NM's surprise meniscus trim and medial plica excision

[NadiaMac]

It's a cold rainy day here in Northern California and I am procrastinating my swim in the outdoor pool, so I thought I'd post a quick update on the knee stuff.

Two themes:  Better! but also: Too Much, Too Fast!

Starting with better: after xmas holiday, I continued with weekend hikes.  You can see some details & pictures here:
nadiamac.blogspot.com 

Short story: outdoor activity made me very very happy.  But gait is still odd and I still seriously favor the right (non-injury leg). I built up distance and elevation gain a bit too fast and developed some bursitis (probably per anserine bursitis) in my right (non-injury ) leg- this is the TooMuchTOoFast bit.  So, I am currently on a break from hiking (for the last four weeks), stretching a lot and back on consistent anti-inflammatories.  The good/now bad knee is improving and I hope to add back some hiking once I get a better pair of shoes.  Sad that I am fragile enough that something relatively mild like hiking caused an injury in my good/now-no-so-good leg.

Also improved is my back.  Keeping this short, since this is kneegeeks, not lowerbackgeeks (heh): pilates is really helping.  My lower back is by no means normal, but I am tolerating activity and work (sitting) much better.  Still a ways to go, but I'm quite encouraged!  We are also working on leg/hip stuff, in particular, working on my weaker left (injury) leg, where there's quite a lot of imbalance and instability.  On the whole, ten visits to pilates has been more productive than months of PT. 

I'm still largely off of the bike. I'm sad about this, but I do think it (regular riding) will happen again at some point in the future.  I did get out for about a one-hour ride last weekend while I was down south of the bay area- had to take advantage of weather up into the 70s!.  mostly, things felt OK, legwise (I am really out of shape).  My back/neck were the major limiter, as has been the case on the bike.

[Clarkey]

Hi NM,

I have my own knee blog on KG and undated it last week Friday as I am now over 15 months post op and still regret having had the surgery. I can now can pin point where the knee pain is coming from and is around the medial portal area in my right knee and having IMS which has helped slighlty but cannot see it getting rid of the scar tissue.

I hope you can return back to hiking and its important to have a decent set of walking shoes and should not be afraid to spend a good amount as it better for your feet, knees and back. Good that your back pain is easing and been told pilates is great if you are having back problems. There no rush to bike long distance and can slowley increase the time on the bike.

For back and neck pain an Osteopath is a good person to see as they are better at dealing with back and neck pain and not great at dealing with knee problems as I found out when I saw one about my knees.

I will take a look at your blog and think I will start another blog as well.

Nick {2011}

[NadiaMac]

Time for a spring update!

I had an interesting visit this week to my patellofemoral specialist. I made the appointment because the bursitis in my "good" (right) knee did not go away, despite reduction in my activity level, antiinflammatories, massage, icing, etc.  In addition, a disturbing level of crepitis developed in the knee- so much that people near me have commented that they can hear my knee crunch.  It took ages to get in to see the doctor, and I was surprised to notice just now that I've had the bursitis since February.

Uninteresting part: I have per aserine bursitis in the right ("good", ie nonsurgery) knee. I am getting an MRI next week to look at the bursa, since it hasn't gone away despite 3 months of rest.  The crepitis is likely arthritis, and may or may not be a sign of continuing damage in the knee.  I remain disturbed by it, since the right knee has never given me trouble and never really made a lot of noise, so sudden ultra noisy crunching seems odd to me.  But the MRI will also give us a look into the right knee to see if there's arthritic or other types of damage in there.  For the bursa- if MRI shows significant inflammation, I will likely get a steroid shot into bursa to try to get rid of the inflamamtion.  Also been sent to (yet more) PT.  Doc also suggested that I need to strengthen my glutes, and stretch ITB, hamstrings and quads more.  (can I just say that I am really getting tired of stretching-- complete stretching burnout. I stretch about 45 mins a day, sometimes more. Boring!)


Interesting part: while I was there, he asked if I wanted to participate in a clinical study, which related to comparing Merchant (sunset) view xray to a reclining view xray for measuring malalignment in patients with PFS (don't recall the precise endpoint of the trial).  So, I was measured (q factor, etc) and had the scans. My left (surgery) patella looked OK, but the right one had some lateral tilt and wasn't seated properly in the groove. I also had high q factor on both sides.  Anyhow, nothing tremendously abnormal there, but interesting to see the scans and to be measured.  I'll get more info when I have the follow up appointment for the trial. 

Anyhow, I am not feeling fantastically excited about more PT, since I don't really have a trusted physical therapist. I am trying to find a recommendation for a practitioner at my nearby medical center, UCSF Sports Medicine (so if anyone reading has someone they like, please PM me).

