LR on knee 5 wks ago. Problem now, advice please

[Sore knee]

I had a LR done on my right knee with cartilage fixed etc. Now 5 weeks post op and still on crutches. Physio has now cancelled sessions and referred me back to OS. They have asked for aspiration of the joint or something to remove fluid. ROM is no more than 90 and have been in phsyio since 3 days post op.

Obviously they are not happy with the swelling. Do you know what my options are, even when swelling is reduced it comes back up, I can ice it reduce it a bit but once I am on my feet again it comes back. What options do I have, steroid injections have been mentioned but I would like an idea of what other people have faced and what options can be offered other than the usual RICE etc which obviously now isn't enough.

Thanks.

[Sore knee]

ok can anyone give me ideas on how your docs treated swelling like this that they think is too much. Even if a different operation. I just wondered what options I have . ANy input gratefully received.

[lgeorge106]

Hi Joanne,
I had a LR done on my R knee in Dec 05.  My recovery was nothing like the "2 weeks and you'll be back to normal" recovery the OS told me it would be.  I thought all had gone well, so well that I was released to go to Disney World just 3 weeks after surgery if I promised to use a wheelchair in the parks.  But while doing my exercises in the hotel room I noticed a problem with my extension.  I had a second surgery 2 months later to remove scar tissue that was limiting my ROM (extension specifically).  I was on a crutch for almost 6 months because the leg just didn't feel strong enough to support me.  My PT was stumped, my OS was stumped.  I was stumped and ticked.  My quads shut down completely after the first surgery.  I had PT (in my opinion not soon enough after the first surgery) before the 2nd surgery but we couldn't get the quads to fire.  He thought I was just lazy!!  Another doctor suggested I get a home e-stim unit.  That did the trick for me to get my quads to remember how to fire.  During this time I was going through a pilates teacher training program.  The trainers are wonderful people and helped me learn to walk again.  The one owner is also a PT and a myofascial release (MFR) therapist (a specific form of therapeutic massage) as well as a pilates instructor.  Working with Chris changed my rehab immensely!!!!  He didn't take insurance so I couldn't afford to pay to use him instead of the one my insurance was covering.  During my pilates lessons he would also do a little PT with me and talk about what exercises the PT had me doing.  My initial PT was very "old school" and had one way of treating knee recovery.  But that way wasn't working for me and he wasn't interested in finding something that would.  I could see the "red flags" that Chris was trying not to show me.  Chris would push me and push me just to the edge (although at the time I thought I was going over the edge!).  He showed me how to use my e-stim machine correctly, pushed me to fight for my SLR and extension, encouraged me to work on the flexion.  His philosphy was "if it's going to hurt and swell anyway, might as well do the exercises".  I thought he was crazy.  But it worked for me.  If the pain didn't dramatically increase or change in the type of pain, he felt it was safe to keep going.  Yes I had pain and swelling.  I would ice after working out even 6-9 months after the LR.  The more I had to use the leg the more the quads would kick in and the stronger it would get.  It took about a year for the swelling to subside, the quad to be restrengthened, the knee to feel like it won't give out on me.  Having MFR has helped me as well to break down the scar tissue and help the muscles and fascia to heal.  There are still things I can't do and things I probably won't ever do.  Like running, but I never ran before and have no desire to run!  But as I continue to workout I find things I can do now I couldn't do a week ago.  I still don't have full active extension, but I have full passive and enough to not limp anymore.  I'm doing things now in my pilates lessons that I never thought I would be able to do!!

5 weeks is not long after a LR.  They say it takes about a year.  My knees look totally different from each other (had LR on other knee 20 yrs before by different doctor).

