NM's surprise meniscus trim and medial plica excision

[NadiaMac]

week 11 post-surgery

This week I started feeling optomistic for the first time that I might recover. While I still have a long way to go, the knee is tolerating increased activity well and I seem to recover from effort better.  I still have swelling around the portals, but it seems to be slowly decreasing though I still have to stay off my feet and elevate the leg to manage this.

I'm kind of tired so this might be a bit spacy. I just wanted to log what I've been doing this week as well as some thoughts on what helped

Current activity level-- I have slowly increased the cycling and am now up to about 45 minutes a day. I alternate interval workouts (30 or 45 sec intervals of high cadence with 30 secs rest) with steady spinning workouts (moderate to high candence).  PT says I can push up the time, but best to increase time rather than resistance.  I am mostly following orders but have included some increased resistance as well.  At PT last week, they had me ride out of the saddle for the first time. I was terrified, as this was extremely painful pre-surgery, but I did ok! I held some of my weight with my arms and favored the bad leg, but was able to do 6 15 sec stints out of the saddle.  Wildly exciting!!

PT/home PT- I noticed that my ankle was very unstable on the bad leg. I had foot surgery 4 yeas ago and while I regained most functionality in the foot, it never returned to normal stability and the knee injury seems to have weakened the foot. Long story short, the ankle and arch are now kind of weak and wobbly, so I've started doing foot (ankle) PT as well as the knee PT.  Which makes for a very long day at PT!  I think it's helping, though. 

Also ramped up the table workouts (now doing super sets of 30 quad set, 50 off the table quad pumps, then 30 SLRs except that you never return your leg to the table.  This times three.  Very tiring!).  Same routine as before on the side leg raises and bridges, about 60lb X75 on leg press, plus a closed-chain hamstring machine and the sled.  And squats, which I can now get into on my own (I mostly hold these, but do some modest pumps).  One improvement: I noticed that there was a point in my ROM where it is painful when I bear load. So we are currently avoiding that point in sled, leg press, squats.  This REALLY helps recovery and minimization of swelling. I hope when I am stronger that this pain will go away, but will have to see.

Stretching/massage- I ramped up my stretching and self-massage with the massage stick and foam roller, plus a tennis ball for the glutes.  My quads, hamstrings, and glutes have been sore and very tight and the self-massage seems to help a lot (I've even been doing this in my office at work, fortunately no one seems to notice!).  I also got two massages from a real massage person, which magically loosened up my hip flexors and glutes and ankle, which are all quite stiff. 

Walking. My gait gets very wobbly when I am tired and I recently noticed that I am turning my bad foot out when I walk, which makes me a bit knock-kneed on that side, plus contributes to a sort of stomping gait. I think the knock-kneed walk is something I unconsciously adopted trying to manage the pain presurgery.  I started wearing my support brace again when I am tired and it seems to help me walk straight.  I recover from being on my feet (still quite fatiguing for me) a lot better, so will continue to do this for the moment.  I hope to improve my gait and strength so this won't be necessary for long.

Icing. I noticed that icing the back and side of my knee helped with swelling and recovery. I now think this is mostly due to some soreness in the side of the knee (medially, near the plication running out into my VMO) which the icing relieves. I am quite paranoid about scar tissue around the site of my former plica so have been massaging the sore stuff (some unidentified ligament/tendons that run from the medial knee up into the quad).  It's pretty tight in there and I am hoping there isn't a lot of scar tissue gumming everything up. 

Work. Went back to work last week and the sitting continues to bother me (due to the arrangement of my office it's difficult to elevate my leg while working at the computer). I've started sitting on the floor and this seems to help, but isn't very comfortable for other body parts, such as my back. I will continue to work at home one day a week, I think.  I'm doing better with the walking at work, which is encouraging.

Swimming-- started swimming regularly again and have been slowly restarting to kick, which is going surprisingly well!  I'm psyched because kicking was fairly iffy presurgery, so this is a sign of progress I think.  I'm up to about 30 minutes of kicking (though it's pretty weak kicking). 

Pain- I think the pain is reduced. I have some pain below the knee around the portals, which are still swollen, but the dull shooting pains from the meniscectomy and plica site have really abated. I still get twinges of pain if I overdo it, eg, bearing load while bending when tired, but these seem less frequent.  Slightly encouraged in this area.  Still taking tylenol (acetominophen) to manage swelling, but I don't think I need it for pain management.

