Lateral release with medial reefing<

[BrokenMaMa]

Oh Pumpkln! Thank You for that!! These posts are starting to help me out of my depression. It is starting to creep up on me at a rapid pace. I'd rather not add antidepressants into the mix if things!!

 

[Pumpkin]

Go back and read the thread about the post op blues in the recovery reading (post#2.)
Hope you start feeling better.
A guess is your family is upset because you are not taking care of them, now it is their turn to help take care of you.
Assistance from friends and family: how to let go and accept it

 

[BrokenMaMa]

Like all of us...I have my good days and bad.. sometimes bad takes over and I welcome the good! These pep talks help.
Looking into one of those floor pedal excerise machine....read those help with ROM.

 

[sistersinhim]

And those peddlers are so easy to adjust. You just move the whole thing where you want it. Closer for more bend. Further away for less bend.

I was told that for the lateral release, the tendon was cut about halfway through, making it less strong. The medial is supposed to take over more of the kneecap tracking. It didn't work for me for long because of kneecap deformities.

 

[Josephine]

I am pretty confused how lotion and cling wrap can help.... anybody???

Not everything has an answer and this is one of them. It either works for you or it doesn't. But it's always worth a try.

My Dr. did say I can apply lotion now

Lotion for what? If it's for the scar, forget it! Massage post THR

I have been applying icy hot all around the incisions.

"icy hot"??? What does that mean?

My question is: is the lateral release with medial reefing a pretty serious surgery?

It's not serious as in major but it is invasive.

In effect, what you've had done is the muscle and muscle sheath around the knee and adjacent to the patella, has been cut and repositioned in a tighter fashion to remove any slack that was allowing your patella to move badly.

This image explains it more clearly

At site 1, the vastus mediallis has been cut away from the knee and lifted out of the way to allow access to the fascia (the white stuff!) below so the repair can take place.

At site 2, the fascia or muscle sheath has been incised and the the inner edge stitched to the inside iof the capsule as stage one of securing the reefing.

At site 3, the top layer is then pulled over and stitched to the outer side of the capsule, thus making two areas of anchoring.

Finally, the VM is stitched back into place.

This gives you
a) a tight knee because of the reefing which makes most movement difficult and painful
b) a similarly tight and painful bend because of the stitching back of the VM muscle.



I hope this has helped but I'd also really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[BrokenMaMa]

Fingers crossed mine works. I wasn't told anything about any other issues besides the knee cap being off track....
I will absolutely not have any other surgery to my knee!!

 

[Josephine]

I was told that for the lateral release, the tendon was cut about halfway through, making it less strong.

This is true but it's not the important part of BrokenMaMa's problem. The reefing is that's giving her the grief.

 

[BrokenMaMa]

Josephine, thanks for the explanation... perfect for me to understand!! Just what I was looking for!!!
I'll gladly answer questions.
The lotion is just for the dry skin on my leg. I haven't put any on the incisions..just around them. Though all but one looks pretty well healed.
Icy hot is like a ben gay ointment with lidocaine in it. Again...no where on my incisions.
Again...thank you for your reply!!

 

[BrokenMaMa]

I believe you're right...the reefing is the danged culprit!!

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[sistersinhim]

I'm glad Josephine was able to explain your problem area.

 

[BrokenMaMa]

OK!! Here we go! Bear with me, i only have my phone to reply.

1. Pain is at 2-3 while resting. If trying to bend or the pulling takes place it's about 5-6.

2. Norco 10 mg every 4 hours.
Meloxicam 15 mg once in morning.

3. Swelling is moderate.
Hasn't changed since week 2. Always measures at 38 cm

4. Last PT visit on 6/6 ROM was 70 and extension 0

5. I ice 5-6 times daily for an hour. I use the ice machine all through the night.

6. I elevate for 2-3 hours at least 3 times a day.

7. Activities happen in morning. Make breafast and usually a load of laundry.
Dinner at evening. I make frequent trips to the bathroom and to the front porch to sit outside a while.
Have made 3 shopping trips for groceries.
And PT twice a week but haven't been since 6/7.

8. Home excerises:
-ankle excerises/ flexing ankle back and forth and side to side. 2-3 times/ 30 reps
-Standing heel raises same as above
-heel slides 2 times a day 4/5 reps
Pulling is bad with these

9. PT same as above.
On 6/6 & 6/7 they introduced new excerises with resistance bands. Standing and pulling leg out at different angles.
Also lifting leg on a step and pushing fwd.
Both 30 reps.
I haven't been back cuz it really set me back.