Other news: my back is finally starting to come around, after several months of pilates 2-3 times a week. It's still not great, but I was able to travel by plane for the first time in two years (!)-- first to NY city for a wedding, then to Europe for work. While in Switzerland, I walked around quite a bit and even did some hiking (crepitis and all). This felt very liberating, since my knee & back have kept me in a two hour car drive radius of home for the last two years.  A significant milestone, even if I am not yet painfree. 

[NadiaMac]

Summer update!

Lots of positive developments in the last few weeks. I started PT at a new place and have been really pleased with the therapist and facility.  Things that are different: I work one-on-one with the PT about 25 mins once a week (1 hour for the initial session), then the rest is up to me. He's been great- less rote routine as with my prior two therapists, and more mixing it up depending on how I present on the particular day. Also, lots of new "modalities": cupping on my amazingly tight lateral retinacum and ITB on the right side (painful, but seems to have loosened things up), this giant suction cup thingy on my right patella, lots of taping-- fat pad, and this kinesio tape full leg tape job that is intended to remind me to walk with correct posture. Plus, clear demonstration and practice of relatively simple exercises & stretches I can do at home or at my gym. In sum, I am super-happy with the PT choice and grateful to my doc for making the calls that he did to get me into the facility fast and with the right practitioner.

The new PT has had a couple of helpful insights: my glutes are very weak on both the injury and non-injury side (leading to very unstable hips), and he diagnosed the issues with my gait.  So, I've been complaining that my gait feels off and that I feel like my right leg is too far to the left as I walk for a while now, and prior PTs shook their collective heads and said that it looked all right to them.  but new PT noted almost immediatedly that while I don't have structural malignment problems (no miserable misalignment or leg length discrepency, for example), I am walking with my right shin rotated a lot to the outside and my knee bending a lot to the inside. Also, my left knee is prone to collapsing to the inside, as is the left (old surgery) ankle.  He showed me how to walk properly and taped my up with kinesiotape as a reminder. This has been extremely helpful and my walking pace sped up almost immediately-- incredible how minimizing excess and weird motion translates to greater efficiency. It's also helped a lot with the pes anserine bursitis/fat pad inflammation on the right side, because the right leg twisting/torquing puts strain on those ligaments and the fat pad area on my right knee.  Still have a ways to go with this, but I am definitely progressing. I've been able to cut way back on the anti-inflammatories (though, to be fair, some of this may be due to warmer weather reducing the aches and pains).

On the pes anserine bursitis: I had a MRI of the right (nonsurgery knee) and area and it showed inflammation in the bursa, tendinitis of some of the ligaments in the region, plus some arthritis in the knee (all compartments, including a 1 cm defect that luckily isn't generating pain). Arthritis is mainly asymptomatic except for the extremely loud crunching sound in the right quad tendon, which doc is not concerned about.   I had a steroid shot into the bursa (big needle, as they went in about 2 inches below the bursa and carefully threaded the needle up into the cavity using ultrasound) and there was pain relief immediately.  Generally, things have improved since the shot, which I attribute to the shot and to improvements to my gait.  I'm not sure that the MRI and shot were really necessary, but the shot does seem to have sped up the healing process as I have had more progress in the 3 wees since the shot than in the preceding five + months.

Outside of PT, I continue to do a lot of pilates and my back continues to improve a lot. Still not normal but significant progress such that I am now making it through the work week in one piece (stiff and sore, but I don't need to spend the entire weekend in bed recovering from work, for example). I've done a few small hikes in the last couple of weeks (3-5 miles) and I'm generally holding up knee-wise.  I even did a few small bike rides- did OK with the shorter one, the slightly longer but still super short ride resulted in some right knee irritation-- I think there's either an issue with my clipless pedals/fit or with my right knee rotation/angle, as my right adductor was unbelievably tight after the ride (and still is about a week later).  Working on this one.

Hope everyone is having a good summer!
 

[Clarkey]

Hi NM,

Glad you are still doing ok and can now say that my medial plica excision was successful and now back to running and jogging and can kneel and squat pain free. It took 18 months to recover from the surgery and 4 IMS sessions but got there in the end.

Good you are still seeing your PT and no longer need to see mine as I done what he asked me to do and there no point spending money to see him if my knee is ok. Not so great you have some arthritis in the knee that not been operated on and its the norm to have some arthritis on the knee operated as you are more prone to it after knee surgery.

Nick {2011}

[NadiaMac]

Thanks for the post Nick! I am glad to hear that you are back to full activity and that your knee is no longer bothering you!
-NM