Author Topic: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2  (Read 240478 times)

Offline Clarkey

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18/06/17 35 Months Day 1066 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: July 12, 2017, 11:15:19 PM by Clarkey »
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
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

Offline Clarkey

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12/07/17 35 Months Day 1090 Post Op

After nearly 3 years since my last surgery of AIR on 18/07/14 I will be back for what I hope will be the 3rd and final surgery for a very long time. I have now run out of none invasive treatments for patella tendonitis over the last 36 months, scheduled for another AIR surgery, decompression of the patella tendon and excision of accessory pole of the patella that seems to be the culprit to my never ending knee saga! The increase in joint effusion was the turning point and a significant finding to warrant another surgery showing a positive find for surgical intervention.The inferior pole of the patella is larger than it should that will be the main focus point during surgery.

There is a chance that the anterior knee pain might improve if the hip pain is sorted out first, I said I rather have surgery at this stage that has been dragging on for too long with surgery as the last option in the hope that I am 3rd time lucky. I have signed the pre-op form and filled out the questions with swabs around the groin and up the inside of the nose nostrils. October is the month I should get a date for scope #3 that I always had at the back of my mind that's no great surprise or shock as I have been preparing myself for the surgery.

I will remain positive, I will not overdo it after scope #3, seeing a PT is not really necessary after AIR surgery. The private PT ruined the last surgery which was going ok until he made me do too much PT in one session causing the scar tissue to build up again excessively. Taking a risk and gamble, the worse outcome is the knee remaining the same, even if I am not able to run again if I can walk at a quicker pace and maybe run a few paces before feeling anterior knee pain I would be happy with the result.

Finally have ended my post-op diary #2 with just one final review on my 3rd anniversary next week Tuesday.

[email protected]
« Last Edit: July 13, 2017, 09:26:49 PM by Clarkey »
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
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

Offline Clarkey

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18/07/17 Three Year Anniversary Day 1096 Post Op

My 2nd post-op diary has finally come to an ending only to be shortly followed by my 3rd and hopefully last pre-op diary. The last 3 years I have been through all the none invasive methods of treatment options that  unfortunately not made any difference to the anterior knee pain and discomfort.


October 2017 3rd surgery for patella tendonitis and AIR take 2 for arthrofibrosis.

04/04/17 Cortisone injection right hip for labral tear and femoroacetabular impingement.

28/09/16, 05/10/16, 12/10/16 (ESWT) Shockwave Therapy.

21/06/16 2nd Opinion Private Clinic.

10/05/16 Consultation with Sports Medicine Doctor.

23/12/15, 22/10/15, 13/05/15 Cortisone injections right knee.

18/07/14 Right knee (AIR) Anterior interval release.



None of the above methods of treatment plans have made any difference with a slowed down in walking pace with anterior knee pain around the bottom of the kneecap by the tibia. Have not been able to run since January 2013, hoping that my 3rd surgery will help improve my mobility so I can at least walk at a quicker pace. Running again would be a big bonus that may not happen, still remaining strong minded living in hope that one day I can return back to long distance running for my local running club.

[email protected]
« Last Edit: August 19, 2017, 08:50:05 AM by Clarkey »
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
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

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1488 on: September 21, 2017, 05:42:32 PM »
21/09/17 Preoperative Report Update

I rang up Prof Snow secretary this morning to enquire when I will be booked in for my 3rd scope and would have been booked during the last week in October or the 1st week in November. I have had to postpone it until January as I have a very important contribution taking part in a book writing workshop and conference at NUI Galway in southern Ireland.

https://ercvoices.com/2016/09/14/meet-the-storyteller-nicholas-clarke/

https://ercvoices.com/2016/09/15/meet-the-respondent-nell-munro/

I have been working on the chapter with my respondent throughout this year that has taken several hours to get the chapter to come across well in a powerful and emotional manner. I handed the final draft chapter last week Tuesday 12th September, I have just had feedback today with a few changes from the organiser with the final book writing workshop on 21st to 22nd November before it sent to the book publisher.

I shot myself in the foot during my probation period at the autism young peoples group where I was a volunteer for over 2 years. I got a job position in May at the Saturday Club as an Autism Support Worker getting high praise from the staff and leader saying I will fly through my probation with ease. I personally chose to do 4 weeks at the summer holiday club that was too much transition from once day a week to 5 days a week. Due to my Asperger's I did not manage and cope with the sudden changes as I had not worked full time for over 5 years.