Still a long way to go for sure. Hopefully I will continue to progress in the coming weeks. In particular, I look forward to regaining some endurance as I fatigue extremely easily at the moment (eg, after being at work for a few hours).

[Clarkey]

Hi NadiaMac,

I am 8 weeks post surgery today and my knee still swollen and painful and feels tight when bending knee 90+ degrees, I also have swelling around the portal and pain on the medial portal. Its good that you are keeping on top of your physio and can cycle at longer intervals it helps to build up the leg muscles again, which go to waste after surgery. I will try and ice the back and sides of my knee to see if it reduces the swelling and ask my GP if it would help taking tylenol to try and get the swelling down. What side affects does tylenol have!

Keep on doing your physio and you should start to recover.

Nick {2010}

[mollyc]

You go girl! Great news!

[Knobby]

4 weeks post. Still feeling pain at medial portal and often times the bone feels swollen. Stiill feeling an awful lot of tightness under the base of the knee and medial side of the knee. Almost feels like a tight rubberband. Sometimes I confuse that pain with patella pain. 4 visits now to PT and i feel discouraged. Granted my right thigh feels like a noodle and just feels like skin and bone, I still can't help but beat myself up when I'm driving in my car and all I do is try to lift my foot to readjust my footing on the pedals and it hurts and something simple as bending your leg while you are sleeping on your back. Extending it back is so painful with pops and cracks. Can't even shove my foot into my shoe without feeling painful pressure on the patella. I'm sorry I sound like Negative Nellie but it feels debilitating.

Hope you guys are faring much better than I am. Keep on with the exercises!

[Clarkey]

Hi Knobby,

Sorry to read on your post that your knee not improving but its only 4 weeks post op for you and are bound to feel pain and discomfort still. I have only seen slight improvements so far as knee still swollen and tight and also feel pain on my medial portal and I am 8 weeks post op and was in more pain 4 weeks ago but its come back again since I returned to work so taken the last 3 days off work till my knee feels ok. I took it as a holiday which I have to use up by the end of March and have about 6 days left.

Nick {2010}

[Knobby]

I'm sorry that you are 8 weeks post op and still feeling discomfort and pain. I can only imagine your frustration. I've heard from many people who have had knee surgeries, PTs and even surgeons state that it will take at least 6 months for the knee to feel normal again. So we still have a ways to go.

It's funny, I get sad when I see people sitting on the floor indian style, a lady having coffee with her legs crossed, people scurrying to the elevator, my boyfriend running up the stairs to fetch my glasses, women strutting down the walkway in high heels looking so confident and sexy and I can't do much of anything but look frumpy in big white tennis shoes! Really gets you down.

I can tolerate the soreness at the portals and tightness at the base but the one thing I can't is the shooting pain behind the patella when I drive, sleep or go down the stairs. I guess it's a reminder of something that is always going to be a thorn in my side. I think the patella is tracking bad as I noticed less pain when I push my patella laterally to the left then the right doesn't rub so much. I guess I have to talk to OS. I'm pretty sure there a more surgeries to come!

Do you have a follow-up with your OS? Are you going to PT? You said you have bad maltracking so do you have patella issues too?

I feel bad that I am thread jacking you post Nadia but reading your progress gives me hope that I can get to where you are. I tried to leg press 20lbs last night and my kneecap felt as if it was going to shoot out! PT said I'm not ready and will do resistance training for now with bands and balls. I need to wake this noodle up! 

[Clarkey]

Hi Knobby,

I can take the pain and discomfort for now but hope it improves when I see my OS on 30th March for my 2nd post op appointment. I been told by the physio's I saw that I have maltracking in both knees but the left knee worse then my right the one that has had surgery. My Physio said if you build up your quads it makes the knee stronger and may solve the tracking problems. My Physio also told me that I should not do any long distance running with my maltracking as it will my my knee worse but cannot do that as I want to be able to run a marathon if my knee heals up to prove to everyone you can still do long distance running if with knees are not 100%.

