NM's surprise meniscus trim and medial plica excision

[Clarkey]

Hi Carman,

What you describe is is the same as my operated knee feels and now it gives in as I found out today, twice knee gave in this morning and felt pain at the bottom of the kneecap. I keep getting told it takes time and things will improve but at the moment cannot see that happening. Sorry you are still having problems and hope things improve for both of us soon as it is no fun having the pressure/pulling like pain and hope it goes away soon.

Enjoy the weekend.

Nick {2010}

[Knobby]

Hi Nick,

I am sick of hearing them say it will get better. And once in awhile they will say that it will never be 100%. If this is as good as it gets, then I am screwed as I can't even get out of a chair without using my arms.

I was doing my wall squats last night and felt pain in my unoperated knee (which also has chondromalacia patella). By night time both knees were hurting. It's a vicious cycle.

I too hope things start to look up. I really do.

Carmen

[Clarkey]

Hi Carmen,

Sorry that you are not getting any better and can understand that you are getting fed up when people say it will get better and just takes time but I got to a stage where it not getting worse or better. Its improved slightly but as soon as I squat feel intense pain around bottom of the kneecap around the portal areas and you do not have to be a knee expert to work out it is scar tissue causing the pain and discomfort.

I can join you as I also feel pain in ther good knee not operated on but its always been a problem, but it is manageable for now. I hope things improve for both of us soon as at the moment regret having the surgery as so far worse off as I can not do as much as I like to in the gym anymore as my physio told me not to use the cross trainer which I enjoyed using before my surgery.

Nick {2010}

[NadiaMac]

hello Kneegeeks,
my goodness, it's been a while since i've posted.  The good news since my last post is that the knee has improved quite a bit, in terms of pain, swelling and tolerance for activity, especially activities of daily living (you know, walking, sitting, being at work).  The bad news is that my lower back is trashed-- it's been really really painful and I have numbness in my legs and am uncomfortable sitting or standing or walking. It started about 4 weeks ago, exactly when I started sitting with my feet on the floor again (you know, normally) rather than elevating legs as I did for 11 months or so.  It seems that 11 months of walking funny/malaligned pelvis/sitting with legs up has messed up my back something terribly. Sitting normally (or perhaps having my pelvic alignment fixed) seems to have triggered the symptoms.

 I'm in the middle of sorting out exactly what is wrong (MRI monday to look at soft tissue-- disc, nerve-- stuff), but candidate is L4/5 disc problems. doc says "your symptoms are unusual", not what you really want to hear.  More will be figured out monday at my MRI, hopefully.  I've been very down about this. And worried.  I've never had lower back problems before.  Or spinal problems.  So I worry that this will be some sort of chronic horribleness. 

The knee is feeling rather decent, at least with normal levels of walking, standing, being at work.  It is still very weak and there are still issues with stairs and bearing load. But there's been a big improvement nonetheless. Currently, the knee feels a bit on hold,though, since my activity has been limited due to the back issues. 

Anyhow, I am not going to turn this into a "backgeeks" posting. I'll post more when I get back to the knee geek business (which I hope will be in a few weeks when hopefully the back thing resolves). wish me luck!

[Clarkey]

Sorry that your back is playing up which cannot be nice but at least you got some good news with your knee improving. I never had any back problems so far but cannot be very pleasant and hope your back surgeon can work out whats causing the pain and how to fix it. I think there should be or at least someone should start a forum and website on back problems as many people have problems with their back and be great to have a back problems website set out like kneeguru but gives infomation about back problems.

I am seeing my OS on Tuesday as my knee still swollen and hurts to squat and kneel, I will be 19 weeks post op on monday and would love to be able to run again one day.

Enjoy the weekend.

Nick {2010}

[NadiaMac]

Hi Nick-
Thanks for the note.  How did your doctor's apptment go today?
 My MRI showed that I have a herniated disc in my lower spine. The doc says this type of thing usually goes away by itself, with time (he says about two months). So, hopefully that will happen with me. I've been referred for PT and will also do a short course of oral steroids to try and diminish the inflammation. Am trying to take it easy and ice a lot, keep the pain in check and at least maintain my leg strength, such as it is.  Hope to get back to knee improvement soon.

