NM's surprise meniscus trim and medial plica excision

[Clarkey]

Hi Carmen,

Sorry to read that you are still having a lot of issues with your knee and know how you are feeling right now as I also finding it hard to recover from my medial plica excision and fat pad and will be 11 weeks post op on Monday but going backwards rather then forward. Like yourself feeling pain in both my hips and knees but been overdoing it at work and the gym so should ease off more, but I find it hard to take things easy and want to build up my quads again.

I also afraid to squat as if I try to my whole kneecap becomes tight and hurts so will not try and force it as I could be doing more harm then good. I even get pain now when doing leg raises and was not as painful a few weeks back. I also go to the gym and do not over do it use the low levels on all the machines but causing pain in both knees once I finished my workout. My main concern right now is the swelling which wont go down and know someone that had the same surgery and her swelling went down after 6 weeks and mine wont go down. I suppose everyone recovers differently some recover quicker then others.

I will not let it get me down will get through it and run again some day, life too short to worry about a stupid knee.

Nick {2010}

[NadiaMac]

Nick, Knobby: the glute/thigh tightness with leg raises may be because you are raising the leg too high (this is what my PT has told me). Also, make sure you are contracting the quad quite firmly before you raise the leg. My PT likes me to have the heel off the ground (from the force of the quad contraction) before raising the leg, but this might not be appropriate for everyone. 

16 weeks post-surgery (aka almost 3.5 months)
It's been a while since I updated and it's been an up-and-down several weeks.  The week after my last post (where I notice that I stated my pain was minimal), the patellar pain worsened a lot, really restricting my ability to do hard work at PT and hurting quite a lot just walking around.  My knee was quite swollen both generally (I could feel pressure on the patella from the inside of the knee) and at the portals.  So I saw OS and he said:
-portals often stay swollen for up to three months, for some folks up to six months and even up to a year
-I may have more generalized arthritis in the knee (after I told him about the swollen sensation in my knee)
-pain in kneecap is due to area of damaged cartilage on the patella (which everyone agrees is preexisting wear and tear damage, not due to my impact injury)
-"you really need to strengthen up your leg" as my best shot for recovery, at which point I burst into tears and said that I wanted nothing more than to be ABLE to strengthen my leg, but the patellar pain is interfering with my ability to do hard work.

Anyhow, all in all an apptment that gave rise to some uncertaintly-- do I now have ongoing arthritis (and what does this mean for future joint pain, future deterioration, etc), how can I manage the patellar pain so that I can try to continue to rehab the leg, is patellar pain something that I will be living with for a while rather than something that I can recover from, etc. Also an apptment that reinforced my dissatifaction with this OS as someone to manage on-going knee problems.  He appears to be great at cutting, not so good at caring for non-surgical patients. Actually "not so good" is very generous, he's kind of a dick to be honest. Very impatient and dismissive.  Only positive from the apptment is that I am now on celebrex (previously tylenol) and it really helps with the pain and inflammation.  As an aside, if I see another MD for the knee, I am thinking it will be a sports medicine PF specialist, not a surgeon.

But, after the rollercoaster of this week and the crap OS apptment, things have actually eased up a little with the knee.  I started getting McConnel taping at PT again, which has permitted MUCH harder work at PT-- squats, leg presses, other hard work-- and my leg has definitely gotten stronger. The taping also helps with my recovery and my knee has barely been swollen the day after PT.  I've also been pretty conscientious about ice machine and icing at work, and rearranged my work office so that i can elevate my leg more comfortable (still a challenge, and my back/arms are not crazy about the new arrangement).  I try to work from home one day a week, usually Wednesday, which gives me a recovery day (recovery from all of the walking and uncomfortable sitting at work), and this has really helped with the swelling issue.  All in all, my leg has looked almost normal a few times this week, and the swelling when present has been much reduced.  Finally!

