Knee Denervation due to multiple knee surgeries

[rob wilson]

I have already had the knee denervation surgery to both my medial and lateral areas of my left knee. It was hugely successful. I believe that my latest scar tissue surgery aggravated this. I will be seeing a specialist next week to review my options. My symptoms are burning and stinging in the incision areas.

http://dellon.com/publications/ipns.brochure.6.05-2010.update.2pp.pdf

[missmyknee]

Hi Rob

Did you use Dr Dellon?  If yes, how did you find out? When was your surgery.  Dr Dellon is my nerve surgeon. He is awesome ! He is hoping I can get back to see him at the end of Oct for surgery. In Nov 09, He did 8 procedures thru 4 incisions :

Neurolysis of the sciatic nerve, common and peroneal nerve at the knee, denervation of the proximal tibiofibular joint, neurolysis of the superficial peroneal nerve, fasciotomy of the anterolateral compartments of the leg ( for compartment syndrome of the left anterior and lateral compartments), resection of the deep peroneal nerve, resection of the saphenous nerve in the thigh and implantation of the nerve into the adductor muscle group, resection of the medial cutaneous nerve of the thigh and implantation if the nerve into the vastus medialis, resection neuroma of the medial retinacular nerve and implantation of the nerve into the vastus medialis and denervating the sinus tarsi

Did you buy his book, "Pain Solutions" ?  I did, it is very good. 

Pam

[rob wilson]

Pam - Dr Dellon has performed 3 surgeries for me. All very successful. 2 knee denervations and 1 tarsal tunnel release. Yes he is deifintely awesome.

[marco4432]

After two torn meniscus surgery I'm in constant pain, I am scheduled to have surgery with Dr Tollestup who trained under Dr Dellon this friday for knee denervation, he gave me a nerve block and for 12 hours I felt like I had a new knee, am worried about upcoming oporation as it seems that not many people have had this surgery done, any furter info you might have would be greatly appeciated.

Marco

[Stasha83]

I am also very interested in this, I didn't realise you could denerve a knee. Could anyone explain how it works please?

[rob wilson]

[/quote

If you read this you should understand better.

http://dellon.com/publications/ipns.brochure.6.05-2010.update.2pp.pdf

[missmyknee]

Hi

Here is an excerpt from my blog, about my experience with Dr Dellon

   " Today was my appointment with Dr Dellon at the Dellon Institue of Peripheral Nerve Surgery, in Baltimore or rather Towson Md. All I can say is WOW! I was really impressed with his knowledge, easy explaination,and amount of time spent with me. I was there 5 hours , the first hour spent waiting, paperwork, ( reading his textbooks) and the next 4 hours undergoing time with Dr concerning history and exam, series of nerve blocks, anatomy of nerves in the knee and treatment plan. I had all sorts of ink marks on my knee and leg , plus he took pictures.  I found out I also have peroneal nerve damage on the lateral side from my TKR dislocation in 2006 and shattered proximal fibula 2000 and deep peroneal nerve and sinus tarsi nerve from my broken ankle and surgery in 2000, besides all the medial knee pain. I've had pain in those areas for a long time and he knew just where to hit the nerve. He did several nerve blocks. He says I am one of the worst cases he's seen and he will need to do 6 procedures that involve each, their own incision. I will have some major nerve work done to the saphenous nerve at the adductor canal and 3 incisions with nerve resection on the medial side of the patella and down near the mcl. On the lateral side he will be going in near the fibular head to the peroneal nerve to decompress that nerve and halfway down from there will be at the deep peroneal nerve and further down to the sinus tarsi. He won't know til he sees the area whether it will be a resection or a decompression.  This is an outpatient procedure, so I will go back to the hotel afterwards. I asked about potential for redevelopement with scar tissue. He says there are no guarentees but did say with plastic surgery techniques, they are very precise and done in a way as to not inflict collateral tissue damage unlike orthopaedic surgery so recovery takes less time . I will be able to walk around soon after. He did say that about 10% of patients will need an additional procedure to other nerves.  He was very eager to teach about the nerves and use visuals to show me. There were other patients there from other countries and states. He feels very confidant he can help me become nerve pain free and to get off PM meds. These are sensory nerves and will not affect ROM. I will not lose the ability to feel if I developed a mechanical problem . I was concerned since I have scar tissue anteromedial to the patella that we are watching.