[Clarkey]

Hi NM,

My appointment could have gone better on Tuesday as I never saw Mr Green as he was not in the clinic that day and the other OS I saw made out there not much wrong with my knee but was given a cortisone injection that has eased the pain. You can read more about it in my thread on the other 100 post op section.

I hope the herniated disc improves during the next 2 months and your physio can work on it with oral steroids.

Happy Easter, hope you have a good weekend with freinds and family.

Nick {2010}

[NadiaMac]

hello KneeGeeks:
Well, it's been about three months since my last visit and I thought I'd post an update.  Though the last three months have been dominated by my lower-back troubles (more on that in a bit), knee progress has slowly continued, and I have even started riding my bike outdoors again.

So, the back: this has really dominated my rehab and general health these last three months.  Back pain and fatigue from back pain (and severe insomnia due to pain) meant that I really had to ratchet back my knee rehab efforts and alter/substitute rehab activites. For example, leg pressing really irritated the back, so I substituted wall squats (using a large exercise ball) and stair climbing (slowly!).  Cycling bothered the back, so I substituted elliptical which didn't, and continued to swim (which really helps the back). Core exercises are completely tailored to the back.  Etc. Etc.  Back is slowly improving, fortunately. It is no where near normal, but slowly and surely I am increasing activity level and the pain is easing.  I continue lots of stretching and core exercising to help.  Recently, I've been able to tolerate riding my road bike- yay!

Despite the rather severe activity restrictions, the knee/leg continued to strengthen.  But, I still can't go down stairs or bear weight when squatting under load or cycling out of the saddle. And I continue to swell a lot at the portals if I am at all active (eg, 30 mins elliptical, 30 mins cycling).  My PT suggested I return to the doctor to check-in, as PT felt my leg was muscularly strong enough to allow me to go downstairs/ride out of the saddle, so he didn't think strength per se was the problem. So I made an appointment with a fairly prominent SM doc at a local university who specializes in PF pain.  Decided NOT to see my OS again because he was such a jerk the last time I saw him...

This appointment was last week and long story short, I liked the doctor (wish I had seen him after my accident rather than surgeons), and there are two possibilities. 

First and most likely, is fat pad irritation further to the surgery.  This is apparently not too uncommon, as the portals go right through the fat pad. I am to have PT tape me to unload the fat pad (hopefully I will be able to recreate this), rub anti-inflammatory gel into the area four times a day and get steroid/iontophoresis into the fat pad during PT.  This Dx makes some sense to me, and taping at my former PT (McConnel taping, but below the knee cap, provided some relief, even though it irritated my patella b/c I don't have tracking problems).  I am busy reading up on fat pad problems, which seem to be kind of chronic with some folks...

Second possibility is that the pain is due to my grade 3+ cartilage damage on the patella.  Best bet to address this is to continue leg strengthening (you know, theusual "strengthen your VMO thing") and make sure the VMO is firing with the proper timing (there can be "dynamic instability" if the outer and inner quads don't fire synchronously, so transient maltracking even though I don't appear to have a tracking disorder per se).  I fear that this is the cause and that I won't be able to strengthen up to manage it, but I suppose I will just have to see.

In the meantime, I am taking the next two weeks off of work for a staycation-- can't travel due to the back, but I still need a vacation so will stay home and stretch, exercise and generally relax.  I had two glorious bike rides over the weekend up in the wine country North of SF, by far the longest and more climbing of any ride since the surgery. I did pretty well with the rides & the climbing and my mind even drifted away from my knee at moments, which was really nice! There's still something weird about my position on the bike (I think I am sitting crookedly STILL) and I will be bak at the bike fitter for some input on this.  I was slightly depressed at how far I am from my normal fitness level, but am trying to focus on looking forward.

[Clarkey]

Hi NM,

Sorry you are having back problems as well as having problems still with your operated knee. I have still got swelling around the portal areas and over 7 months post op and seeing my OS next week Tuesday. I had problems with my fat pad and had it trimmed and maybe its swelled up again but think its the medial plice excision thats causing me my knee pain.