I hope this is what you were looking for. Just let me know if you need additional info.

 

[Josephine]

That looks good so far, thank you.

1. Pain is at 2-3 while resting. If trying to bend or the pulling takes place it's about 5-6

Oh yes, that's not good but then you are only 5 weeks out so not unexpected.

2. Norco 10 mg every 4 hours.
Meloxicam 15 mg once in morning.

I cannot conceive that the once a day Meloxicam is helping at all!
However, the Norco has 325mg of Tylenol in it which means you could add in up to one 500mg Tylenol with each dose. This will make your daily intake of Tylenol 3,300 (safe maximum per 24hrs is 4,000mg). I think you will find that little extra makes a difference and it's not a narcotic or prescription!

3. Swelling is moderate.

Sounds about right

4. Last PT visit on 6/6 ROM was 70 and extension 0

also sounds about right

5. I ice 5-6 times daily for an hour. I use the ice machine all through the night.

Jolly good. Of course, you could ice a lot more if it helps.

6. I elevate for 2-3 hours at least 3 times a day.

I'd elevate a lot more - like all the time you are sitting, resting or whatever, up with the leg!

7. Activities happen in morning. Make breakfast and usually a load of laundry. Dinner at evening. I make frequent trips to the bathroom and to the front porch to sit outside a while. Have made 3 shopping trips for groceries.

Do you live alone? Because I really wouldn't advise you going shopping yet. Absolutely designed to make your knee swell and hurt. Plus don't do laundry every day - I never do! And don't spend longer than 1015 minutes standing in the kitchen.

My comments in bold
8. Home exercises:
- ankle exercises/flexing ankle back and forth and side to side. 2-3 times/30 reps - these are only anti-clot exercises and since you are so mobile they are now unnecessary.
- standing heel raises 2-3 times a day/3- reps - this is not a good exercise as it stresses the muscles in a bad way
- heel slides 2 times a day 4/5 reps - heel slides are famously easy to do badly and this is a perfect example of doing them badly! Read this Heel slides and how to do them properly (which was actually in the articles Pumpkln left you in post #2!)
Pulling is bad with these - then don't pull. In the guidelines left you in post #2 it says "If it hurts, don't do it"

9. PT same as above.
On 6/6 & 6/7 they introduced new exercises with resistance bands.
standing and pulling leg out at different angles 30 reps - NO resistance bands, ever!
lifting leg on a step and pushing fwd 30 reps - this is a lunge and not a good idea to do so many times.
I haven't been back cuz it really set me back - I'm very pleased to hear it!

Can I ask you if you actually ever read the articles in post #2? Because it doesn't sound to me like you did. I've repeated one there that you were given before which are pertinent to this. Here is another BoneSmart philosophy for sensible post op therapy


I hope this all helps.

 

[BrokenMaMa]

This does help, Thank You.
I did read through most of the articles. The ones regarding excerises I hadn't gotten to before those PT visits I mentioned.
As far as the heel slides and pulling...once the pull starts I quit where I'm at. I don't keep at it and make it pull more.
I don't live alone and my children do help with what they can help with. My husband is out the door around 6 am and doesn't usually return home until 6-7 pm.
Also, all I have is my phone so I do need to watch data usage so I admit I have picked articles by title and what I think/ thought of importance. My WiFi is also used like data due to living in a very rural area. I am trying.

 

[Josephine]

Aw bless - I can't imagine what it must be like having to limit your internet access like that. I have mine on all day long. Never really appreciated that until I read your post.

 

[BrokenMaMa]

Yes ma'am...it is rough sometimes. Especially now that I'm sitting around so much.

 

[BrokenMaMa]

Good morning all!
I'm not sure if this is the proper place for this discussion so I apologize in advance if it isn't!

I'm wondering if anybody has used kinseo tape during recovery?
I've read it aids in swelling and helps with pain. I see my PT put it on other patients and am curious... thought I'd turn to the experts!

 

[susieo461]

My PT used it on the back of my knee and down my leg. I had swelling in the back of my knee and I couldn't bend it very far without severe cramp. At first it helped but after while it didn't make a difference. I was sure disappointed.


Sent from my iPad using BoneSmart Forum

 

[BrokenMaMa]

Hmmm..... maybe I'll see if I can get PT to try on me today. Worth a try I suppose.

 

[sistersinhim]

I'm spoiled, too. I have unlimited internet and am on almost all day. I use my phone's hotspot.