# has anyone had this surgery?



## buldog (Oct 13, 2007)

Has anyone out there every ever had or heard of Tibial Tubercle Transfer (TTT) surgery?  It repositions the patellar tendon to keep the kneecap from subluxing or dislocating.  I could really use this but the procedure is pretty major and my track record with surgery is pretty poor.  There is a web site that has a lot of info on patellar injuries(more than any Orthopedic specialist I have consulted) but I would like to hear if anyone has had this done before.www.patellamd.com 
                                 Thanks, Scott


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## Ceicei (Oct 13, 2007)

Your link somehow mixes up with the martialtalk URL.

The correct homepage link is http://www.patellamd.com/1.html and the next one, http://www.patellamd.com/16.html, talks about different solutions.  (Warning:  There are graphic surgical pictures.)

My son has problems with his right knee.  We are exploring several possibilities on what may be done to help his knee better.  Thank you for bringing up this subject.

- Ceicei


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## Shuto (Oct 13, 2007)

FWIW I have had issues with subluxation of my patella that have been resolved by strengthening my quads.  I am not familiar with the procedure you describe.


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## buldog (Oct 13, 2007)

Ciecie, Thanks for the technical help, I'm kind of new at this computer stuff.  Good luck with your son, try to get a handle on it early it can get worse as time goes on.
 Shuto, I recently have been doing some leg extensions with light weight and it has helped somewhat.  The joint seems more stable but I still get frequent sublaxtions(today as a matter of fact).  The main problem is how to strengthen it sufficiently without doing more damage.  What exercises did you use?
                            Thanks, Scott


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## Shuto (Oct 14, 2007)

buldog said:


> What exercises did you use?
> Thanks, Scott


 
Ichimonji kamae which is kind of like a squat and hold.  Also, I use an eliptical trainer which has a variable incline.  I cycle through all of the angles which seems to work different parts of my quads (and other muscles).  

Have you talked with a physical therapist?  I'll bet that they have a lot of ideas about dealling with subluxation of the patella.  

Subluxation of the patella.  Why do doctors have to talk like that?  Why don't they just say dislocated knee cap so that almost everyone will understand what they are talking about?


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## buldog (Oct 14, 2007)

Shuto said:


> Ichimonji kamae which is kind of like a squat and hold. Also, I use an eliptical trainer which has a variable incline. I cycle through all of the angles which seems to work different parts of my quads (and other muscles).
> 
> Have you talked with a physical therapist? I'll bet that they have a lot of ideas about dealling with subluxation of the patella.
> 
> Subluxation of the patella. Why do doctors have to talk like that? Why don't they just say dislocated knee cap so that almost everyone will understand what they are talking about?


They talk like that so you are really impressed with their knowledge and intimidate you into not asking them any questions which reveal that they really don't know what they are doing.  After being screwed over a few times I have learned to ask the difficult questions and pin them down to a real answer.  That Ichi squat thing sounds real painful is it similar to horse stance?  Also tried elipticals once and it was kind of uncomfortable but didn't really give it a chance.  Thanks again for the input. 
                                          Scott


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## exile (Oct 14, 2007)

Buldog, I'm very sorry to hear about your knee troubles. I would caution about rushing into surgery (and I speak as one who has no quarrel at all with modern hi-tech medicine, the medical/biochemical model of most afflictions, or the virtues of precision corrective surgery); but it's also true that there's no guarantee that in any given case surgery is your best bet. I had a pretty savage weightlifting accident a couple of years ago, just before a long trip to my in-laws in Vancouver, so no time to see a doctor, and I was pretty much in agony for much of the two months we were away. When I got back to the US, I got myself X-rayed and MRI'd, and the news was bad: full-thickness tears in multiple places in the rotator cuff complex, a cracked shoulderblade..._but_, the fracture had healed on its own by that point, and the people at the sports medicine clinic were willing to try physio with me instead of shipping me off for the complex orthopædic surgery and muscle-stitching that, the doctors assured me, they would have done in a heartbeat if I'd been around that summer instead of off travelling. And, as one of them later admitted, there was no guarantee that the results would have been better than what I was able to do with physio: a full recovery, with just a small amount of residual pain when I extend my right arm in certain directions. So they themselves are willing to ackowledge that surgery is something of a crapshoot. 