I can squat but not fully as the bottom of my kneecap hurts and also find it hard to kneel without feelingh knee pain. I started to use the cross trainer as well for the 1st time yesterday for a couple of months as I think my knee ready to use it again.

Nick {2010}

[NadiaMac]

Back again for my bimonthly knee geeks update.  Things continue to improve, albeit rather slowly.  I've been a little down lately about how long this has all been going on-- 18 months now for the knee (10 months since surgery) and 6 months for the back. On the other hand, progress has been made, and I am trying to focus on this rather than dwelling on the last XX months. 

WI last updated, there's been a lot of progress with the fat pad inflammation which was causing quite a lot of painful swelling at my medial portal site.  I started going to PT twice a week (up from once), got steroid iontophoresis on the portal area at each PT session and rubbed smelly voltarin gel (topical analgesic) onto the knee four times a day for several weeks.  This actually really seemed to help and the portal area is now generally rather normal looking and feeling.  I still can't go down stairs without severe pain, but going up stairs is now almost normal sometimes and I can go down a small stair without pain.  So, some progress and we are working very hard at PT on the stairs situation.  Another bonus: I've been able to cut back on the anti-inflammatory (celebrex). I still use it, just half as much.

I have continued to increase cycling distance and climbing (I live in a very hilly area- san francisco) and recently completed a climb to the top of the coastal mountains that divide the SF bay from the ocean-- about a 6 mile climb with 1800 vertical feet of climbing.  This is a real milestone for me as much of the riding in this area feature sustained climbs and I am now hopeful that I'll be back to some of my favorite rides sooner rather than later. Lots of work to do still, as cycling makes my quads very very tight. I have to spend quite a lot of time stretching and foam rolling or else there can be some pain in the knee. I've also developed a little bit of tendonitis (very minor, almost incipient) in the quad tendon and a hint of bursitis in the per anserine bursa. I am watching this very carefull and have re-started regular deep tissue massages, which really help with this (my knee can feel almost normal after a massage-- incredible).  Still a long way to go to regain some semblence of fitness, but it's been great to be back riding outdoors!

The back continues to be a pain, but there has been a lot of improvement and I can now tolerate a full day at work if I avoid sitting a lot.  But it's still pretty far from normal. One symptom that remains is that my glutes, pyriformis, TFL , hip flexor and hamstrings are really tight especially if I've been doing a lot of sitting.  So, my legs and hips have been feeling generally pretty geriatric and crummy (see abve about the tight quads as well!).  I spend a ton of time stretching and rolling myself on softballs, tennis balls and foam rollers.  I am looking forward to some future day when my body responds normally to moderate activity, rather than freaking out and hypercontracting.

Ok, that's all for now. 

[Clarkey]

Hi NM,

Glad you have seen some improvements with your knee and its now 9 months since my surgery and have scar tissue now causing me problems and see my OS on 24th August. I am having friction massage on my medial portal area and have not felt any benefits yet and a steroid injection. The next thing would be a scope to remove the scar tissue. I really want to run again and kneel and squat without feeling pain that I need to be able to do in my job on the golf course.

I find I am ok cycling and can walk out a steady pace and go to the gym 3 times a week and swimming once a week. I hope you back problems also improve for you.

Nick {2010}

[kimmysu]

Hi Nadia!
Just wanted to say I read your blog starting around May when I had surgery to discover my knee pain problem and came out with a drilled out plica.  I was so sad to realize what i thought would be either a meniscal tear (two week recovery) or arthritis (something to adjust my life to) I had this looong recovery ahead.  I wasn't sure how long or what would happen, then i found your blog.  So now it's been 6 months about and I'm still recovering.  Really testing out my ability to run is hampered because I twisted my ankle on the opposite leg pretty badly and I'm undergoing cancer treatment (sigh) anyhow, just wondered how you're knee is healing and if, like me, when the swelling went down, did the mobility increase?  I have managed a run walk for the first time since my surgery (2 miles, 7 tenths jogged, 1.3 walked yay! baby steps)
I haven't gone back to see what happened to your back.  Sorry about your new injury! :-(
Hopefully you will respond with good news.  Or if anyone out there has any news about their knees healing 100% after plica removal and how long it took.
Thanks!
Kimberly