I would encourage you NOT to give up on the PT and definitely NOT stop doing the exercises.  If you have a limit on the number of PT visits for your insurance, he possibly is trying to spread them out so you can go longer.  Not doing the home exercises and/or PT is just giving into the quads desire to not work.  We have something called "reflexive inhibition" in our quads that when there is swelling and/or pain in the knee the quads shut down in anticipation of that pain.  It's your body's defense mechanism.  You have to try to work through that so they "remember" how they are supposed to work.  The swelling will inhibit your ROM.  Are you taking anti-inflammatory medicine?  Try a different brand if you can.  What works for one may not work as well for another.

I know for me if I am not working out at least 3 days a week I can tell.  My knee starts to bother me a little and doesn't feel as strong.  But once I get back to working out it feels better. If it swells or bothers me too much, I ice it. And I'm 18 months post LR.

There are types of massage that can be done to help with swelling as wells as lots of ice.  Some doctors will aspirate the knee (needle).  Others take the wait and see approach.  Most won't consider massage as it is usually beyond the scope of "standard medicine" and seen as "alternative".  I was ready to try anything (almost!) to get rid of my pain and lack of quad cooperation.

I hope some of this can be of encouragement to you!!!!  I saw your other posts and wanted to respond to you.  Don't give up!

Lisa

[dww]

I am five weeks out as well (LR, Synovectomy, Buff and Polish).  Still have the large knot/swelling on the outside of my knee where they did the cutting and somedays like you wonder if it is ever going to subside. 

Three days after surgery, my OS tried to aspirate (too coagulated to work) and did give me a steriod injection.

I am amazed about the differences between UK and US.  I was never on crutches this time (Right knee LR in 93, crurtches for two weeks). I was told that it is best that you walk on it (even when I went in whining three days post-op that there was no way I could go back to work without something). 

Diane

[Sore knee]

Thanks, I couldn't weight bear at all for the first few days post op and needed crutches.

I am now approx 11 weeks post op and went to see my OS 4 weeks ago, his attitude was go the gym do a bike ride....I may add I was still on crutches when I went to see him and my pt and me were both amazed at quite how I would manage either of the above on crutches.

Anyhow my PT and me continued and now another 5 almost 6 weeks down the line the knee is still swollen and VMO inhibited completely, I have lost muscle tone and the diameter of my leg (thigh) has decreased quite a bit compared to the other one,so my pt gently suggested he would like to me to see an OS but given what mine said last time perhaps if I wanted I could see a different one for a fresh perspective. I took it from this that its time to seek a 2nd opinion and as yet I can't go a bike ride, I have about 100 ROM and still can't lock the leg straight or do a straight leg lift so we will see. My PT says yes this can be a long rode to recovery but that there should be progress, even tiny things that he just isn't seeing and he is at a loss to see where to go now. I have a clicking or catching in the knee - not every step but it happens every day many times and its so uncomfortable, it feels like its my knee cap catching on something but I may be wrong there.

Anyway replies very much appreciated and we will see what happens o the 6th of Aug. All physio is cancelled until after that anyway.

[Amanda1975]

I am currently 4 and a bit weeks post operation and still have quite a bit of swelling, I have 100 degrees ROM but cannot lock the knee enough to walk more than a few steps.  You can see at the bottom what I had done, quite a bit I suppose.

I would be interested to hear how you get on in August.

Amanda

[Sore knee]

Thanks, I will let you know how 6th Aug goes.

[plantgeek58]

Hi Joanne,
I just had an LR done 11 days ago on my left knee and my recovery has been nowhere near as difficult as yours has been. You really shouldn't be having this many problems at this point, I don't think. It sounds like its definitely time to go back to the OS. I'd advise getting a second opinion. Sounds like your current OS just doesn't want to be bothered.
I'm from the US and, like Diane, was told not to use crutches. The first couple of days I thought my OS was completely nuts. I could barely hobble to the bathroom. But now I'm doing OK and I think getting on it right away helped a lot.
I think the instability you're feeling in the kneecap is probably due to all the swelling. It should subside once you get that under control. Then you'll really need to push to get your VMO built up. That will prevent the lateral ligaments from pulling the kneecap off-track again. The VMO, in case you didn't know, is the muscle on the medial side that opposes the lateral retinaculum. Those two tissues have to be balanced in strength for your kneecap to stay where it's supposed to.
Does your physio have you doing compressive massage over the area where they cut the retinaculum? My therapist had me start doing that right away to break up adhesions and prevent scar tissue from causing the ligaments to tighten back up again. It sounds like that may be what's happening with you, but I'm no expert, so don't take my word for it.
Terre

