Friday, I went in for some chondroplasty and came out with chondroplasty, lateral meniscus trim and the excision of a scarred, thickened medial plica.   Ok, there's a reason the procedure was called exploratory surgery 

On the one hand, I'd plateaued after 5 months of PT/SynVist/cortisone/etc.  My MRI was relatively clean, showing only modest cartilage damage on the patella (grade 2+) & OS had suggested that I could non-surgically rehab the knee.  But I continued to suffer severe pain while bearing load (stairs, mild squatting, any open chain activity) and have been unable to cycle more than 35 minutes without swelling, despite significant strengthening of the leg.  It really seemed like there was something else going on down there, and the surgery confirmed that. 

On the other hand, I don't really know what to expect from a plica and meniscus rehab.  Neither had previously been mentioned as a possibility by my two OSs and PT.  I've done a little reading on plica excision since surgery and it looks like it is a painful recovery for some people.  And my cartilage damage was more severe than predicted from MRI (grade 3 on patella, grade 2+ on femoral condyl). I am wondering what I've gotten myself into!  But also really want to believe/hope that this surgery will help me recover

Day 0
The procedure was early Friday morning and I was home by 11 am.  The procedure was pretty short and I recovered well from the anesthesia. I was not put on crutches and even got into the car myself (albeit under the watchful eyes of the hovering attendant).  The knee was bandaged with a bulky dressing and compression sock and I was unable to bend it.  Walking was fine, but I am limping because I can't bend the knee due to the dressing.  I spent the rest of the day in bed with leg elevated, per doctor's orders.  He did not want me to ice (is this normal?).  One hydrocodone every four hours managed the pain nicely, though I felt some twinges when I raised or lowered the leg and I could tell the knee was pretty swollen.  One surprise: I felt bright eyed and almost a little manic, and didnt sleep at all during the day despite geting up at 4 am for the surgery.  By contrast, after my last surgery, I slept about 22 hours straight after getting home. 

I had serious trouble sleeping, waking up every hour and even reading from 3 am to 6 am (very unusual for me). I was not in any pain, just couldn't sleep.  It must be the medication.

day 1
Just as I was finally nodding off to sleep at around 9 am, workers surprisingly showed up to work on the house (I rent a flat in a 2 unit building).  Banging, shouting, sawing, drilling, door bell ringing, door slamming, requests to move my car, flame throwing and stinky roof melting asphalt odors continued on and off all day through 7 pm. And on a Saturday.  Not the restful environment I had hoped for and on a Saturday to boot. I was pretty annoyed.   

Despite this, I spent a pretty mellow day on the couch, leg elevated, surrounded by felines.  My BF did a fantastic job at making me comfortable and fetching drinks, meds, etc., and my sister set me up with books and groceries.

Pain was slightly stronger today and it felt really sore when I got an hour behind on the hydrocodone.  Really sore.  Mid-afternoon, I took the dressing off as instructed.  There were three layers of padding, some gauze, then a giant ace bandage, then a pressure sock on top.  The knee has two small slits (covered by small bandaids), one on either side of the patella.  Swelling is not so bad-- knots on top of the incision sites and some swelling visible mostly on the lateral side (surprised me, since most of the work was on the medial side). 

I covered up the bandaids with some cellophane stuff and took a quick shower to get the nasty itchy iodine off of my leg.  I could bend the knee and it wasn't particularly painful, but I didn't push it since I was instructed to take it super easy for 48 hours.  After the shower, I put the padding, ace bandage and pressure sock back on, since it seemed to be helping with the swelling, plus it felt more secure to put some protective padding over the knee.  It definitely feels weird not to be icing, and I even have one of those continuous circulation ice machines that my sister loaned to me.  I may try it tomorrow, just to see.

I went to sleep pretty late, still kind of wired by the meds, I guess, but largely slept through the night, waking only to take some meds. 

day 3
First PT today.  I was a bit nervous about this last night, as the knee felt pretty sore and honestly I couldn't imagine what they were going to have me do just three days after the surgery.  The knee felt pretty good when I woke up, though-- still sore but less sore than yesterday and visibly less swollen.

