Swelling

[Megwi]

Guys,

I am 4 months post arthroscopy and open fixation of a Tibial avulsion with ACL fracture. My query is that my knee is still fairly swollen and although I am icing every day and resting as much as I can it still looks nothing like my other knee. In others experience is this normal? I am beginning to wonder if it will ever look right again. I dont want to spend the rest of my life in trousers!

Any comments greatly appreciated

Meg

[emphatic]

Meg,

It can take a long, long time for an operated knee to return to normal. In some cases, it'll never quite look like the other one. Depending on whether your doctor finds it appropriate, you could try some massage to move the fluid out, rather than just icing. Some physical therapists can do this, so can some trained massage therapists. It can really make a difference. (It does have to be repeated fairly often for full resolution -- it's not a one-time deal.)

I guess I don't care what other people think about how my knee looks, because I wear shorts and skirts if I feel like it, and I don't feel bad about it at all. In fact, I prefer to not have anything around my knee, even though I have a 12-inch incision and quite a bit of swelling at the moment (I'm not quite 7 weeks post-op unicompartmental knee replacement). My knee will never look good again. I'm totally OK with that, though, as long as it works well.

As long as your doctor feels you're on track, please don't fret about the swelling... it will go down eventually. And even if it never ends up looking quite like the other leg, at least it functions well!

Good luck!

(another) Meg

[favouritesearcher]

Hi Meg,

I had a lot of swelling too, it was hard to tell that I had a kneecap.  Immediately after a lysis of adhesions at 5 months post-injury, my knee looked much the same size as the other one, the swelling almost disappeared and the white colour came back.  I was absolutely amazed that taking the scar tissue out could make such a big difference.

John

[Megwi]

John,

I have been told by my OS that unless I get full ROM by end of July I have to have an MUA which is worrying me hugely! However I have had another good PT session today and have -5 to 115 ish now so I'm hoping it won't be needed. Do you still have the same ROM as in your biog despite having the scar tissue removed? I'm wondering if this is why I'm still swollen, but then again I don't think its that bad and does seem to be decreasing every week......

Another question as you appear to have had the same injusry as me (?) at what point if any did you have a post operative scan/xray?

Meg

[favouritesearcher]

Hi  Meg,

My rom now is 3-125.  If I push hard, flexion can go to 130-135.  Useful flexion would be about 100-110; if I try to put weight on my leg after 100-110, the back of the kneecap starts to hurt because it is being pulled into the joint, so there is too much pressure on it.  Pre-op my useful flexion would have been about 45: to get to 70 I had to push for 5 minutes or more.  So after having the scar tissue removed there was a huge increase in my flexion and extension.  There is a course on the kneeguru.co.uk website under Tutorials (left hand side of screen) and I think that it is part 3 which goes into where scar tissue can be.

Having scar tissue cut out usually produces a better result than an MUA and as the others have said an MUA by itself carries the risk of tearing tissue and breaking bones.  My first surgeon was a general orthopaedic surgeon and he proposed an MUA but he thought that 4 months was "too early, come back in 3 months".  At this stage it dawned on me that he wasn't someone who could help me, so I switched to a knee specialist, but it is a hard decision to make to change surgeons to one who wanted to do a lysis of adhesions (LOA), but I'm so glad that I did.

I used to have an x-ray every month for the first 4 months, mainly to check if the fracture had healed, but the later ones also showed a lot of scar tissue.  I had an MRI about 6 months ago, and some x-rays taken at special angles in March; the metal screw obscures the ACL though in the MRI.  I organised to have a bone density scan myself (for general osteoporosis, not just dis-use osteoporosis) because there is some talk that this type of injury is a sign of osteoporosis, and it was in my case.

I will keep an eye out for how you go.

John
P.S. The fact that my original surgeon wanted to do an MUA by itself wasn't the only reason I got a new one.  I went to speak to the external consultant who he was getting advice from, and was not at all impressed.  He barely glanced at the x-ray and did not even touch my knee, just got me to straighten and bend it and said it was up to me to get it moving.  Plus there was no mention of a CPM machine afterwards (which helps maintain any improvement) and he came across as not caring what my outcome was, and he was not interested in learning how to do things better.  Finally, my physio told me that he was not an expert at knees.
Maybe you could ask your own surgeon how many cases of flexion contracture he has dealt with, how he dealt with those cases, and what the final result was?
I still think that you've done really well to get your hyper-extension back and that you'll get a result you'll be happy with in the end.