14 mons post surgery - something is wrong!

[drparent]

It's been 14 months post ACL & meniscus surgery and I'm stilling having problems strengthening my muscles and healing properly. I had the hamstring graft. I've been to PT 3 different sessions w/n 14 months - 2 different PTs! No other pain - just stiff and sore knee w/ pain below knee cap etc after sitting for a long period of time. I often feel like i have patella tendonitis or patellofemoral syndrome. I did regain my full range of motion post surgery! No real swelling anymore - maybe a little internal. I’m still unable to run...in fact, I can only do a limited amount of any weight bearing exercises w/o experiencing pain and set backs in my recovery.  All the MRIs come back normal saying nothing is wrong in there...but this can't be normal! 

Any suggestions or advice…???

[spartanpele]

dr...I responded to your posting in the emergency section...    Look at what I wrote, and give some feedback so we can help you...   

[feeny]

Hi Dr,

Sorry to hear about your problems - especially so far into the process.
I am not sure what advice to give - everytime I have a setback and pain I do exactly the same thing - which is as advised by my surgeon:

"Go back to basics, follow the early rehab protocol (quad sets, basic stretches etc.) and rest for a few days doing nothing else but rest and early rehab exercises. Then gradually return to what you want to do. If there is swelling, ice it regularly."

Now that has worked really well for me - but I suspect most of my problems have been reactionary to my overdoing it - and if you are still having issues 14months into the process, it does sound like there is something more sinister happening

So, I think the absolute best advice to give is to go back to your OS and demand an explanation for what is going on and what you should be doing about it.

I hope things get better very soon.

[hottubpam]

I know you have been to 2 different OS's, but I'd recommend you seek our further opinions.  After my ACL and subsequent re-hab problems I went to FIVE OS before I found one that knew what to do.  The third OS diagnosed the problem, but didn't know how to treat it.  The 4th and 5th OS agreed on the diagnosis and came up with the same treatment protocol.  I went with the 5th OS.

Good luck,
Pam

[Jaci]

I agree with Pam. It's time for another opinion.

On the matter of MRI-- An MRI is only as good as the radiologist interpretting it. They do miss things and, on occassion, not recognize something that is glaringly obvious to a more knowledgeable and experienced radiologist. I had an MRI done through a local facility and had the images sent to a specific radiologist that my OS (who I travel to see) uses for all his patients. The report from the local radiologist was completely different from the report from my OS's preferred radiologist. I had to pay a consultation fee to the preferred radiologist because it was not coverd by my medical insurance; but in my opinion, it was a small price to pay for more reliable info.

Jaci

[drparent]

Since all of you have been so supportive regarding my knee surgery and complications, I just wanted to share w/ you what the 3rd surgeon told me yesterday. It was exactly what I thought it was…. I have Patellofemoral syndrome in my left knee. It’s basically pain near the knee cap (patella), and below it.  This condition occurs when the knee cap does not track correctly around the knee joint, and the bone starts rubbing underneath causing great pain.

I’m in a catch 22 since I have to build up my quad muscles so my knee cap will track properly again, however I’m unable to work out to full capacity due to this condition. So it’s going to be extremely difficult to build up the muscles around my knee cap, and it may take a great deal of more time (i.e. maybe even another year!). He also advised me that once I do heal and regain some muscle mass in my quads…I should be able to play sports again at a lower level (not competitive sports as I was playing). Although he suggested I do not return to jogging on a daily basis ever again since the impact will be too hard on my knee.

He advised me to take as many yoga and spinning (cycle) classes as I can to strengthen my quads w/o the intense impact on my knee. He also suggested swimming as an option for me now.

D

[zengirl]

Patellofemoral syndrome - I thinkI have that!!!!!!

Will find out tomorrow. But it's so painful, and seems to be right on the patellar bone, not on the tendon underneath.

[drparent]

Let me know what your surgeon says to you a/b it! Good luck tomorrow!

[contraaclr]

Since all of you have been so supportive regarding my knee surgery and complications, I just wanted to share w/ you what the 3rd surgeon told me yesterday. It was exactly what I thought it was…. I have Patellofemoral syndrome in my left knee. It’s basically pain near the knee cap (patella), and below it.  This condition occurs when the knee cap does not track correctly around the knee joint, and the bone starts rubbing underneath causing great pain.

I’m in a catch 22 since I have to build up my quad muscles so my knee cap will track properly again, however I’m unable to work out to full capacity due to this condition. So it’s going to be extremely difficult to build up the muscles around my knee cap, and it may take a great deal of more time (i.e. maybe even another year!). He also advised me that once I do heal and regain some muscle mass in my quads…I should be able to play sports again at a lower level (not competitive sports as I was playing). Although he suggested I do not return to jogging on a daily basis ever again since the impact will be too hard on my knee.

He advised me to take as many yoga and spinning (cycle) classes as I can to strengthen my quads w/o the intense impact on my knee. He also suggested swimming as an option for me now.

D

Did you get to see the surgeon I suggested?

[drparent]

I ended up going to see Dr. John Xerogeanes, MD in Atlanta, GA - a friend of mine went to him and recommended him.

[celinenj03]

Rehab can cure this. I know it take s a lot of time and you have to start out very slow back to basics like Feeny said. But you can overcome it. Thank God no problems on the MRI so it is probably due to weakened muscles which will stress the patella tendon and cause pain. It's a hard cycle to break but if you take it slow and stick to it, you can break the cycle. I have been working out for 5 months and can just now finally squat with little to no pain. I had lost all muscle mass in my entire leg from hip down because I was braced for awhile before my surgeries. In the 4 months before my ACLR I lost all muscle tone, so slowly had to build it up. I'm about 70% there, but still have ways to go. I will get there, and so will you. Keep training. I looked at pictures of the leg and when you see all the muslce that wraps around the knee you really understand that you just can't expect to be pain free without building all the muscle back up. How is your VMO muscle coming along?