Life Waiting for MPFL Reconstruction
The period between my MPFL injury and reconstructive surgery.
Hurry Up and Wait
I could have scheduled my MPFL reconstruction in the office right that minute, but I ended up waiting about two months; the first month was to figure out the timing of some photoshoots I had booked and anticipated, coordinating the ~2 months of downtime I’d need with some of my regular clients, and the next month was due to work, travel, and generalized worry about committing to such a rough surgery and lengthy rehab. I visited my friend Alyssa in Rhode Island for her birthday, and when she dropped me at the airport to fly home I told her the next time I saw her I’d hopefully have a fixed and fully functioning brace-free knee again; I finally called to set a date. After a little phone-tag, October 4th was finally on the calendar.
By this time I’d long since recovered full function of my knee after my injury in May; it took me about a month to regain real stability on my knee after the initial dislocation and MPFL tear, and maybe a week or two after that to completely regain full range of motion in that leg. I was out of the knee brace, except I still wore it anytime I went out anywhere. The J-Brace I’d been given at the orthopedist slipped too much (I think it was too large, since they’d sized me when my knee was still swollen from the injury), so I’d ended up buying a Shock Doctor brace with adjustable straps which fit much better, didn’t slip, and seemed to support my knee with more stability.
There weren’t many differences I noticed once my knee was recovering from the injury, but it was different. Firstly, my quads and hamstrings had lost a lot of power since the injury; despite being right handed, my left has always been my stronger side, however with my leg this was no longer the case. I couldn’t push and stand my entire body weight up using just my left leg anymore — I could still do it with my right, but attempting it with my left just resulted in painful shaking, straining, and failure; it takes time to build muscle mass back up, but you lose it quick. As for pain, day-to-day I wasn’t in any; it felt like a normal knee, however now my kneecap felt loose, like a rock in a sock. Now and then I’d get pain on the outside of my knee down to my fibula; you could see and feel a tendon moving, and I determined this was my IT band acting up, which was totally new to me — until then I’d never even heard of an IT band, yet here it was clear as day bothering me here and there. While mowing the lawn, I encountered a sharp, stabbing, ice pick pain somewhere in my knee so that I couldn’t place it exactly; this pain would be intense, make me gasp, but would be gone immediately on the next step. This was very worrying, and I thought it meant I may have a torn meniscus or floating cartilage in my knee despite neither issue showing on my MRI. I only had it happen a total less than 10 times (including other times just walking), and I realized it’s possible this was my kneecap subluxing, however it’s still not clear even to time of writing what this was. Over the months between my injury and my surgery I also variably encountered tendonitis, which was pretty easy to figure out since it was the tendon the hurt, and only bothered me on stairs, or after sitting in the same position for long periods.
The best way to describe how my knee felt with a torn MPFL is “vulnerable.” Everything felt risky, even walking on flat surfaces. It’s hard to describe the feeling exactly, but the feeling is a deep, instinctual distrust of your own body and abilities. It prevents you from doing some things the way you did before; your body reflexively forces you to defend your injured knee, even though it’s back to “full function.”
Making Friends
By some kind of irony, the week after my initial injury, a friend of mine from highschool underwent MPFL reconstruction surgery — since I’d been given the diagnosis of needing MPFL reconstruction, of course I asked her about her experience several times. When we spoke on the phone about 5 weeks after her surgery, she walked me through her experience with the surgery step by step, and told me about the pain to expect and how it is managed. For her, the pain wasn’t too bad, and was very manageable with Percocet; this was comforting to hear, given that it was in direct contrast with all the stories about pain I’d read online, and my concerns about how well the Percocet would work since it had no effect on my initial injury. After all, reconstructing the MPFL involves drilling holes into the patella and femur to anchor harvested tendon. She told me about her physical therapy, and how she was progressing faster than expected, though you do hit plateaus — it’s just something to be aware of and keep from getting discouraged. Her account was very calming to me because of the effectiveness of pain management; pain was my main concern going into the surgery.
About two weeks before my surgery I rounded a corner in the grocery store and came face-to-face with a guy roughly my age sporting a Breg T Scope Premiere leg brace bearing the OrthoVirginia logo, so naturally I pointed at it and said, “what did they do to you?!” He smiled and said, “MPFL reconstruction surgery!” to which I said, “Great; tell me everything about it — I’m having that done in a few weeks!” We stood in the aisle talking for about 20 minutes. The gist of what he told me was that, like my highschool friend, he’d experienced increasingly worse dislocations and subluxations gradually over time, and those gradually led to him needing an MPFL reconstruction, unlike my singular traumatic injury which immediatley ruptured the ligament. He assured me that I’d be crutch-free and able to get back to my photoshoots within the 6 week goal I had in mind; probably sooner given my youth and attitude toward recovery. We didn’t have the same orthopedist, but we were going to the same OrthoVirginia office. He told me that for him the surgery was very painful, but not until the next day, because of a femoral nerve block which wore off after 24hrs; after that, though, the Percocet was ineffective (that was my fear; just like my injury in May), but he said fear not, because you’re provided with a 24/7 post-op phone number, and they got him an extended release morphine prescription by the next morning which took care of his pain until it went down after a week or two. The disclaimer, however, is that he underwent a bit more work than I was scheduled for; he was given metal plates to supplement the trochlear groove (I don’t know the exact name of this proceedure and didn’t ask, since I wasn’t scheduled for it) in addition an MPFL allograft (I was scheduled for autograft — as the doctor explained, autograft of the gracilis tendon regenerates, and is a somewhat more reliable graft than cadaver or sythetic grafts). This additional work could explain the additional pain levels. He kindly offered to help any other questions I had if I thought of some later, and we exchanged email addresses before going our separate ways.
Long before I was even born, my dad suffered an ACL, PCL, and MCL rupture in a knee injury in the Army. He’s had knee problems as long as I can remember because of it, so of course I asked him about his experience getting them fixed. Multi-ligament orthopedic repair was just becoming possible at the time of his injury, and wasn’t very common yet, so his experience came with the large asterisk of taking place over 30 years ago, in a military hospital, and before the advent of arthroscopic surgery. Because of this, his repair was open-knee, and only the PCL and MCL were replaced, using synthetic grafts (wire). His ACL was never reconstructed, and as a result he’s had knee instability which after all these years has led to arthritis, meaning he now needs a knee replacement. This all doesn’t surprise me; it’s a very different situation, which is handled much better today than 30+ year old Army medicine. All this said, with the invasiveness of the surgery, and no nerve blocks, he told me the surgery really wasn’t that painful; he said he woke up, was given the pain meds as needed, and while it was sore, it wasn’t excruciating, like so many of the stories I’d read or been told. He assured me that his traumatic knee injury which tore the ACL was the most painful thing he’s felt, and it knocked him to the ground almost unconscious from the traumatic pain, so my experience would likely mirror his; after all, tearing the MPFL was the most painful experience I’d ever had, and it squarely pinned me to the ground. My Dad has always had a high pain tolerance, so the key was also trying to decypher how ours relate. In general life experiences I’ve noticed I have a higher pain tolerance than others, but that doesn’t necessarily mean I have a “high” pain tolerance — it just means everyone’s tolerance is different.