I hope to be able to run again by summer the latest otherwise surgery was a waste of time as the reason I had my scope was to be able to run again and will do all I can to run again.

Surgery does not always solve knee problems and do say once you had a scope your knee never 100% again.

Hope your knee starts to improve sorry I cannot give better news about my recovery as it does not give you encouragemen that your knee will improve after reading all the negative posts about medial plica excision.

Nick  {2010}

[NadiaMac]

Hey Knobby, do not despair! It's only been four weeks & I think it's possibly a bit early to conclude that the surgery didn't work!!  Something I noticed is that my knee likes it much more if I consciously avoid activities that cause pain, especially intense/shooting pain.  For me, that's stairs (so I do them one step at a time, up and down, or take elevators. always), bearing weight under load in other contexts (so I am not putting my knee into the bad position for the moment and have worked w/ PT to get strengthening exercises that accomplish this), too much walking, too much sitting at work, etc.  By doing as much as possible to avoid pain and excessive fatigue, I find that I have been able to recover better from activity and work the leg harder.

Also, I try to do PT/strengthening stuff (and especially cycling) in the morning when I can work the knee harder.  By the evening, my knee is sore from the days activities and it's really a struggle to get the most out of PT stuff.  One positive of this for me (never previously a morning exerciser) is that it's done and out of the way and I feel like I have a lot more time after work (which I spend snuggled up with my ice machine   ).  Anyhow, just some ideas. I know this won't be feasible or optimal for everyone.
NM

[Knobby]

Hi Nadia - I just signed up with a gym as i think my PT is useless. I've had therapy with her for 6 visits now and yesterday she was massaging my incisions and I was asking her about a hard lumd I was feeling just under my kneecap and she said, "So, what was wrong with your knee that you needed to have surgery?" I was dumbfounded! Well, this morning I tried to get up to get to the gym and just cycle with the same thought as you have in that I get it over and done with but my bed was too comfy! I'm going in the evening but will change that. Plus I look so lame when I am at the gym. My boyfriend calls me Fire Marshall Bill (Jim Carrey's character on In Living Color). I can't find a way to get off the ground. I sit awkwardly on the weights machines. Blah. I'm going to find a new PT and push at the gym. I just get so discouraged when I see people squatting, jumping, running...I want to be just like them!

Taking all your advice and going to work out the smart way!

Hi Clarkey - Yes, i was also told that after surgery the knee will not be 100%. Plus I now feel a round lump on the underside of my kneecap. I don't know what it is but I am assuming more surgery as it is starting to protrude when I bend my knee.

Are you seeing any difference in your quad strength? How many times a week do you work it? The squats don't do anything for me as my good leg always compensates so it doesn't help. Good leg also has chondromalacia but pain is manageable.

I hope you get to running again. I used to be a runner but can't anymore. Just hurts too bad when I do. I'm sorry you are going through a hard time recovering. Maybe it just takes time and we all recover at different levels but let's focus on those quads and keep strengthening. I told myself that I am goint to concentrate on one thing at a time.

[Clarkey]

Hi Knobby,

Tell me about it trying to build up the quads is hard work mine are still like jelly and been doing physio everyday during the last couple of weeks. My OS commented on how strong my quads are but now my right quads have gone to waste and hard to build up again. I will also start going to the gym again next week 3 times a week like I use to before my scope and really want to try all I can to be able to run again.

The lump in your knee does not sound too good and should get it checked out sooner rather then lator to find out what it is and how to get rid of it. I hope it does not involve another surgery and a more conservative method can reduce or get rid of the lump.

How swollen is your knee I am finding it a chore to reduce the swelling and hindering my progress as it makes my knee more tight and painful if I try to squat or kneel.

Nick {2010}

[Knobby]

It is hard work. Sometimes I think I will never get it back. It's a vicious cycle. Can't strengthen quads with bad knee but strong quads will help bad knee. Like the chicken and the egg. Frustrating.

Mine are like jelly too. I can feel a jiggle in my right thigh when i wallk. My left is firm and hard. I've lost inches too on it. I'm at the gym everyday. I've been trying different things and what's funny is that my good quad will burn while I do and exercise but I won't feel a thing in my bad. Whether it's cyclying, leg presses, etc. The only thing that makes it burn or at least reacts with pain is leg lifts and this morning discovered that the eliptical set on resistance and an incline started making my bad quad burn. I'm hoping that it's reacting and somehow knowing it's time to get to work, in essence.