One very good exercise for quads you can do which seems to help lots with the patella, using only free bodyweight, is this: assume a seated position with your back against a wall, so that the wall is like the back of a chair, except there's no chair under you. Now raise the `other' leg. Keep that position for as long as you can. Give yourself a couple of days rest, then do it again, trying to add 2 more seconds. And so on. Work your way up to the point where you can maintain that position for a couple of minutes.

Long before I started working out with free weights, heavy squats and leg press machines, I developed a painful, achey deterioration of the patella, a condition called chondromalachia, and, luckily for me, discovered this ski-conditioning exercise at the same time. I did it religiously, developed very powerful quads, got the patella locked into place, and it stopped bothering me permanently. You might give it a try. It seems to do great things for excessively mobile kneecap bones...


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## Jai (Oct 14, 2007)

I had serious knee issues years back that ended Martial Arts for me for years. I was told the only option was surgery, however as was mentioned above I did quad strength training and the problem has since corrected itself. For some like me it works great, for others sometimes surgery is the only options. I would suggest a workout program before you move into the surgery aspect of correcting your problems, more so if you have a shady track record as you mentioned.


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## buldog (Oct 15, 2007)

Shuto said:


> Ichimonji kamae which is kind of like a squat and hold. Also, I use an eliptical trainer which has a variable incline. I cycle through all of the angles which seems to work different parts of my quads (and other muscles).
> 
> Have you talked with a physical therapist? I'll bet that they have a lot of ideas about dealling with subluxation of the patella.
> 
> Subluxation of the patella. Why do doctors have to talk like that? Why don't they just say dislocated knee cap so that almost everyone will understand what they are talking about?


 


Jai said:


> I had serious knee issues years back that ended Martial Arts for me for years. I was told the only option was surgery, however as was mentioned above I did quad strength training and the problem has since corrected itself. For some like me it works great, for others sometimes surgery is the only options. I would suggest a workout program before you move into the surgery aspect of correcting your problems, more so if you have a shady track record as you mentioned.


Still not used to these computers.  Exile and Jai good advice I think I will put off any thoughts about surgery for at least another year.  Exile, I used to do that wall exercise many years ago but never on one leg.  I also have hurt myself pretty bad in the gym (Knee  in 1980 squats,rebroke my collarbone during incline press 1992) as a result I have stayed away until recently.  Trying to go real slow and stay away from heavy weights but the old powerlifter in me wants to rear its ugly head sometimes.  Tried a bench press with 100 lbs and that was a very bad idea, heck even pushups hurt too much.  But I am determined to get back in shape again no matter how long it takes.
                                    Thanks, Scott


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## exile (Oct 15, 2007)

buldog said:


> Still not used to these computers.  Exile and Jai good advice I think I will put off any thoughts about surgery for at least another year.  Exile, I used to do that wall exercise many years ago but never on one leg. I also have hurt myself pretty bad in the gym (Knee  in 1980 squats,rebroke my collarbone during incline press 1992) as a result I have stayed away until recently.



The one leg wall sit does work really well, Buldog, and like many bodyweight exercises, it's very safe. If you work up to it gradually, it won't even be all that uncomfortable.



buldog said:


> Trying to go real slow and stay away from heavy weights but the old powerlifter in me wants to rear its ugly head sometimes.  Tried a bench press with 100 lbs and that was a very bad idea, heck even pushups hurt too much.  But I am determined to get back in shape again no matter how long it takes.
> Thanks, Scott



One thing that might help, Scott: work your way up gradually to heavier weights by using a power rack, and do the benches this way: pick the barbell off the pins and just bring the barbell down to the _bottom of your strongest leverage range._ If you set the cross-rods so they're just an inch or so below that point, you can always let the barbell down quickly in perfect safety if you feel excessive pressure building up anywhere. One problem with full-range benches is that you can get in trouble when the barbell comes down out of that strongest range; doing more rapid shorter range reps gets you the same total distance in moving the bar as you'd have if you did a single rep over a longer range. Four 3" reps needn't take any longer than one 12" rep, and the best thing is, since it's in your strongest range, you can do the short-range benches with more weight on the bar, safely. So you get more overload. I know that kind of program (you might recognize it as the bare bones of the Sisco/Little Power Factor system) must run counter to your powerlifting instincts&#8212;for you guys, it's the full range or you lose right away, I know&#8212;but if you can convince yourself it's therapy&#8212;which in a way it  really is&#8212;it might be easier to swallow! :wink1:

