Here we go

So I guess for the next little bit, this may turn into a bit of an update blog. If this pans out, I don't think I'll be up for much communication for a bit, so I'll update here as I can. I guess for the record and people who don't know, here's the scoop:

I had the four left knee surgeries (to say nothing of the right) after patellofemoral pain started when I was fourteen. The last was eight years ago and provided moderate relief but since November my whole leg has gone rapidly downhill (fibular dislocation/subluxation, kneecap subluxation, and pain. Everywhere.). Saw the guru doc of treatment for these things up in Michigan this past week. I like him a lot as a physician, which is why I'm willing to go with the freakish, barbaric-sounding surgery he proposed (though for the record, it's not an exceedingly rare procedure and I'm his norm).

However, he can't do it until April of two thousand twelve. Yeah, next year. I guess that's what happens when you're the top of your specialty and pushing seventy years old and choose to do surgery once a week. Gack. So I'm going with who he (and many other people) recommend in Texas. I called Dr. Texas upon arrival back home on Wednesday, hoping he could get me in within six months. Instead they said they could probably get me into surgery in six days.

So basic anatomy. Both your femur (thigh bone) and tibia (shin bone) naturally have some rotation. This allows your hips, knees, and ankles to work in alignment as your leg naturally swings out and in during the course of walking. It's not unusual or even considered abnormal for babies to be born with their bones all twisted excessively- they need to be able to flex in utero. For the most part they outgrow it by age four, but some of us don't. If you're really all that interested, there's a more detailed description here.

We "twisted" folks have been diagnosed with any number of bucket diagnoses, which means to say they don't really know what's causing the patellofemoral pain. My favorite diagnosis (I kid you not) is "miserable malalignment." I think it's particularly descriptive. But there are at least fifty-six variables identified as contributing to patellofemoral pain. Rotational deformities are common causes, though most people have multiple things wrong. You can read about femoral torsion and tibial torsion here.

Me, I have excessive femoral anteversion and external tibial torsion. Several procedures done in the previous surgeries inadvertently made the knee structurally worse (and therefore now unstable and painful). At the time, mostly it was a case of the orthopedic surgeons not widely understanding the problem, how to assess it, and obviously then how to fix it. In order to fix my leg now, it requires undoing those previous alterations and then doing what should have been done in the first place. Said plainly, the seven hour surgery proposed by Dr. Michigan has four major parts:

1. Femoral derotational osteotomy

2. Tibial derotational osteotomy

3. Tibial Tubercle Transfer (TTT) to undo the first one

4. Reverse lateral release (requiring a graft)

Ugg. We'll see what Dr. Texas says. I'm assuming he'll come to the same conclusion (at least, over the phone he said that sounds about right), but I won't know for certain until Monday. I also won't know until Monday for certain if he can do the surgery on Wednesday. Something about making sure the necessary hardware and possible donor tendon grafts are available.

Why yes, I am freaked out. More to come I'm sure.