    My surgery lasted 3 hours. Dr Dellon said surgery involved 8 very complex procedures thru 4 incisions. He said each incision was a single surgical procedure done all by it's own , so to do all 4 of these procedures in one session was really unheard of. Two of the places involved having to cut into muscle. One of those was the surgery on the saphenous nerve thru the adductor canal. this is a about a 4 inch incision going from  about mid medial knee up to the thigh. He said he could see all the areas where Dr N had worked on the nerve. He said the nerve was very scarred down onto muscle, tissue, ect. No wonder this hurts now since it involves muscle work. He had another incision on the medial patella to the medial patella nerve and said he had to go into the joint , I was so scarred down there, He resected the saphenous nerve and buried the ends in the muscle. I am numb from the patella to the whole medial side of my knee and from the middle of the tibia over medially halfway down.

    The next incision is on the lateral side where the fibular head is located. This incision is about 3 inches and was for work on the common peroneal nerve. It was for debidement and decompression. Once again Dr D said it was so scarred down then he went on to the deep peroneal nerve and sinus tarsi. This was done thru the incision on my lateral ankle where it had been previously broken and surgically rebroken back in 2000 and 2001 and more work to trim bone last January. He said that area was very bad and took a lot of time. My deep peroneal nerve was kinked under bone, He cut between muscle and had go between the tibia and fibula. He said he visualized the 2 fracture sites where nerve was adhiesed to bone and muscle. He was just really amazed at the scarring but he was so happy he was able to save the deep peroneal nerve and not have to resect it. He also resected the sinus tarsi to help with the anterolateral ankle pain I have and will continue to have regardless of a nonunion or not of the ST joint fusion. My leg is bandaged from thigh to ankle. He said I would be able to walk afterwards and just use my cane. We went back to the hotel about 4:30. I'll keep the dressing on til the 19th after that I can remove them and start using betadine 3 times day to the incisions. I'll get the stitches out in 2 weeks at PCP office. I kept my leg elevated and ice paks to the thigh and ankle where the muscle was cut. That evening Dr Dellon called me to see how I was doing and said he would be stopping by at 9am to check on me.

    At 9am Dr D came to my hotel room to see how I was doing. He had me touch several areas on my leg/foot and told me which ones were numb from anesthetic injected in and from resected nerve. I did not have any nerve pain ! He went over my surgery again and answered some questions I had. He went over my return visit at the end of January and we discussed another surgery to possibly be done at that time. This would be to the tarsal tunnel, to work on the lateral plantar nerve. I lost the use of that nerve when I had the plantar fascia ruptured and lost the tibial tendon function which is why the ST fusion was done. I have no movement to all my toes except the big toe of my foot and they kind of just flop when I walk. He was very happy with this surgery and so am I. I have not had any nerve pain since...no burning,needle sticks,zingers,throbbing aching...nothing. I should be able to get copies of surgery and Dr's report soon , so I'll be able to describe more accurately, what was done.
    I am so excited to have no nerve pain !!.....I am almost afraid to be excited and happy. I have surgical pain from all these incisions and muscle involvement, but no nerve pain  Grin Let's hope no scarring up.  Dr Dellon has been great, very nice, loves to explain all aspects of surgery and really cares to make you painfree. I highly recommend him for nerve issues.

 Today I got a copy of my op report. He did:

    Neurolysis of the sciatic nerve, common and peroneal nerve at the knee, denervation of the proximal tibiofibular joint, neurolysis of the superficial peroneal nerve, fasciotomy of the anterolateral compartments of the leg ( for compartment syndrome of the left anterior and lateral compartments), resection of the deep peroneal nerve, resection of the saphenous nerve in the thigh and implantation of the nerve into the adductor muscle group, resection of the medial cutaneous nerve of the thigh and implantation if the nerve into the vastus medialis, resection neuroma of the medial retinacular nerve and implantation of the nerve into the vastus medialis and denervating the sinus tarsi.The procedures took up 3 pages of the report."

I hope this might shed some light. You can go to his website and read some of his pamphlets on the subject or email him.                   www.dellon.com

Pam

   

[Stasha83]

Thank you for all the info and for sharing your experience Pam.