As for the surgery, it would probably be worth getting second and even third opinions on any judgments of the situation you got from your own doctor. Orthopædic specialists seem to come in two species: those that think of surgery as the default and those that think of it as an absolute last resort. A certain skepticism is probably a good defense when one of the first kind starts going on enthusiastically about how a two hour operation under a general anæsthetic is the treatment of choice in your case. I've just heard too many stories like mine, where things worked out probably at least as well without surgery as with, and a few stories about people who had surgery, and then had to have followup surgery to correct problems that arose in the first surgery, and who _still_ had problems in the aftermath...

Again, good luck and I really do hope it all solves itself with minumum effort. Keep us posted on how your inquires about all this turn out...


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## setboy (Oct 15, 2007)

have you looked into prolotherapy?


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## buldog (Oct 15, 2007)

Exile, I tried the one leg wall sit during a slow moment at work.  It was a more difficult than it sounds.  I had trouble getting the knee to a full 90 degrees, had to start with the foot several inches forward and the thigh a few inches above parallel.  Only able to do 8-10 seconds at a time but did enough sets to get in about 1 minute's worth.  Knee is a little sore with some swelling but seems to somewhat tolerable.  It definitely fully invloves the quads, a great exercise!  Is a true 90 degrees the correct form and should I do multiple sets?  Also did some wall pushups while resting between sets and even that little bit really irritated my collarbone after only 40 or so reps over 3 sets.  The chest muscles aren't even getting warmed up and I have to stop.  I think my chest work will have to consist of very light dumbell flys or cable exercises.  
As far as my expectations in the gym goes I gave up powerlifting 27 yrs ago and bodybuilding at 25 yrs(with only a few brief sessions over the years).  Basically my goals now are to get rid of the extra 50 or so pounds I have accumulated.  The training philosophies and many of the machines in the gym are all new to me.  When I started it was 2-3 hrs a day 5-6 days a week training all body parts 2-3 times each.  Now people say if you train a major body part more than once a week your crazy, which with the scientific evidence makes a lot of sense.  Also, it was always slow and controlled reps with very strict form to prevent injury so the short quick reps you spoke of go against all my prior experience(again i'm outdated by more than 20yrs).  To make a very long story short, i'm satisfied with the size of the muscles(except for the quads) just want to trim down to a healthy weight(maybe 180-190 from the current 240) but i'm struggling psychologically by working out with weights lighter than I did when I was 13(started at 10yrs old).  Anyway, thanks again for all your sage advice.
                                      Scott


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## buldog (Oct 16, 2007)

setboy said:


> have you looked into prolotherapy?


Had to google that one.  Looks interesting and may help with my wrist and rotator cuff problems.  Didn't see any info on patella problems which are different from normal knee problems(ACL, MCL, etc.).  Seems like most practitioners are in CA but I did find 1 in CT.  Have you had any personal experience with this Setboy?
                              Thanks, Scott


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## exile (Oct 16, 2007)

buldog said:


> Exile, I tried the one leg wall sit during a slow moment at work.  It was a more difficult than it sounds.  I had trouble getting the knee to a full 90 degrees, had to start with the foot several inches forward and the thigh a few inches above parallel.  Only able to do 8-10 seconds at a time but did enough sets to get in about 1 minute's worth.  Knee is a little sore with some swelling but seems to somewhat tolerable.  It definitely fully invloves the quads, a great exercise!  Is a true 90 degrees the correct form and should I do multiple sets?



Hi buldog, ideally you're doing a perfect 90ºs on the sit, but I wouldn't do multiple sets. I'd start off doing it every other day. Bit by bit you should find that the quads above the knee in particular get strengthened noticeably.



buldog said:


> Also did some wall pushups while resting between sets and even that little bit really irritated my collarbone after only 40 or so reps over 3 sets.  The chest muscles aren't even getting warmed up and I have to stop.  I think my chest work will have to consist of very light dumbell flys or cable exercises.



