Author Topic: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2  (Read 236156 times)

Offline Clarkey

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  • Never put 100% trust into a negative MRI scan!
18/06/17 35 Months Day 1076 Post Op

I have decided to ease back on the PT exercises to show that it is not an overuse injury condition when I next see Prof Snow on 12/07/17 @11:00. The anterior knee pain remains the same with the pain intensified around the tibia region, it is clear that something is not right with swelling at the bottom of the kneecap.

My outpatient letter dated 16/05/17, two months after the consultation on 15/03/17. I had to ask twice for a copy that finally arrived in the post towards the end of May.

Dear Dr ****

Persistent anterior knee pain with recurrent effusion and impingement.

Nicholas returns to clinic having been treated by out sports physicians with extracorporeal shock wave therapy. He persists with anterior knee pain below the patella tendon which is worse on impact activities and he is currently unable to run. Kneeling is also difficult. He has also developed some hip pain and an MRI has shown a potential labral tear. He has ab appointment with ***** ****** on 16th June.

On examination toady Nicholas has a grade 1 effusion. He has tenderness over the inferior pole of the patella with a positive fat pad impingement test.

MRI of the knee again shows an effusion with fat pad scarring and a signal change within the fat pad. This has always been a slightly confusing with Nicholas, is why he has a recurrent effusions. MRI scans have not shown any obvious reasons why this would occur. At his previous arthroscopy he had a very tight plical band which was rubbing on the medial femoral condyle causing bone marrow oedema. This was resected with good effect but unfortunately following aggressive physiotherapy has recurred. His blood tests in the past have never shown evidence of an inflammatory condition and all his to look at the alignment of the patello-femoral joint have been entirely normal.

I think given the fact that he does have this labral tear we should organise a hip injection and based on the response to this we can then decide how to proceed with his knee. If he gets a good response from the injection then this will help his consultation with Mr **** *****. Conversely if he gets no response to the injection then can potentially look at options for his knee.

I think the only option left to Nicholas would be a further anterior release and excision of accessory pole of the patella. If it wasn't for the recurrent effusions I would not recommend this but in the presence of such a significant finding it does suggest there is a therapeutic target. I will see Nicholas back in 4 months time after his hip injection.

Your sincerely,

Professor M Snow

I have already had the hip cortisone injection that had been beneficial easing the right hip pain. However the right knee is not improving that is hindering my new job as an Autism Support Worker for young people aged 14 to 19 at the Saturday Club. I am doing one to one support for service users that attend the club. My right knee injury is limiting which service user I can do one to one with, I was doing well with a service user that has challenging/distress behaviour as he more calm around me. As he inclined to run off in the park when we go there in the morning he runs off if he see a dog! Then have to rely on another staff member to give chase putting their service user at risk be left not holding their arm/hand that is standard safeguarding practice for the morning complex needs group. I would love to be able to take part in physically activities that impossible right now and the Line Manager and Main Manager are both supportive when I go ahead with surgery with sick leave not being a concern. Many staff have long time period off as they have main jobs and only work weekly on a Saturday that at times clash together.

My report sounds mainly positive with a good knee alignment and blood tests have shown in the patello-femoral joint are entirely normal. This hopefully means there is no major wear and tear in the knee and a 3rd scope will be beneficial not making the knee any worse than it is right now. The worse cases scenario is that the anterior knee pain remains the same post-op. I hope that it improves the pain and discomfort around the tibia area. If I can walk at a faster pace or do larger strides without intense tibia pain then I would be happy with the surgery result.

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« Last Edit: June 18, 2017, 08:03:01 PM by Clarkey »
RK: PFS, Maltracking & arthrofibrosis
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-hip 04/04/17 R-knee 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09