said that surgery would have a much quicker recovery, but I'm way too young to have a knee replacement and they won't even consider that as an option.

So in the meantime, I'm continuing physical therapy religiously, and if/when the pain becomes absolutely unbearable, I can get steroid injections about twice a year for a few years.  After that, I don't know what, but they told me I'll need total knee replacements by the time I'm 50 or 60.  My poor kids... I already know Annie got my bad knees, but I sure hope I didn't pass my knees on to Molly and Lexie!