Cable crossovers are probably a good way to get going on that. A collarbone fracture is really the pits, I'm sorry that you had that trouble. It's such a fragile bone to start with... something I think that human skeletal structure isn't exactly the greatest piece of engineeringweak bones in critical places, weak muscles like the rotator cuff complex in super-critical place, all the stuff that goes wrong with people's spines... I kind of figure it's maybe a B/C+ term project: not absolutely horrible, but it could have been done a lot better...




buldog said:


> As far as my expectations in the gym goes I gave up powerlifting 27 yrs ago and bodybuilding at 25 yrs(with only a few brief sessions over the years).  Basically my goals now are to get rid of the extra 50 or so pounds I have accumulated.  The training philosophies and many of the machines in the gym are all new to me.  When I started it was 2-3 hrs a day 5-6 days a week training all body parts 2-3 times each.  Now people say if you train a major body part more than once a week your crazy, which with the scientific evidence makes a lot of sense.



Well, we know a lot more about how muscle tissue gets stimulated to grow than we used to, and it's not surprising that people start with the `one set good, twenty sets better' assumption. Serious understanding of the role of high intensity in training is a relatively recent thing. As you lose more weight, I suspect you'll find your resistance training improves steadily. Losing intramuscular fatthe kind that isn't visible but makes intense muscular contraction more difficultgenerally translates into faster, more intense muscle contraction. 

One thing that seems to help people who are trying to shed excess weight is taking a realistic view of the timeline involved. From what I've read, weight losses of one to one and a half pounds a weekfrom a combination of calorie reduction, food choices (complex carbs over simple carbs especially) and aerobic exerciseare safe, sustainable, and much less likely to reversed by periodic binge eating than higher loss numbers involving weird diets. So assume conservatively a lb/week. That means that you can accomplish your goal in a year, or building in a margin of error, around fourteen months, say. So if you simply do a reasonable weight loss routine, emphasis on `reasonable', and think long term, it's probably going to happen relatively easily. 




buldog said:


> Also, it was always slow and controlled reps with very strict form to prevent injury so the short quick reps you spoke of go against all my prior experience(again i'm outdated by more than 20yrs).  To make a very long story short, i'm satisfied with the size of the muscles(except for the quads) just want to trim down to a healthy weight(maybe 180-190 from the current 240) but i'm struggling psychologically by working out with weights lighter than I did when I was 13(started at 10yrs old).



I know what that's like; I had to stop lifting weights for a year after my bad accident a couple of years ago, and it's very discouraging to see myself fighting to do reps, even in my strongest range, that were at the _bottom_ of my descending pyramid routine five years back or so. What I keep telling myself is, just keep at it, you'll get back there. I believe in muscle memory: once muscles have been trained to a certain size and intensity of contraction, they get back there much more quickly than muscles do which have never been trained to that point, even after years have gone by. I don't know the reason, but hard-headed exercise physiologists whom I respect swear this is true, and I suspect they've seen it happen enough to know, even if they themselves don't have a story yet about how it happens.

The important thing is never to be discouraged. Every workout leaves you better than you were before, even if it doesn't go brilliantly. Keeping your morale high is the hard part; you just have to keep reminding yourself that you _are_ making progress, even if it's not yet visible. For some reason it seems to work like that: nothing, nothing, nothing, and then, all of a sudden, you're at the next level....


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## buldog (Oct 16, 2007)

Exile, As always, thanks for the great advice.  I already figured out that multiple sets on the sit is not ideal(feeling it today!).  At the time 10 seconds didn't seem like enough, but as you say a little at a time and before you know it you're there.   I'm just glad I had already been working on the leg for 2 months before trying that one.  
        My motivation level is very high right now and I intend to keep it that way.  I'm going through some lifestyle changes(moving, new job, working out, starting MA again and old friends I haven't seen in many yrs) that I hope will get me back on the right path.  The 12-14 month timeline was about what I had planned on.  I started at about 250 and have lost 10 lbs in about 9 weeks so i'm right on schedule for now.  Feeling great apart from the pain from old injuries.  Even the knee is feeling more stable than its been in yrs(still subluxing but not as badly or as often).  
                              Scott


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