What is wrong with me?

[Disclaimer] I'm going to try blogging about my knee misadventures as a way of:

• Letting friends and family know what's going on with my surgery and recovery
• Venting about my pain and frustrations
• Keeping tabs on what is happening, so I can explain it to doctors in the future, should knee problems arise again after this ordeal is over.
• Trying to make sense of what is happening or about to happen.  It's all terribly confusing, and the best way to fully understand something is to teach, right? :)

This is what the MRI of a "normal" knee is supposed to look like, give or take.

This is my MRI.  I will attempt to cleanly enumerate all the things that are going on here. As always (for anyone whos ever seen a work presentation from me) things are color-coded :)

Broken bone Sometime during the past few years, most likely when I had a very traumatic disloaction in Vale, CO during a highly dangerous tubing run (yeah, I'm that awesome.), I actually broke the kneecap.  I was unfortunately misdiagnosed with a sprain. 

[Action Item] We're not going to do anything about this one.  It's a pretty small fragment, and seems to have healed on its own as a separate chunk of bone.  The caveat here is that if it's causing cartilage damage (difficult to tell from the MRI), we may have to do something.  Fingers crossed- it seems to have healed enough on its own to let it be.

MPFL (medial patelloformal ligament) See that long stringy thing in my MRI?  It don't work no more.  After years of repeated patellar dislocation, it's done with being a ligament.  Notice how it's holding the kneecap in place?  Yeah me neither.

[Action Item] My Orthopedic Surgeon (OS, from now on) is going to do a medial tightening, where he folds it over and makes it strong enough to actually exert some force on the kneecap.  There is a nontrivial possibility that the tissue will be too thin or scarred to do this, at which point he will build me a new ligament from kedaver tissue.  At this point, it becomes a MPFL reconstruction, rather than a tightening.

Kneecap Groove is ... MIA The blue arrow from the normal MRI is pointing to a thing called the patellofemoral groove.  I don't seem to have one (notice how my femur seems to be flat in that same area?).  This is likely a big part of the reason I have a chronic dislocation problem.

[Action Item] Unfortunately modern medicine doesn't seem to have caught up to this hereditary issue yet.  The best I can do is get the bones into alignment (and the ligaments fixed up), and go through a lot of physical therapy to strengthen the surrounding muscle groups to keep the kneecap in place.  This issue is the reason that my problem is difficult to solve :(

The lateral collateral ligament Seems like this ligament is the only part of my knee doing its job... unfortunately it's doing it a little too well.  While working with my physical therapist over the past 3 months to avoid getting surgery (had to try!) we discovered that i have and exceedingly tight IT band.  Even after doing months of massage and loosening techniques you can still see it pulling the kneecap to the outside of the joint.

[Action Item] The OS will perform what's called a lateral release, where he cuts a piece of this ligament away from the patella, in order to let it naturally sit in the place where my patellofemoral groove should be.  I will have a difficult few months ahead of me preventing that incision from scarring over, and undoing the procedure.  That's why the lateral-release by itself is not recommended for PF instability.

TT-TG between 15 and 20mm The MRI doesn't show this in one picture, and I don't have a copy of my X-Rays to draw one, unfortunately.  I tried doing the thing on my own, but the OS used my xrays and came up with a number of around 16mm.  I came out at about 19mm based on an internet howto.   I probably did it wrong, but so you can see how it's calculated, the gist of it is:

 The cyan line is the final number I calculated following instructions from other diagrams I saw on how to calculate this number, by using google.  The blue line is the deepest point on the pink circle connected to the deepest point on the femur.  The yellow line is the line that passes through the back of the knee, and the deepest point in the kneecap curve.  The green line is just the back axis of my knee.

[Action Item] More surgery :(  I'm probably going to have what's called a Fulkerson's procedure, also known as a Tibeal Tuburcule Osteotomy.  It basically gives them a way of breaking the bone and making it connect in a way that makes sense for my knees.  I'm still wrapping my head around it, but i found an infograph video in french that shows scary pictures D:  Watch at your own risk.  

Anyway, that's it for now.  I have a second opinion on the 9th, and surgery to follow shortly after that. Keep your fingers crossed for me, and if you want to correct me on any assessments I've made above, please do so (as long as you don't say anything scarier than I did ;) ).