I've decided to drop my current PT and get a fresh perspective with a new one.  I feel like I am in a rut with current PT and want one who provides a little more individualized attention and focuses a bit more on stretching and flexibility.  I've got a few candidates and need to sort out how to move forward.

Yesterday, I had my first real deep tissue massage since the surgery. He spent a lot of time on the knee area and thinks that I have a little tendinitis in the quad tendon and something below the kneecap as well (patellar ligament?)- he said they felt very tight and less flexible than they should.  Plus, my adductor, VMO and middle quad (vastus medialis?) were super tight. Glutes also needed a lot of work, but ITB (usually my nemesis) was decent.  He hypothesized that my VMO/adductor may have contracted a bit when they wasted after surgery, and that they need some stretching out. He thinks that this might be tugging on the portal area, causing some of the swelling.  Just an idea, but interesting to think about.   Overall a very uncomfortable apptment (deep tissue massage can be very ouchy), but I feel GREAT today (it was yesterday).  My knee feels almost like a normal knee when I walk, absolutely incredible.  I also could squat relatively pain free today.  So super interesting and I really need to get back in a routine with this guy because I think it's incredibly beneficial for me. Unfortunately the location is very inconvenient, so I'm not sure I'll be able to make it every week.

Other newish development: I've added some elliptical as I hope it will increase my walking endurance and also improve hamstring/glute strength. I'm only doing 15 mins as tolerated for now, but may ramp up depending how I feel.  I generally do this after swimming so my legs are kind of tired going into it, so I don't want to overdo it.  I've also restarted swimming lessons, which are great. The instructor is so positive and I leave the lessons with a smile and a sense of physical empowerment (which is pretty incredible when you consider that I am not a very fluid swimmer).  I plan to continue these for 5-10 more lessons.

Here's my current workout schedule for my future reference: swim 4X week (35-45 mins) with kicking (albeit a feeble little kick). No flipturns yet; cycle (indoors with my road bike on a trainer) 6 or 7 times a week, range from 25 mins to 1 hour (workout varies depending on time and fatigue, but I am trying to do intervals 4-5 times a weeks, plus at least two workouts at higher resistance), about 1-1.25 hours mat work  (home PT as I call it-- quad sets, SLRs, bridges, side-leg work, squats, toe raises, other ankle exercises, misc exercises) and stretching each day; PT twice a week (my only time with weight machines due to needing PT to tape me; I am looking into McConnel taping for myself, since PT refuses to show me how), core work one or two times a week (relatively brief sessions of situps and planks if I am feeling energetic); elliptical as tolerated when I happen to be at my gym.  whew this is making me tired to look at it!

Hope everyone else is feeling better.  Update and let me know how you are doing!
NM

[Clarkey]

Hi NM,

Just like myself you are finding it hard to recover from my medial plica excision and are worse off because of it. I also like yourself have a swollen knee on the top of kneecap and portal areas and been told like you pointed out can take 6 months to a year for swelling to go down in the portal areas, my physio even told me may have some swelling all the time around the portal areas. I like yourself feel pressure around the knee and portal area if I try to squat or bend my leg up to my thigh. Sorry you have arthritus and thinking I may have it as well in the job I am in working outside all year round.

I am little bit behind you post op (3 months) but as we both have found out so far our surgery has not been successful.

Nick {2010}

[NadiaMac]

Hey Nick- I'm very sympathetic to how hard it must be to be on your feet all day for work, not to mention the chilly outdoor weather. I'm having trouble with the walking at my desk job where I sit most of the day.  Makes it tough on you for sure!

I actually don't think that my surgery is a failure, at least I am not ready to so conclude.  There are a lot of things that are better now, a lot better than before the surgery.  It's just that pesky patellar pain that's the current obstacle. I am hopeful that the swelling will slowly pass and that I will slowly strengthen up and will return to some level of pain-free activity...  Time will tell and for the moment I am choosing to be optomistic about it   I can't keep plodding along otherwise

[Clarkey]

Hi NM,

I do not really give my knee enough rest at work and when I get back home go to the gym as I cannot sit around doing nothing and enjoy my time at the gym. Maybe it is too early to if say surgery been a failure, but in the same situation as you and my knee worse off now then it was before my surgery and was expecting to see some improvements 12 weeks after surgery.