[NadiaMac]

hi Kimberley-
yes, things improved a lot when the swelling went down. Not sure where you read into the journal, but at some point last summer I saw a new doctor-- patellofemoral specialist SM doc (not surgeon) at stanford and he hypothesized that the severe pain when bearing load was due to an inflamed fat pad (mostly medial, but some lateral).  After following his recommended protocol  for about three weeks (detailed earlier in my thread), things really improved. I still had swelling, especially after working the knee, but way less than before.  Anyhow, less swelling/pain, meant that I could do more focused strengthening of the knee and I've even been able to go down stairs in the last two weeks!  Huge for me, as I honestly wasn't sure that I'd ever be able to do this again!  Only took about a year since surgery to get to this point

As an aside, I've never been convinced that my slow recovery was due to the plica removal, as opposed to a host of other factors -fat pad irritation being a huge factor; my crooked walk and weak leg/glutes being another, with my ongoing lower back issues being a third major factor.  None of these factors are specific to the plica removal.  And I haven't had pain in the plica (medial) area (before or after surgery-- my surgeon removed the plica because it was huge, but I hadn't had classic plica symptoms prior to surgery).  So, I am not sure I am really a representative "slow plica patient".

Sounds like you've made major progress-- running is huge! Sorry to hear about your ankle and cancer treatment!  It sounds like you are dealing with a lot!

On another note, I noticed that I haven't updated since August so I thought I'd post a few remarks.  I decided to stop knee/back PT in early September.  I was pretty burned out on multiple medical appointments each week (PT 2X, massage, chiropractor every two weeks, etc), plus I was particularly tired of my PT-- I felt like we were doing the same rote exercises each week (focusing primarily on VMO strengthening) and I wasn't really progressing anymore.  Plus, PT wasn't addressing the back at all, and in fact, was pretty hard on my back (I'd be in increased pain for 1-2 days after each appointment).

I decided to work a while on my own, then reevaluate what to do next.  Anyhow, long story short, I've been swimming 4 times a week (very good for my back and core strength), massage or rolfing once a week (keeps hips and back loose-- good for knee, back and my gait) and really focusing on my abnormal gait (I am burning out on writing this post, but will provde details if anyone is interested). I do my PT exercises (stuff I was doing with PT guy, but on my own), plus have added glute/adductor strengthening, foot/ankle strengthening a range of core exercises plus some back stuff from a back book that I like.   I feel that there's been a fair amount of progress in October, and as noted above, I recently started going down stairs again! Wow!  Still a lot to be done, and I will probably start some therapeutic pilates (if I can make the schedule work). I also may see a back specialist to get some advice on posture/gait/core stuff that might help.

On the cycling front-- sadly, cycling still continues to challenge my back. I had my bike fit adjusted again, and this helped a lot, but basically I am finding that my back is just really cranky after 20-30 miles of riding, especially if I do several days in a row.  I'm kind of bummed about this, but OTOH, I need to be practical and focus on healing, and if cycling is holding up the back, well, I need to focus on something else for the moment.  So I've been mostly swimming again, and riding way less frequently.  I'll see the bike fitter again in the next couple of weeks to see if we can improve my position, as it would be good to be able to ride more (both physically-- leg strength -- and psychologically).

[NadiaMac]

Well, I am having an optomistic knee & back moment so I thought I'd post an update.

But first, a small review of my history (actually, not so brief, as I tend to be verbose and indulgently self-reflective.  This isn't actually that interesting so feel free to skip!):

April 2009: bad mountain bike crash into a stone-lined ravine, where I landed with full impact 6 feet in on my bent left knee-- significant impact injury to the patella, as well as quite a lot of bruising and damage to my lower leg (and hip)

October 2009: exploratory arthroscopy after many months of trying to non-surgically rehab the knee due to clean MRI.  Much failed PT, synvist, icing. Much mental anguish as I transitioned from being a healthy active cyclist (riding 6-7 times a week) to a more sedentary, injured person. Surgery identified & fixed damage to the knee, all fairly routine stuff.