The PT thought the knee looked really good and that the level of swelling was really low.  My extension is normal and the knee bends decently (though he didn't push this, as the incisions are still healing, etc.). My patella is a little less mobile than he would hope, so he spent some time mobilizing it (manual manipulation, pushing it from side to side gently and some massage around the perimeter).

I then did quad sets, SLRs, quad pumps, and some gentle heal slides and had my quads/hammies stretched.  Leg strength was decent-- not as strong as before the surgery, but strong enough that I got through the exercises pain free and without a struggle.  I am a little sore now, but it wasn't as bad as I thought it would be.  So all in all a decent start to post-surgical PT.

Tomorrow is my post-surgical visit with OS.   I'm very eager to get more info on the procedure and go over the scope images.  Also, as you can imagine, I am eager to find out whether OS thinks that the meniscus or plica were the pain generator in my pre-surgical knee or perhaps whether some of the cartilage damage was due to the injury as opposed to being pre-existing arthritic wear-n-tear.

Hi,
It sounds like we have very similar stories, though I am now 4 months postop. I went in for a medial partial menisectomy, which was done, plus a medial plica excision and debridement of medial femoral and tibial condyles and back of patella. I was told postop that I have grade 3 and 4 areas of degeneration on the condyle and patellar surfaces. A bit of a surprise!!

I was fully weight bearing immediately after surgery, though I did ice frequently along with the elevation and compression from the bandages. I had good range except for the last few degrees of extension. Still can't lock the knee straight. One week post op I had a cortisone injection in the knee to settle synovitis that had also been diagnosed from a biopsy taken at the time of the arthroscopy.

My quads were nearly non existant and I have spent the last 4 months working on them- lots of hydrotherapy initially and now working out with weights at my local gym. Still keeping my walking to a minimum  which means my husband and son  have to do all the dog walking - a large standard poodle who likes at least two + hours a day. My physio tells me that if I have to walk that I should walk fast.Slow walking does seem to irritate my knee more - so no wandering around the shops!

My knee pain is slowly improving. It is a different pain to my preop pain. The former was more like something was pinching in my knee- probably the meniscus and the synovium and pretty constant.Now it is more a grinding. Stairs, twisting, any movts with a slight knee bend all produce a sharp pain but it quickly resolves. I thougt I would be better in a matter of weeks so  the progress has been very slow but is definitely happening. I do know that if my knee continues to deteriorate I will be in line for a TKR in a few years so getting my knee strong is very important.

Your recovery will probably be a lot quicker as it sounds as if your strength was good prior to the surgery. I am told that a lot of the pain will be sorted once the muscles are strong enough to protect the joint.

Good luck and keep up the exercises.

gillyb

Hi again,

Stairs have been a problem both before and after surgery.  Before the surgery it was a toss up which was worse between going up or down stairs. More recently going up stairs is most uncomfortable though it can depend on the time of day. First thing in the morning descending stairs is painful. My knee gets very stiff overnight, and whenever  the knee stay in the same position for a period of time. Sometimes after driving for 20 minutes or more when I get out of the car  I have to stand still and prepare for the first few steps. I think this is the arthritis and is something I just have to put up with. Today I have a really sore ankle - but this may be due to the orthotics my phsysio has me wearing - just started yesterday. They are supposed to stop me rolling inwards at the ankle and therefore change some forces through my knees. Hope I get used to them soon!
gillyb

1 week
The continuous circulation ice machine is really a marvel and after about 4 hours use yesterday (2 hours on, one hour off times two), the swelling at the incision sites was almost gone this morning. I wish I had started using it earlier!