I am now thinking that running again is the thing of the passed and maybe will never run again!

Nick {2010}

[NadiaMac]

Brief news flash
Yesterday, I rode my bike on the road for the first time since the accident in April-- I was in a rural area near Pinnacles National Monument (100 miles south of San Francisco) to help run a bike race and took the opportunity to ride on the quiet country road.  I rode for about an hour and ten minutes and it went really well!  At first, I was quite nervous about the knee-- was I going too hard?  How would I handle the hills (gentle, but definitely long rollers/small hills)? Is my knee tracking ok?  Etc.  But after turning around (I rode out and back on the race route), I got into the rhythm of riding and almost forgot about my knee! I did not feel any pain and my leg wasn't obviously fatigued when I finished. I iced and stretched, pretty much as I do on any day, and it was fine later in the day and this morning when I woke up.  Needless to say I am very pleased and excited!  Hope I can continue to strengthen up so I can ride a little more locally. It's pretty hilly locally with the longer/steeper climbs presenting a higher bar for cycling, so I have a ways to go before this is an option...

Tomorrow, I start with the new PT. Wish me luck. I hope it goes well.
NM

[mollyc]

Congratulations! That is such great news!!! And, so different than the last time you tried it pre-surgery. This must be very encouraging for you...and, a testament to all the hard work you've done and care you've taken in your rehab.

How did the PT go?

[NadiaMac]

thanks! alas, no PT apptment-- apparently a miscommunication about the time/existence of an apptment. Bummer. Hope I can get in later in the week, otherwise, I'll have to try the other place (which is super inconveniently located).

[Knobby]

Hi Clarkey and Nadia,

Sorry for the delay in responding. Aside from the knee problems, I've been struggling with cubital tunnel syndrome (ulnar nerve pain in my elbow) which is now interfering with my gym work. One after the other. It's really bringing me down. The hard part is that I need my arms to help me off the potty (TMI sorry), get up from a chair, get in/out of car, etc. and it hurts so bad.

The knee still has its days. I think the swelling is going down. Still can't squat low enough. Wall squats are painful for me. I've been going to the gym everyday, doing 30 minutes on the eliptical, hip adbductor work, leg raises at every angle, thera band exercises. I tried walking up the stairs at the gym and i did it without the th help of the railing although I looked weird walking with my butt sticking out reaching way up into the sky but I was just glad that it seemed like progress to me.

I see my OS tomorrow and I'm hoping he sees changes. I can't tell or maybe I am so bummed by the elbow as well and the knee that I can't see any good in anything.

But I am going to go to the gym and continue my PT. If anything, I really have to work this knee if it comes down to having to have surgery to fix the elbow.

Carmen

[Clarkey]

Hi Carman,

I am glad some of the swelling has gone down but sorry you now have another problem to deal with. It cannot be nice to have pain in the elbow as well as the knee, I also find it impossibe to squat still as bottom of my knee becomes tight and painful. Good luck when you see your OS tomorrow hope he can do something to help you out. It is good that you are going to the gym and keeping on top of your PT, I have been told today by my physio to do less work at the gym that involves using my knees and concentrate on my upper body more and to go swimming more often.

NM great that you was able to cycle without feeling your knee too much and hope things start to improve from now onwards.