Feb 2010: while short-term recovery from the surgery went well, with significant reduction in pain (particularly the super intense joint line pain, that I think was due to torn meniscus), I remained unable to bear load while bending the left knee.  And there was significant swelling at the portals.  Surgeon was very dismissive of pain, stating that while most folks recover from portal swelling in 6 weeks, some stay swollen for up to a year and there is nothing he could do about it. [editorial comment: still very annoyed at surgeon for dismissive comments, plus he was very rough when he examined me-- seemed quite frustrated that my knee dared to remain very swollen and painful]
So, I took lots of celebrex and iced to manage the swelling & associated pain, and continued a lot of PT.  General condition was improved over pre-surgery but I still could not go downstairs or sit with my left knee bent.  Still in a fair amount of low-grade pain.

~March 2010: One year past my initial crash.  switched to a new PT who "adjusted" an imbalance in my hip alignment. PT program was much reduced in intensity, and after a few weeks, I could sit with my knee bent normally.  But, suddently, my lower back completely gave up and I was in enormous discomfort (or worse, head-spinning levels of pain) while sitting or standing. Also had numbness on the front of my shins and minor sciatica.  Only lying down on ice provided relief.  Back injury would dominate my rehab efforts for the rest of 2010. 

~July 2010: saw a new sports medicine doc regarding continued knee swelling at portals and inability to bear load on left knee. He diagnosed fat pad inflammation, and prescribed a regimen of various antiinflammatories (steroid iontophoresis, voltarren gel) and it really helped.  Back was still pretty sucky.  My overall activity level was very low, except for swimming, due to back.  I continued to do back-friendly body weight strengthening and some cycling, so knee/leg strength did improve some.

August 2010: went downstairs using my left leg for the first time!  So psyched about this!  I still get a smile on my face when I walk downstairs normally. [edit: this was in November]
September 2010: dropped PT#2, due to combination of major treatment fatigue (knee and back rehab, + major circuit of specialist apptments for the back due to some potentially nasty back symptoms which thankfully went away without major intervention, but left me super burned out on medical/rehab world) + loss of confidence in PT's rehab program.  Worked on my own, and actually was pleasantly surprised to find myself way more accountable for exercise and stretching than I was while seeing PTs.  I continued to have therapeutic massage every two weeks, as I have been on and off since my injury.

Oct 2010: one year past my surgery.  Knee/leg a bit stronger, but back still sucked.  Incremental tiny babystep progress on the back.  Pretty depressing time, to be honest.  While I continued to improve knee and back-wise, things were going rather slowly.  The back injury presented a huge limit on my knee rehab, essentially prevented travel (car more than 30 mins, plane/train out of the question) and significantly interfered with my social life. I'd been growing increasingly remorse about the limits that I found myself with.  Plus, my fairly intense desk job (long hours sitting) was very hard on the back, and quite fatiguing.  I worried that the demans of my job, which I generally like, would prevent full recovery.  My level of fatigue after work made it hard to exercise/stretch/rehab as much as I would've liked.  And my personal life was suffering. My partner, generally super-supportive, was developing some compassion fatigue (it's tough to be with someone who can't do anything that you both formerly did together, and who doesn't want to do much on the weekends because rest & gentle boring rehab exercise is vitally important).  This was a tough month, mentally, and super intense work during this period did not help.

