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Author Topic: What to expect after manipulation under anesthesia  (Read 13404 times)

Offline chopchopturtleboy

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What to expect after manipulation under anesthesia
« on: August 01, 2011, 07:46:47 AM »
Hi all. I'm currently 60 days post PCL reconstruction and having range of motion issues. I'm currently at about 8-90 degrees range of motion with only about 20 degrees of improvement in 5 weeks of PT :-\. I seem to be kinda stuck getting past 90 degrees, and my knee is still swollen and warm. My physical therapist called my lack of ROM progress "exceedingly stubborn," and my surgeon has scheduled a manipulation under anesthesia this week.

I'm trying to figure out what to expect after the MUA procedure. Will I be sore as heck for a day, a week? Need to be on pain (narcotic) meds again? Or just feeling like nothing much happened and with much better ROM?

Thanks in advance.

Rick
4-11 - Complete PCL tear (snowboarding collision with a tree)
6-11 - PCL reconstruction surgery

Offline Decruz

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Re: What to expect after manipulation under anesthesia
« Reply #1 on: August 01, 2011, 05:30:40 PM »
Hi chopchopturtleboy,
don't want to scare you, but if you have possible arthrofibrosis (scar tissues into and/or outside the joint) only an expert in dealing with this very specific problem can help you (and you're lucky you're still in the very first months post-op, key thing to succesfully fix this problem if necessary BUT under the care of an AF expert): if your current doctor/surgeon didn't mention scar tissues/fibrosis issues but just generic post-op problems in regaining ROM (such as swelling, fluids, healing, slow recovery, etc) my personal advice, from a lot of experience, is that is stronlgy recommended for you to deeply question him about what's in his opinion the cause of the lacking in regaining ROM post-op (for sure with MRI + xRays for possible onset of patella baya to get his comments about these exams, crucial to understand what he thinks is the cause) and if he'll not mention arthrofibrosis issues, or if he'll admit he don't know a lot about it once you'll mention him about it, or even if he'll say in his opinon you've not this problem (a lot of OS don't know it and sadly answer this way...) it's highly worth, at least to be doubtless, to quickly e-mail you MRI/xRays, BEFORE doing any manipulation under anesthesia, to an arthrofibrosis expert (see a list of names who demonstrated success in dealing with arthrofibrosis here: http://www.kneeguru.co.uk/KNEEnotes/node/427) to understand if you have a post-op onset of arthrofibrosis or if your OS point of view is correct about other causes.
Consider one key thing: the risk is extremely high (maybe is not your case but missing so much ROM post-op is a typical AF signal and if your OS scheduled a MUA is because he feel adhesions and scar tissues are the issue, IMHO), so if are in US and you can easy consult an AF expert to be 100% sure it's priceless, as in the good case you'll know is not AF and what is right to do (MUA or not) and in the bad one you'll be able to be under a specific care for AF not later than the 1st 3-4 months post-op (later could be too late).
Again, ddn't want to scare you, but possible AF is not a thing to play with...
Hope this helped, goodbye
Decruz

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Offline chopchopturtleboy

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Re: What to expect after manipulation under anesthesia
« Reply #2 on: August 04, 2011, 08:04:23 AM »
Thanks for the reply Decruz.

I'm going to have the MUA later today, but will be sure to instruct my surgeon to not push it. Hoping the MUA works, but will ask him about surgical options. I have PT scheduled for the day after the MUA and three times next week. Sounds like frequent PT to keep the ROM gains is very important.

I'm doing the MUA because time is of the essence, and I feel I already waited too long in questioning my surgeon about my poor ROM advances. I'm in Colorado and will call Steadman Clinic if I do not get satisfactory answers from my surgeon.

Would love to hear from fellow PCl reconstruction forum members about their experience with ROM after surgery. I've learned much from this forum and I'm thankful for the resource  :)

Rick

4-11 - Complete PCL tear (snowboarding collision with a tree)
6-11 - PCL reconstruction surgery

Offline Tagranor84

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Re: What to expect after manipulation under anesthesia
« Reply #3 on: August 04, 2011, 09:31:24 AM »
Hey Guys

I am having MUA on Monday I am 4 and half weeks post TKR and have scar tissue preventing me from bending my knee I can only get about 65.