Nick {2010}

[NadiaMac]

short update: new PT

Today I saw my new PT. In the interest of keeping this kind of short, I'll skip a lot of details.  Long story short, the apptment was very interesting, and the upshot is that my pelvis is malaligned with the bad (left) side raised up almost 1/2 inch.  This effectively shortens my left (bad) leg, so that my left foot is about 1/2 inch shorter when I lie on a table and line up my feet.  As you can imagine, this leads to all sorts of horribles in the knee (and my gait), as well as strain on the quads and adductors, etc.  The therapist speculates that the prolonged swelling in my knee and portals is due in part to this.  He also says that I have tendonitis in my quad tendon (it is thickened and a bit stiff) and adhesions at the top of my patella, and these are pushing the patella down a bit so that it enters the trochlear groove too early. He thinks this is probably the source of some of the patellar pain I feel when bearing load. 

What next??  Fortunately, my pelvis was easily realigned by a little stretching exercise (it was cool-- my feet lined up properly afterwards and I could feel a difference when I walked).  The trick now is to strengthen the muscles in my pelvis to keep proper alignment.  I have a few basic exercises and will get more at the next apptment. I am also to continue deep tissue massage (to work on my sorry tight and knotted quads and adhesions around the patella) and continue my regimen of stretching, foam rollering and cycling. He also wants me to add some leg pressing to help maintain muscle.

Something else I've been doing (independent of any medical advice) is to wear a compression sock on my bad leg-- it comes up just to the base of the knee, covering the portal area, and really seems to help keep the swelling down.  Hopefully I won't need to do this in the future, but for the meantime, the combo of compression sock and some elevation and icing at work is keeping me in reasonable shape at work. Which is a great relief because it was a big drag to be in pain and exhausted after a day at my desk job.

I'm cautiously optomistic, but of course, need to see how the new therapist/program work out over a couple of weeks.

[Clarkey]

I am pleased you may have found out the reason for your knee pain and discomfort and it is great that you have a good physio who knows what he talking about. Hope you can get you pelvis realigned by doing the stetching and the compression sock helps as well.

Nick {2010}

[Knobby]

I'm amazed that your PT can pinpoint all the issues that are causing you pain. I'm glad that you can at least work from what you know. Sometimes I wonder if I have a good PT. I've had two so far and none have come close to diagnosing issues that are causing me pain. All they keep telling me is your quad is weak.

I had my one month progress test at PT yesterday and I didn't fare well. Could not squat. Could not fully do my heel touches. Could not walk down the steps. Could not hop. So, have to keep at it. And all I was told was that my quads are weak. I think I have scar tissue just under my kneecap from the incision but they keep saying, "It will go away." Think not. I wonder if it hinders the movement of my kneecap.

She asked me what I did on other days. I told her eliptical, bike, exercises with the bands, squats to which she said not to overdo it as it will hamper my progress at PT (as in my knee will be too tired to fully gain from exercises at PT). I was confused and two weeks ago she was talking about how patients don't exercise outside of PT which makes the recovery go slower or become non-effective.

Anyway, I think you are doing great Nadia. I wish my PT could tell half of what you know from your PT sessions.

For now, I will still continue gym work and PT. I measured my thighs last night and the athropied quad is 1.5 inches smaller than the normal one. So that will be my tracking chart and walking down a flight of steps. Small victories I guess.

[Clarkey]

Hi Carman,

I am also lucky to have found a good PT and he told me not to use the cross trainer at the gym and not to use the bike too often. I been told I have scar tissue by my PT who manipulates it every time I see him and wants me to see my OS earlier. When you squat does your kneecap become tight and painful around the portal area as mine does each time I try to squat. It feels as if someone is putting pressure along the bottom of kneecap and is very painful if I try to squat too far.

Nick {2010}

[Knobby]

My PT never touches mt incision areas. I massage it myself although I think it's far too late now and it can't be massaged away. When I squat, I fell a pulling pressure on each side of my kneecap and the bottom part of my kneecap. Almost a pressure/pulling like pain. I also feel pain/pressure under the kneecap. The bad part is my other knee is bad too, so it's hard to tell which is causing me more fear, the bad one or the good one. I think that in time, if my quads get back to normal and pain has reduced, i will get the other one fixed too. Right now, I can hardly get to 90 degrees as both knees will start to hurt.