Nov 2010: started to see a Rolfer for the back.  Alternating weeks of rolfing and deep tissue massage with another practitioner really helped with the back situation and with left leg tightness (my leg gets super tight with modest exercise, still). Began working on strengthening weak muscles/imbalance on left side-- glutes, adductor-- in an effort to normalize my gait which was still a bit weird (and hard on left leg/right lower back).  Still had significant back pain, especially if I cycled (my passion) or if I didn't stretch 45mins + a day.  Plus, my right (non-injured) knee is giving me some trouble-- puzzling medial pain.  This resolves if I strech my right quad/adductor/hammies, so i am not super worried about this.  My right knee was actually the bad knee prior to my left side injury and I've had some medial pain before (mostly from hard cycling/itb tightness). Nothing serious, and hopefully this won't progress to be a problem.

also: went downstairs using my left leg for the first time!  So psyched about this!  I still get a smile on my face when I walk downstairs normally.



OK, here's the update part of this overly long post:
I had ten days off of work over the holidays, due to a company shut-down.  I was home alone over christmas, since everyone else traveled (by plane) and I am still unable to fly due to the back.  So, I did a lot of thinking about what I wanted to do next with rehab.  I decided to try rehab pilates, recommended several times by my chiropractor, to focus on posture and certain muscle imbalances on my left side (glute weakness, adductor weakness). I started this during the holiday break. My hope is that this will address the root causes of the back pain- posture and weakness. I also rested a lot (minimal sitting) but swam a lot, stretched a lot, got rolfed and generally did all of the rehab work fairly diligently. 

In the second half of the holiday week, we headed out to wine country, where some of the family got together and stayed at a spa.  I made the discovery that my back really responds well to heat.  This was not the case as recently as august, and my back medical professionals had recommended against heat (they wanted me to ice, to reduce inflammation).  Anyhow, it seems that much of the back stuff at the moment is muscle pain, and that heat-- heating pad or spa pools-- is tremendously useful in managing the tightness and lower back pain.  I am by no means normal at the moment, but I've been using the heating pad a lot at home and at work and it's made an enormous difference.  I've been able to cut back on my antiinflammatory and have been able to do more leg related exercise during the week, even after a day at work sitting (this is a huge change).

We also did some hiking while in sonoma.  While my back became uncomfortable, I was pleasantly surprise (actually, super pleased) to find that my knee tolerated the hiking really well, with just a bit of soreness after the second day's hike.  The second hike was all up or down on muddy, mostly unevenly surfaced trails (eg, long portions that were off-camber, such that the left foot was walking on a lower level than the right) and my knee did must fine. I was quite pleased with this.  Also, my leg/gait overall improved after the week of greater leg activity, which was permitted in part by my back feeling a lot better (but also because I wasn't at work getting tired and sore).

So, overall, I am feeling a lot better at the moment.  I need to maintain this momentum, and I've scheduled pilates twice a week to help with this (I find that I am more likely to comply if I schedule actiivities before work, rather than trying to make myself do something after work when I am tired).  Here's hoping that I will continue to progress in 2011. A lot of this is up to me, in terms of balancing work/rehab/rest.  My plan: rehab pilates twice a week if possible, once a week (mandatory), body work every one to two weeks, swim before work one or two days a week and on the weekend, leg exercise (trampoline, cycling indoors, wall squats, etc.) each day (cycling/trampoline less frequently as this is very back dependent). 

OK, enough said for the moment.  Hope everyone has a nice weekend and I am heading out for a morning swim in the fog.

[Clarkey]

 Hi NM,

I am now 14 months post op and still have alot of swelling in the portal areas and still cannot run without feeling pain and discomfort. I still cannot kneel or squat as I feel pain and tightness at the bottom of my knee. I will try whats called IMS dry needling an another form of acupuncture as I could have problems with nerve pain but still think it could be soft tissue damage as my knee was better off pre op then it was post op and think it could be AF. I may be wrong and IMS may work out for me as some members with PFS say IMS has reduced the knee pain and medial plica excision is closely linked with PFS.

I am seeing a sports medicine doc at the moment who will try out IMS and if that does not work not sure what he can do next. Sorry you back is playing up as well as your knee, my PT did deep tissue massage but has not really helped. My good knee is also causing me problems but been told  I have maltracking in both knees so will never be 100% again.

No worries about having a long post it whats KG is there for to post on how we are feeling at the moment with our stupid knees.

Happy New Year hope 2011 is a better knee year for both of us.

Nick {2011}