[Linds]

Hi Joanne,
you shoudl check back in with your OS, however when I had LR on both my knees.. one 3 years ago and one 5 years ago.. I had significant swelling for months.  With my PT we worked through it best we could, I had to keep my knee elevated and iced as much as is possible.. but it took a really long time.. and still now they get puffy at times..
But check with your doctor because some swelling requires more treatment.  Draining the fluid can help, it depends what is actually c ausing the swelling.  Best to have the OS look at it though if your PT's aren't comfortable with it.
Goodluck

[Sore knee]

 :)Thanks guys, very much appreciated. I go on Monday now so we will see what OS number 2 says about it all. I am nervous and not sure what to expect so we will see.

Thanks so much for the input.....keep it coming and I will let you know what he says.

[Sore knee]

Hi guys

I saw OS number 2 this morning and he was lovely 

He said its not a surgery he likes doing and rarely does it as it can lead to all sorts of other issues after.......don't I know it ! ANyway he said the muscle wastage in the leg was bad and that alone leaves the knee very unstable. He said we needed to try a 3 prong attack:

The biomechanics of the knee are wrong, the load bearing of the knee is wrong so he got me insoles to wear that wil better distribute the weight across the knee.
He then aspirated the knee and injected steroids into it. I have to say it was painful, he said getting the needle in is usually the painful part but once the needle was in I found it sorer and he said thats unusual, also he said there was not a huge volume of fluid and yet my knee looks pretty huge. He said the knee can tilt the other way and then catch and rub and these can all be issues afterwards but we would try this intensive approach first.
Lastly back on crutches again and intensive physio for 3 weeks.

I go back to see him in 3 weeks by which time he says he hopes we have made significant improvement. Afterthat we will talk about more invasive things if required.

So all in all I am sore, but happy. He at least is offering me a path and alternatives rather than just go to the gym. SO here is to the next 3 weeks

How did you all find steroids ?

[plantgeek58]

Hi Joanne,
that is really good news. Glad to hear that you found an OS who won't dismiss your pain and is giving you new options and new hope. I really don't understand these doctors who do the surgery and blow off their patients' complaints afterwards. Sounds like you're on your way to a good recovery now. Keep us posted as to your progress.
Can't comment on the steroid treatment, as I've never had it. Discussed it with my OS once for my right knee, but we decided against it. I had quite a bit of chondromalacia and there was a possibility that the steroids might accelerate the breakdown process. It was only a small possibility, but I didn't want to risk it.
Terre

[Sore knee]

  ok Q for you, my knee is swollen very badly tonight and the pain is much worse than this morning. It is very sore and bigger even though it was aspirated. Is this common after steroid injections.

I have pain running down the side of my knee now (near the LR site) round into the back of my knee and going down the side of my leg just sort of between my shin and my calf but up the top end near my knee. It is so sore !!! Any ideas anyone ?

Thanks

[Sore knee]

I should add inside the knee feels as if its catching more today also, perhaps coincidence but definitely more of it today. There is also pain inside the knee under the knee cap as well as what I already decsribed.


Thanks for any input !

[kc1124]

Hi Joanne,

I am so sorry for all the difficulties you are having.  I have chatted with you on Margaret's post.  I am having some computer problems right now - will not allow me to post anythign of length.  So, off to Word I go to hopefully give you some insight and encouragment.  I will post it here later tonight when I have a chance.

Fell better!

Kat