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Author Topic: knee cap stiff and swollen still eight months after surgery - please help  (Read 6549 times)

Offline knee_swollen

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Hi All,

    I had surgery in the first week of January and the doctor said he removed 20% of the lateral meniscus and 15% of the medial meniscus.Recovery was slow but I could slowly take stairs by the end of February but by the end of March I have been getting a constant stiffness on the kneecap and have been unable to take stairs since then.I have been biking three times a week for 20mins since February but I still cannot take stairs.I don't know why I have got worse after being able to take stairs in February.Since March when I get up after sitting for sometime I have to be careful while standing because the knee feels stiff.The doctor ordered another MRI last month and he says he doesn't see anything bad.I have been two two doctors other than the one who did surgery and one of them said I have scar tissue and the other said he doesn't think its scar tissue,he said it is fat pad syndrome.Please help since my life has been completely affected.The knee cap feels very stiff in the morning on waking up but the stiffness reduces after some activity but it comes back after sitting.The swelling is considerably less in the morning but comes back after some activity.

regards,
jim

Offline Heather M.

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It is actually possible that you might have both conditions--that you might have fat pad syndrome due to excess scar tissue in the joint following your surgery.  This is a problem called arthrofibrosis, and it is very, very difficult to properly diagnose.  And even harder to treat, unfortunately.  It's also quite a rare problem, so rare that many doctors out there fail to recognize it.  They will diagnose things like fat pad syndrome or tendinitis without really understanding WHY the patient has developed these.  That is, you can have fat pad syndrome or tendinitis that starts by itself, due to overusing the knee (like if you're training for a marathon or something).  But you can also develop these conditions secondary to having a knee joint full of scar tissue.  So the scar tissue is the actual problem, and the tendinitis or fat pad syndrome are symptoms of this underlying problem.

Go to the soft tissue healing problems section and read up on arthrofibrosis/scar tissue in the knee joint following surgery.  There are many posts/threads which deal with people's individual journey's following surgery to remove excess scar tissue (called a lysis of adhesions or LOA).  Other threads go through the process of people trying to get a proper diagnosis--as you will see, it can be a real struggle.  You can sometimes hear several different opinions from doctors about what the problem really is...you'll often hear incorrect comments like "your range of motion is too good for you to have scar tissue," or "it's not possible to develop arthrofibrosis after such a minimally invasive procedure like an arthroscopy."  Wrong and wrong again.   So it's important to make sure that the doctor you see for an opinion on whether you do have arthrofibrosis is very knowledgable about this condition.  Otherwise, you can waste a lot of time trying to get appropriate diagnosis and treatment...or worse, the problem in your knee can be compounded by ill-conceived procedures and incorrect treatments for your condition.  Remember that there is never a problem so bad it can't be made worse by inappropriate surgery!!

So anyway, read up and educate yourself about arthrofibrosis.  That can be an important first step.  Then, find the doctor with the most experience treating this condition--be prepared to do lots of homework.  And sometimes people have to travel, if they don't have the good fortune to live close to one of the dozen or so doctors who have done a lot of research and work on arthrofibrosis treatments.  I have to travel about 800 miles to see my doctor, but after undergoing FIVE knee procedures in TEN months--and being left worse off than ever due to the return of the dreaded scar tissue--I finally decided that I couldn't afford to waste my time with any more doctors who didn't know what they were doing with this condition.  I saw a specialist, one of the leading doctors in this field who has very progressive ways of treating this condition.  And his methods go directly against the 'standard knee rehab' and treatment methods taught in medical schools and fellowships around the world.  It's really amazing how much improvement I've had following my current surgeon's program--basically, doing the exact OPPOSITE of what most of the doctors I saw told me to do (it turns out that these doctors didn't know this condition very well).  I only wish I'd seen my current surgeon much sooner, because by the time I had surgery with him I'd already had arthrofibrosis for nearly a year and a half.  And unfortunately, all the scar tissue in the knee starts to attach to stuff, move things around, put traction on delicate structures, and in general completely mess up your knee mechanics.  And the longer these problems have been going on, the more likely they are to become permanent.  It stinks.  If I'd known then what I know now....things would be really different.

Read up on arthrofibrosis, scar tissue, internal adhesions, lysis of adhesions/LOA, etc.  And read about tendinosis/tendinitis, chondral lesions, patella baja and infrapatellar contracture syndrome, which are just a few of the long-term consequences of having arthrofibrosis that hasn't been treated properly.  Please don't panic, though!  You don't know for sure that you have this condition.  But since you've heard that diagnosis from one doctor, and had the fat pad syndrome diagnosis (often something found in arthrofibrosis patients) come from another doctor, you have to be open to the possibility that scar tissue is causing your problems.