This is very interesting indeed. I have printed the brochure from the link to read further. I am having another surgery tomorrow so may take the brochure with me and ask my OS if he does a similar procedure. I am based in the UK so wouldn't be able to see Dr Dellon. The thought of getting rid of some of my pain would be amazing.

[Lottiefox]

Wow!

Do you think this kind of approach would work with RSD/CRPS symptoms that began because of nerve damage/disruption during surgery (thinking of foot surgery at the moment). I know RSD has a more diffuse underlying pattern and involves the sympathetic nervous system, but if the cause started with a specific nerve being affected and with pain still localised around the areas linked to that nerve and others coming off it, could denervation short circuit the messages? Or would more surgery just fire up a bigger RSD response?!! Interesting work though.

Lottie

[missmyknee]

Hi Lottie and Stasha

Dr Dellon is a world reknown peripheral nerve surgeon. Peripheral nerve surgeons know all the nerves in the body. OS's don't. So if you want to talk about dennervation, see a very well qualified peripheral nerve surgeon.

Dr Dellon does surgery for RSD. He has taken patients who were completely debilitated and made them active people again. He does not have a pamphlet on it , but there is a whole chapter ( chapter 7)  in his book, Pain Solutions. It looks like you can now down load each chapter free, so down load a read about it at this link:

http://www.dellon.com/content/view/116/307/

Download chapter 3, which talks about knee dennervation

I had to pay $6.00 per chapter a few yrs ago and bought the book.

Pam

[missmyknee]

Here is a link to the book, Anterior Knee Pain and Patellar Instability. Go to Chapter 23, page 363 on Neuromatous Knee Pain, Evaluation and Management

http://www.scribd.com/doc/13227524/Anterior-knee-pain-and-patellar-instability

Pam

[captainruss]

Pam,

I am amazed at your knowledge!  I am going to print the pamphlet from Dr. Devon and download the first chapter of his Pain book.  I read your post and understand that he works on all nerves, but I suffer from my upper spine, lower spine, left and right shoulder, and the right knee.  I see how many separate procedures you endured just for the knee and wonder if he could possibly have a way to affect all my areas.

I was changing a light at a race track I operated in Michigan in 1989.  I heard the pole crack and awakened in the helicopter on the way to the hospital.  They called my wife and told her to hurry and say goodbye.  I actually recovered three months later after two back surgery and two shoulder surgery.  I am not perfect, but prior to the TKR, I worked 70 hours a week as a USCG Captain.  I so much need to work to put my three teenagers through college.

I hate oxycontin, but it and the pain pump are how I get up each day.  I am married to an extraordinary 2nd degree black belt insturctor.  She has never had surgery in her life and is very healthy.  Needless to say...I need to do something to again become healthy and resume chasing her around the neighborhood. 

Thank you again....you gave me more information in one post than I have learned from the past 10 years of doctors.  They either cut on your or push the pills. 

I was so angry my last four knee procedures.  The nerve block did not work and it is murder waking up with my medication tolerances.  I try to tell myself I am strong, but I just laid there and cried sometimes.  I cannot understand why an anesthesiologist cannot perform a common nerve block prior to surgery?

Thanks again.

Russ

[starpolisher]

Another reason why Astym treatments are preferable to repeated operations to remove scar tissue.  I have learned about RSD from the Facebook Knee Geek site and have emailed Astym about having Astym if you have RSD.  I was told if you have a very severe case.....(#4 rating).....it is very painful.  Surprisingly, however, a milder case of RSD responds at times with less pain to Astym than the therapist massaging you.  There is widespread interest at that site re RSD and Astym.  Fortunately I don't have RSD!

[captainruss]

What is RSD?  How does astym work?

Russ

[starpolisher]

Russ,

 Go to the following website for a very in-depth explanation of Astym:  www.astym.com.  You can also email questions and receive excellent answers and very quickly!  I don't have RSD so can't go into any detail there.  I do know that it seems some people who have a number of surgeries on their knees develop a nerve pain problem....RSD....and there are 4 stages of it.  I am sure there is probably information somewhere on this site re RSD.  I only know about it because some of our forum friends who have had a number of operations on their knees have developed it.