Visit 2 to PT this afternoon. I was pretty tired from lack of sleep (haven't slept well since the surgery), but managed to work pretty hard. They had me do quad sets, SLRs, quad pumps, heel slides (but sliding much farther than I had been doing), bridges, side leg raises, and leg holds on the sled.  Oh, also another ten minute bike ride.  My leg felt pretty tired after all of this, slightly depressing since this workout was so much easier than pre-surgery. But my knee tolerated it pretty well (though I am a bit sore now as I write this post).  The therapist thinks we'll be back to harder workouts in about two weeks, and that we'll get some indication then of whether the surgery eliminated the source of the pain.   

Question for anyone reading this:
I am invited to a wedding in colorado next weekend (a member of my BF's giant family who I have never met). Travel to the wedding involves a 2.5 hour flight, then a multi hour car drive. The wedding is a 3 day affair with several activities.  I am thinking I am crazy to think of going. My leg is reasonably comfortable at the moment only if I am lying on the couch, preferably icing.  It seems like I will be very uncomfortable flying and sitting in a car and it may not be much fun at the wedding activities, since I can't really do anything except sit around.

Anyone have any thoughts on where I might be in one week for recovery?  Is it crazy to think of going?

day 20
I am making slow, steady progress, but my knee is still suffering the effects of the surgery for sure.  The knee is mostly not swollen, but the incision sites are swollen bumps that makes my knee feel kind of tight.  And if I overdo it (which is still petty easy to do, unfortunately), I feel pain within the knee, mostly at the site of my former plica (medial), but occasionally a dull ache laterally (site of meniscus trim) and a raw feeling under the patella.  I'm not freaking out about the pain, as it seems more inflammatory and is quite different than the pain before the surgery.  But I certainly hope it goes away at some point!  I'm managing pain/inflammation with a lot of icing/ice machine and ibuprofin or tylenol and I definitely notice it if I get behind on either therapy.  I must say that I'm slightly disturbed that the knee is still so swollen, but then again, I did have surgery and I am prone to swelling, so maybe this isn't that atypical. 

Three strange things: I have occasional loud popping/cracking, like cracking your knuckles, especially first thing in the morning or in the first couple of revolutions on the bike.  I never had this presurgery. It's odd, but goes away with further movement. I am assuming this is due to inflammation (my sister, who had ACLr had similar sounds/sensations during recovery). Hopefully this will not persist (some other plica pts on the board describe this persisting).  Second, I've had full extension since the first day post surgery, but my bend ranges from almost normal (heel to butt) to maybe 120 degrees.  I also assume this is inflammation related, as the swelling at the surgical site is making my knee feel very stiff.  Third, my kneecap seems oddly a bit loose. I've always had a very mobile patella, and that's mostly normal feeling. But if I push down on the patella, it seems to move more than normal. I am wondering if this is also due to inflammation. It's an odd sensation. Prbably I should not push on my patella for the time being! Fourth (ok, i said it was only three, but..), my leg is occasionally instable- the knee sort of does a reverse buckle when I take a step.  Again, something that never happened before the surgery. I am assuming that this is due to fatigue (it mostly happened over the weekend after the 6 hour plane/car trip, and hasn't happened much since).

I'm still not sure whether the surgery got the pain generator, ie the cause of the searing joint line pain that really limited my activity pre-surgery. I have been protecting the knee and PT is still baby-PT so I haven't been doing anything that used to trigger that pain.  I have noticed that I'm more comfortable sitting and walking now, so I am cautiously optomistic about the operation.

I did OK with the travel and wedding activities last weekend. Although I spent a lot of time icing and elevating and just sitting around and generally felt a bit uncomfotable and swollen from the ramped up activity and travel, I felt a lot better on Monday traveling back home than I did on Friday traveling out to Colorado. So I think maybe the increased activity wasn't a bad thing overall, as I felt stronger and more confident walking on Monday relative to Friday.

I still haven't gone swimming, despite being cleared to swim with no kicking almost a week ago.  I am possibly going today.  I think I will be very weak and slow and out of shape, but it will be good to swim.

Another change this week is that I've been back to work for big chunks of each day.  I'm doing OK with this, but my knee has been a bit more swollen as a result (more walking, can't really elevate the leg well in the office). I hope to get back to partial working at home next week.