During the 2nd week a young person that's none verbal under my supervision on a Thursday had a meltdown after doing 6 hours a day one to one from Monday until Thursday when I had to leave the building. An incident report had to be written and were concerned it might happen again and cannot take a risk tarnishing their reputation. Was told I did not pass my probation a day before I was due to start back at the Saturday Club.

My job description was a zero hour contract working during Saturday term time, was optional to work during the holidays. I am sure it violates the Disability Law and Policy (CDLP) for unfair dismissal which is what the ERC Voices is all about how the disabled are mistreated and misunderstood by society with organisations that are meant to treat and understand individuals in the autistic spectrum that I found out in a harsh way. I needed the extra money, now wish I stuck to working Saturdays only as I would still be in a job and not unemployed once again.

I did not want to have surgery in December after the conference with my Birthday and 4 family Birthdays throughout December, my mum can no longer drive she relies on me to get to family gatherings. I asked the secretary to book me in for surgery during the 2nd or 3rd week of January, the 1st week in January Prof Snow is on a well deserved holiday with his family.

Looking forward to see the back end of 2017 feeling more at ease in 2018 knowing I am getting my right knee operated on that a risk and a gamble I am happy to take on after all the bad luck throughout 2017.

[email protected]
« Last Edit: September 21, 2017, 05:54:52 PM by Clarkey »
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
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

Offline Puffy the Knee Slayer

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1489 on: September 23, 2017, 12:13:37 PM »
Hi Clarkey,

Congrats on getting your book chapter done, that is an amazing achievement.

So sorry to hear about the problems you've had at work. I don't see how what happened with your service user was your fault? Not clear if the service user had a meltdown or you did. Does that mean you are no longer doing Saturdays either?

Might be worth getting some advice from ACAS regarding unfair dismissal and disability discrimination. I think unfair dismissal you have to have worked at the place for 2 years, but for disability discrimination you can raise this any time.

It's really hard adjusting to F/T work after a period of unemployment and they should have taken your Asperger's into account and made adjustments. They could have extended your probation period instead of dismissing you.

I really hope you will have better luck with the op and other things in life.

Hope you enjoy the conference.
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1490 on: September 23, 2017, 02:30:19 PM »
Hi Puffy,

It was the service user that had the meltdown, I rarely have meltdowns and if I do it at home never at work or in public view can bottle it up till I get back home. I raised my voice slightly as I was worried being left alone with the young person under my care and supervision for safeguarding reasons as the other staff left the room. Thinking back she should have waited or helped me to get him out of the room, this is perfectly ok as I did this at the Saturday Club. May have raised his anxiety by telling him to stop biting his nails that were below the nail lining becoming sore if he bites any further down.

Would not be on here now typing would be at the Saturday Club Today which suited me well and was very well liked by both the staff and service users engaging well with one to one service users with nothing but high praise from my leader and staff mentor. Saying I show passion and commitment focusing all the time on my key young person that other playworkers are lacking in. To rub salt into the wounds the manager at the staff training came up to me saying you are doing a fantastic job at the Saturday Club keep up the good work.

All my friends and people young and old with Asperger's all say they need to build up gradual transition into doing something they have not done for a long time. They all say it would have also been too much overload for them. Fatigue played a big part with 4 days staff training a week before 4 week holiday club and one evening training the 1st week at holiday club after working all day from 9am until 4pm with training from 5:30pm till 8:30pm the same day.

Said on my probation dismissal letter was nervous around the playworkers and service users not engaging effectively. Struggling to adapt to a new premises that all playworkers need to adapt to without showing any hesitation. Maybe was asking the leader too many questions when I should have used your own initiative. 

Email after the incident had occurred removing the name of the leader and organisation.


Dear ****,

I would like to apologize about how I handled the incident at the holiday club today and am sorry that you think I have been under performing at times. I really enjoy working with the service users, but this week has shown me how difficult it can be to work 1:1 full time with them. I feel anxious now as I have always felt happy and valued at the Saturday club and realize that I may have ruined my chances of completing my probationary period. I really hope I can continue to work for ***** at the Saturday club, where I have shown that I can perform to the standards that are expected of ***** play workers. I look forward to meeting up with you to discuss this.

Kind regards,

Nick



I am just as good as the other playworkers in the right setting engaging well with everyone that I excelled in at the Saturday Club. Should have done 3 days at the summer holiday club with a Saturday service user I engage well with that was given to another playworker by my leader. New surroundings and environment is daunting for someone that is not autistic. If you on the autistic spectrum new surroundings are hard to adjust to unless you do it slow and gradual the transition that the organisation failed on that are meant to understand autism!
 
[email protected]
« Last Edit: September 23, 2017, 02:34:05 PM by Clarkey »
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
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

 

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