I too am interested in how I will be after procedure and if rom is instant and what sort if pain I will be in afterwards. Any advice would be greatly appreciated.

Julie - Sydney
Left knee 2 x key hole clear ups, 1 x lateral release 1 x Patella Femoral Replacement 2004
Right knee repair bucket handle tear July 2008
Right knee TKR July 2011
Right Knee MUA August 2011

Offline missmyknee

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Re: What to expect after manipulation under anesthesia
« Reply #4 on: August 04, 2011, 06:06:05 PM »
Rick

You might want to post down in the cruciate/ligament section to find PCL info

http://www.kneeguru.co.uk/KNEEtalk/index.php?board=57.0

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline chopchopturtleboy

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Re: What to expect after manipulation under anesthesia
« Reply #5 on: August 09, 2011, 05:58:12 AM »
Well, it seems my manipulation under anesthesia was only slightly beneficial. My surgeon was able to get my knee to 126 degrees, but I didn't feel any noticeable ROM gain in the four days since the MUA. The knee was a little more swollen and achy, but not too bad. I took vicodin twice the day after, with valium the second time, as I went to see my PT the next afternoon and wanted to see how pain meds would help me bend in PT. The meds didn't seem to make the PT hurt any less.

Below is the progress that I started tracking when the ROM gains weren't what I'd expected. I think I got to about 84 on my first PT visit at five weeks post-surgery. These are what my PT can get me to, at the edge of my pain tolerance. In other words, it really hurt to reach these numbers:

104 - July 26 PT
108 - August 2 PT
126 - August 4 (manipulation)
115 - August 5 PT

So it appears that I did get a small bump from the MUA, but not what I had hoped for. My PT says that as long as I'm making ROM increases it's good. I just expected to be past 140 at 10 weeks post-op. Guess my 43-year-old body says otherwise.

The one thing I now wish I had done differently was to rehab the leg more before surgery. I didn't have full ROM before surgery, and only learned after the fact that recovery from surgery is much easier when you have gained max pre-op strength and ROM. My surgeon didn't advise me to wait on the surgery until I was stronger. I wish he had.

I'm worried about my quad muscle shrinking, and hoping that the continued PT will be able to push me through. Maybe my surgeon will advise another MUA?

I kinda wish that there was an option to take a stronger IV pain med, like fentanyl, when my physical therapist is bending my knee. I had fentanyl in the ER after I broke some ribs a few years ago, and it worked very fast and faded after an hour, which would be perfect for a PT session. Anyone have any experience with strong narcotics to help make ROM gains during physical therapy?

Rick
4-11 - Complete PCL tear (snowboarding collision with a tree)
6-11 - PCL reconstruction surgery

Offline Decruz

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Re: What to expect after manipulation under anesthesia
« Reply #6 on: August 09, 2011, 02:34:10 PM »
Well, it seems my manipulation under anesthesia was only slightly beneficial.
I'm worried about my quad muscle shrinking, and hoping that the continued PT will be able to push me through. Maybe my surgeon will advise another MUA?

Rick

Rick,
I had a MUA too with zero results in terms of regaining ROM, the only thing I can say for sure is that many knee AF experts say that if is the case it's correct undergoing one MUA, but not over one.
As I posted after your very 1st post here, you should contact a specialist (if your OS is not) to understand what is the best path for you, multiples MUAs, as far as I know, are not advisable.
I also know of some AF experts that don't take anymore new patients with knee AF if they've had more than 1 MUA.
Contacting an AF specialist now and sharing with him/his staff your latest MRI/xRays/surgical note will allow you in few days to be reassured (if you're on the right path with your OS) or will give you the priceless possibility to immediately swith OS to try fixing your knee AF in the proper way (and this without spending a dollar, if then a visit is needed you can go to see him in person - just pick one close to where you're located).
As I said, time is everything...you're still in the first 3-4 months post-op period, later could be too late.
Bye
Bye
Decruz

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