#mpflsurgery

👨‍⚕️ **Case Presentation : MPFL to do or not ? - Dr Sachin Tapasvi**

➡️ *Watch it on Instagram: Click Here* : https://www.instagram.com/reel/C-7uJZlsvQU/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==

🔆 *Catch the Full Video on YouTube: Watch Now* - https://www.youtube.com/watch?v=BXkJHlYlkfc

🚀 *Elevate Your Knowledge!*

How have three weeks passed already?

Things continue to progress with physical therapy. We are focusing mainly on muscle strength and balancing now so lots of single leg presses, straight leg raises with weights, clam shells, balance boards, etc. I am on the stationary bike every day now to not only warm up my knee and its ROM but to build strength. I come home from my PT sessions and my knee and muscles ache but in a good way, like I know we are making progress and getting the muscles back into shape.

For the yogis, I have added supta padangusthasana and downward dog to my stretches for every PT sessions, working on the hamstrings and calves. Feels good to be getting back into some yoga poses! I have to uses props in baddha konasana because we haven’t really worked on hip opening stretches in PT so I am tight in my hips now. Plus baddha konasana can be tough on knees after surgery so it’s one to go slow with and ease into gently. But I can do happy baby now and it feels great to stretch those hips out!

As for my ROM, I no longer am on the ERMI since I maxed out on that a few weeks ago but I am working furiously on the heel-to-butt stretch, where you are on your stomach and use a strap around your foot to draw it towards your butt. Every day I see progress and I can even grab my foot with my hand but it comes with work and it still isn’t comfortable. I know it might still take time to get back to my original 150 degrees where it comes with no effort.

When it comes to getting around, I feel much more comfortable walking now. It might not be perfect sometimes (read: when I wake up in the morning and my knee is stiff) but the moments where I light up with joy and think “Hey, I am walking normally!” are gradually becoming more frequent. And I am starting to tackle stairs more normally too. Going down, I still hold onto the rail quite firmly and it depends on how warmed up my knee is as to how smoothly I make it down, but going up feels pretty good now and sometimes I don’t even have to hold onto the rail. I doubt I will get the point of running up and down the stairs, as a measure to save my cartilage, but if I can go up and down normally, that will be awesome!

To continue that train of thought, as I mentioned in a post right after my surgery, I do have a cartilage defect that determines how hard I push my knee or what exercises we do, as the goal is to protect the remaining cartilage to avoid another surgery. Since cartilage surgeries generally don’t have a great success rate, orthopedic surgeons try to avoid them whenever possible. In my case, even though I have a defect, I don’t have pain from it so we are leaving the defect alone but restricting some of what I do to protect my knee. Treadmills and deep lunges with weights are nowhere in my future but once I have built my muscles up a bit more and am given the OK, I look forward to returning to yoga. Not only will it continue to build muscle strength, flexibility and balance but it is also a great form of exercise that is low impact. Other forms of exercise that I have the OK to do are cycling, walking, and swimming. Which I am fine with. My passion was and will always be yoga and if I can return to it, even if I have to eliminate some poses that compromise my knee cartilage, I will be happy. 

Will that be enough to keep my fit, some might ask. Well, recent research  —though preliminary—shows that yoga can not only keep you flexible, but it can also improve strength, aerobic capacity, and lung function. But having practiced yoga for 8 years, I had already seen that evidence personally. So I hope that at my 12 weeks visit, I can be cleared to start practicing yoga at home.

ROM: After my last entry, I was able to hit 130 and then had an incredible leap up to 138 degrees at the 6.5 week mark! So technically I have reached “full range of motion” based on the average person which is awesome but I still have to work on getting back to 150 in the next couple of months.

Life without crutches and a brace: I still feel vulnerable walking around without any accessories. Perhaps it is because my knee still doesn’t feel normal (i.e. stiff, still learning to overcome any bad habits I picked up in my first 6 weeks of recovery). But also perhaps, as I mentioned before, that am so conditioned to protect my knee and I just don’t have that trust yet.

So there have been ups and downs this past week but what else is new when it comes to rehab. Plus, we keep adding more exercises and haven’t taken much away so it feels like constant PT around the clock! My sessions at Dr N’s PT office are up to almost 3 hours now! 