Many of the threads in the soft tissue healing problems section have links inside them to articles on arthrofibrosis.  So sit down with a good internet connection in a comfy chair and prepare to read all about it.  Also, some related posts (especially dealing with stiffness and limited ROM/range of motion) can be found in the struggling with pain and rehab section. 

Heather

PS if you want to post the general region where you live, and whether you are able to travel and how far to seek a diagnosis and appropriate treatment, someone can likely point you in the right direction.  My scar tissue specialist surgeon is in Colorado, but others are found scattered here and there around the US. 
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline ski bum

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Jim,

I too was told, among other things, that I had an irritated fat pad post-surgery (aka fat pad syndrome).  However, it turned out to be arthrofibrous--and clearly showed up on the MRI as a long, distinct band running through the fat pad.  I too had that stiff knee, particularly in the morning and after sitting (or standing).  But beyond that, the scar tissue had adhered my patellar tendon to the fat pad, restricting its normal range of motiion.  Very painful, leading to muscle shut-down, stiffness and restricted ROM (both flexion and extension)  This is not a normal outcome from ligament surgery but rather an unnessary and unwanted side effect.   

What is your ROM like?  Can you fully extend, fully flex (to match your other leg)?  Does your patella move freely in all directions in a way similar to your other leg?  Is your leg as wide-around as your normal leg (indicated normal muscle mass/presumed strength)  These too could be clues to what's doing on.  Restricted ROM may be why you're having trouble with the stairs (and why it started after some time after your surgery--perhaps because that's when the scarring finally limited ROM)  Did your doctor check this?

You should get another opinion from a doctor who understands this condition, as Heather recommends.  If you do have scarring, it is unlikely to 'remodel' on its own.  You may need to have a surgeon clear it out. 

Good luck,

Andy
« Last Edit: August 02, 2005, 04:29:35 PM by ski bum »
12/23/04:  complete ACL tear, partial LCL, tibia bruise
1/19/05:  allograph ACL
7/8/05:  AIR-scar tissue & ACL graft girth reduction
8/4/05 nearly full ROM-released to ski
8/11/06: AIR-scar tissue, grade 3 cartilage potholes on femur
10/13/10:  Mfx, L knee to fix 3cm pothole

Offline knee_swollen

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Andy,

    The doctor checked the patella by moving it around and he said he doesn't see anything bad.By range of motion I think you mean bending.I can bend my leg so that my ankle touches the thigh- I have been able to to do this since March.The physical therapist worked had worked on bending and straightaining the leg for two months from January and by March it was comparable to the right leg.What treatments are there for scartissue other than surgery,the doctor said another surgery can cause more scar tissue to comeback.Did anbody try acupuncture or chinese herbs.Thanks Heather for the comments.

regards,
jim
   

Offline knee_swollen

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Andy,

     Forgot to ask,what have you been doing for the condition.I have been using celadrin cream which gives quick relief from stiffness but the stiffness comes back after some time.

jim

Offline ski bum

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Jim,

Scar tissue, if pervasive enough to cause significant problems, is a mechanical issue internally--I believe it must be dealt with surgically.  That's what I did.  The surgery left me much, much better--even with the post-op swelling.  My ROM before was limited (both in terms of getting my leg straight and beyond, aka hyperextension--a normal and necessary movement for the leg, and flexed).  Before, I could get to straight leg position, with pain, but not beyond and could only get to within about 6 inches of what my other leg could do flexed--and even that with pain.  Now both legs are equal.  Before, the leg stiffened and hurt if I stood for long of did much of anything in terms of exercise/movement.  I was not out of action much at all from the surgery(although I did work from work for 2 days so that I could continue to use the ice therapy unit 24/7 as ordered by the OS).  Then I returned to work, using crutches for a few days as my office is far from the parking lot and my work involved walking around a fair amount.  I also iced my knee at work every 2 hours or so.  Since that first post-op week, I've just been getting better every day.

If your stiffness is due to arthritis, it may be that non-surgical means would work.  But that's a question for your doctor--I don't have that problem (and hopefully never will).

Talk to your doc and/or (better) get another opinion from a specialist.

Andy
« Last Edit: August 03, 2005, 01:21:30 AM by ski bum »
12/23/04:  complete ACL tear, partial LCL, tibia bruise
1/19/05:  allograph ACL
7/8/05:  AIR-scar tissue & ACL graft girth reduction
8/4/05 nearly full ROM-released to ski
8/11/06: AIR-scar tissue, grade 3 cartilage potholes on femur
10/13/10:  Mfx, L knee to fix 3cm pothole

 















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