I'm worried about the lump too. I think it's a cyst. I'm seeing my OS on Friday. I hope no more surgery.

The medial side of my knee is still swollen.  It's especially tight and restricts movement in the morning and before/after I work out. I've heard that swelling can be there for at least 6 months. It's soft and tender when I touch. Incisions are also still sore. One thing that has helped me is that when I feel it tightening, I stand on my bad leg, lift foot (good) slightly off the ground therefore all weight and balance is on bad leg. While standing, contract your knee (bad) and hold for 20 seconds, release and bend bad knee slightly for 10 seconds. Then straighthen again and contract knee and hold for 20 seconds. I do this 10-20 times in the morning and it helps with the tightness in the morning and when I need to workout.

[Clarkey]

Hi Knobby,

I can understand how you are feeling about not being able to strengthen quads as I have tried to build them up with no success. I also feel some discomfort in the thigh and hip while doing leg raises which did not happen before. And like you my knee still swollen or even more swollen since going back to work and being on my feet all day and using my knee too much.

Hope knee starts to improve for both of us.

Nick {2010}

[Knobby]

Hi Clarkey,

What kind of discomfort are you feeling in your thigh and hip when doing leg raises? I feel discomfort too but it's more of a burn and tightness when doing leg raises. I think they're taking the brunt of the workload as my quads are weak.

I went to see OS for my follow-up on Friday. He said he was surprised to see that my knee still has swelling. He prescribed Meloxicam for two months. A pill a day. I asked about the lump and he said it was scar tissue from the scope and that it will subside. Subside?? He made me do a simple exercise - while sitting, hyperextending my knee as best I could and lifting and I couldn't. He said my quads are so weak. More PT and gym. Then he asked me to squat and get up and I said, "No!" I told him that I already feel sharp pain behind the kneecap just getting up from the potty. I am not squatting!

Anyway, still pounding at the gym. Hopefully, I will see progress and the kneecap pain will subside. I see him again in 1 month. I want to have some progress by then.

Hope you are doing well and so is Nadia.

Carmen

[Clarkey]

Hi Carmen,

I feel tightness and pain around the thigh and hip area when doing leg raises and affects the other hip as well if I been doing too much at work. How many weeks post op are you, I am 10 weeks post op and my knee still swollen and cannot squat without feeling pain and tightness around the kneecap. I see my OS on the 30th March and if its still swollen by then he may also prescribed me some meds for the swelling. I have been to the gym for the 1st time this year today and knee felt sore after my workout but my physio told me its ok to go to the gym

At least your OS is seeing you again next month, hope your knee improves by then. Scar tissue can be a problem and sometimes needs another scope to remove it which would not be a good thing to have done as surgery is no fun to recover from.

Nick {2010}

[Knobby]

I feel the same tightness. After a set of leg lifts, and as I keep continuing, it almost feels like a sharp, painful cramp in the hip, upper thigh area. By the time I am done, I do feel an ache in my hips. I think the hip area is compensating. The next day I will walk funny due to severe soreness in the upper thigh and hip. Sitting down a lot makes it worse for me.

I am about 7 weeks post op. I still can't squat or at least am afraid too because i know there is pain. The first day I started at the gym, I was having trouble just cycling and doing the eliptical. I felt the pain behind my kneecap with every move I made even if I just had to adjust my footing on the bike pedal or on the eliptical foot piece. I've been going now for two weeks and it's feeling a bit better. There is pain but not as uncomfortable. It is normal to feel sore after your frist workout. Take something and rest. Don't overdo it. On days that I don't go to the gym using the machines like the leg presses, hip abductors, bike, eliptical, etc. that cause me pain, I put on light ankle weights and do leg raises, side leg raises, calf exercises, hamsting stretches and some standing leg lifts. None cause pain but helps when I need to give the knee a break. It actually feels better when I exercise it.

I am worried about the scar tissue. I press deep enough, it almost feels like a pea. I hope it is not a cyst. Scar tissue or not, I can't bear another round of surgery. Thsi was the longest 7 weeks of my life!

Carmen