ROM: A week ago I mentioned that I had that outdoor event that really set my knee back. Well, I worked really hard during the four days between the event and my next PT session and only managed to hit 125 degrees on the ERMI - exactly where I was the previous week.  This was hugely disappointing as every other time I had had some sort of progress. I guess the bright side is that I didn’t go back in degrees. With a fire lit, I pushed myself as hard as I could over the next few days and managed to get 128 at my next session. Both my therapist and I think I could have reached 130 but Dr N came to do rounds while I was on my last round on the ERMI and I got interrupted. 

That all said, 128 at just under 6 weeks is a great accomplishment and Dr N is so happy with my progress. In fact, he joked that he wanted to sign my knee! If he is happy, I’m happy.

Clamshells, Bridges and Straight Leg Raises, Oh my!: Up to using 5 pounds now on the SLRs but I actually don’t have to do them anymore. We have moved to clamshells and bridges. I decided to still do SLRs at home since I got muscles tone back pretty quickly after my dislocation by working up to 10 pound SLRs. Clamshells with a resistance band are new to the routine - if you aren’t familiar with them, they look like this: http://fitwirr.com/exercise/mini-band-clamshell/. 

And then came bridges. I was so excited to hear this! A yoga exercise! And one of my favorites! Until I tried to do one.... Oh. My. I still have a stiff ROM in the higher degree range which means I can’t bring my heels in towards my glutes like I used to. I have poor muscle quality from atrophy and weak abs which means I can’t lift up like I used to. Let’s be honest, getting a few inches up is a struggle. And the stretch on my quad tendon, the tendon that was cut up to make my new MPFL, is completely unpleasant. I asked if it was normal for my knee to feel like it was going to explode while in bridge. The answer was yes. Sigh... I have a whole new appreciation for my students who hate this pose and the stretch they get from it. 

Brace and Crutches: Gone. That’s right. Gone. Going forward, I have a compression sleeve to help with swelling but I don’t even wear at night. I don’t have to wear the ROM brace anymore unless I am going somewhere where I feel I need extra protection (aka a crowded area where I could get bumped more easily). And same for the crutch. I don’t need it but if I feel like I need it for longer distances or to give a visual clue to people to give me room if I am in a crowded setting, I can use it.

It’s funny how most of us post-op patients long for the day to be free and when it comes, part of you is freaked out because it is like losing your security blanket. My first few ventures out into the wild I kept thinking, “I really don’t know if I’m ready for this.” Not because my knee feels unstable but most likely because I am so conditioned to protect my knee that it feels like I am putting myself in a vulnerable position. It will just take time to get accustomed to this freedom and to trust my knee.

That being said, there is also a huge part of me that feels like this:

Swelling & Stiffness: Stiffness is a constant up and down, which is normal. It still is at its worst in the morning but I can actually wake up and walk to the bathroom (brace and crutch free) and am able to walk with a normal gait. It is stiff but I don’t look peg legged or like a drunk sailor so that’s improvement. Pushing through ROM still feels like punishment but only at the 90+ range. Swelling continues to go down but I still can’t see a clear definition of my kneecap yet so there is still a way to go.

I haven’t posted a picture of my knee in a while so here is what it looks like now (excuse the slight redness to the knee; I had just iced it). I am really happy with how the scars are looking.

A quick update:

ROM: I hit 125 degrees today on the ERMI. Not a huge jump from my last post but I figure they give us 4 weeks to go from 110 to 135 for a reason. Close but so far away! I also asked if I was expected to hit 135 at 8 weeks or if I was actually supposed to hit 150, which is my original full ROM. Luckily my goal is still 135 for 8 weeks and the remaining 15 degrees will come over time.

Straight Leg Raises: Up to using 3 pounds now while doing these bad boys. My muscles are screaming at me by the end but in a good way.

Crutches: Still on one crutch. Can’t wait to get rid of it!

I know all this PT I am doing both in-office and at home is paying off and I will continue to work hard at it and give it my all. But I am so over it. Yes, I know I have months left to go. But doing all these exercises day in and day out is tedious at times. What I wouldn’t give to be able to just bend my knee normally, sit cross legged on my couch and relax. Or sleep normally. Or do yoga instead of PT.