I've been reading the KG website too much for the past few months - if you have a few mins(maybe 10) for my back story I will share -
I hope this is the right place to post this!
Recently turned 29 and until recently was pretty active - I liked to go to the gym 4-5x a week and do weight training and cardio classes/machines
2 years ago I got medial knee pain that I couldn’t shake - even with PT, rest, cortisone and meds.
The doctor at the time let me know he thinks I need a plica removal with a lateral release - I was told my tilt was minor and since I did not have lateral knee pain I opted to only get the plica excised.
2 years I was great - good as new. Back to the gym and active with no pain at all.
This past June we were on vacation in Canada and I was half asleep in a camper and stretched my leg- I felt like I had to stretch a little further- like you feel pressure in your knuckle before you crack it. And then I felt an audible POP in my knee followed by a quick sharp pain - and then the pain went away. I fell back asleep (maybe from shock!)
The next few days on vacation – swimming and hiking, I became more aware of my knee. It didn’t hurt too much yet but I knew something wasn’t right so I started to take advil and ice it.
Fast forward 2 more days to the 10 hour drive home to Canada - my knee got swollen, hot and hurt. I thought for sure the plica 'regrew' and was causing my medial pain since the pain was so familiar.
Road to treatment -
I saw a doc in the next few days and got some x rays done, - negative- but showed a slight tilt-
Then an MRI- not much going on -some swelling but all looked okay.
1st Cortisone shot - the doc shot it in the front of the knee-(which I questioned the positioning since I had a shot 2 years ago and he said it was fine) Ii had to fly to London for a business trip and the knee FLARED up 2 days in, so painful! . I had to elevate and ice my knee every chance I had. Talk about making a good impression.
Continued with my physical therapy 3x a week - wasn’t really helping but kept stretching and strengthening core, hips and VMO. Pain continued at rest, all day long.
Got a new doctor (doc #2) a knee cap specialist - he tries another cortisone shot thinking the first one missed and got caught in the fat pad.
This cortisone shot didn’t really help either, maybe a little bit. It’s hard to tell if it helped or I am just getting used to the daily pain. I pause on PT since it has been 7 weeks with no progress.. Not sure of the diagnosis and wait to see if the shot will help.
3 months in - schedule arthroscopy knee scope - for this doc to do a possible plica re-re section and possible lateral release.(was in a lot of pain. slept with ice packs on my knee- and every chance i had)
I wake up and nothing was really done - the doc tells me that he doesn’t see the need for a lateral release, the plica scar tissue looks fine - but that I have 2 fissure chondral lesions under my patella on the medial underside- grade 3 out of 4. He says a lateral release would put pressure on that medial side – so he said he had to research and show my case at conferences and try to figure out the best course of action for me. He said he cleaned up some frayed 'crabmeat' and flushed out the joint and hoped that would help while we discuss my surgery options .
Another month or so passes with rechecks and no progress - still in daily pain at rest. He sends me for more tests, more MRI and even a bone scan.
At this point – knowing it was most likely a cartilage issue, I started seeing a cartilage specialist (doc #3) and he advised that the information from the prior scope is not clear - the operative report is not detailed and the 5 pictures from the surgery do not give a clear idea of what is going on (location, size, grade) But that he believes I would be a good candidate for ACI or Denovo - due to the picture of the lesion being clear and the pain I am having.
His concerns were that -
A) I have pain at rest and most people with cartilage lesions have pain with activity or bending or stairs.
B) The pain from cartilage lesions is caused by inflammation - so the debridement and the cortisone shot should have helped and i do not have too much swelling
C) there was no marked injury event.
So we initially agreed to do the Denovo procedure surgery - then I backed out wondering if that is TRUELY the cause of my pain. the rehab is so serious I wanted no doubt in my mind that this was the correct treatement for me.
Now 5 months in daily knee pain - we discussed doing a diagnostic scope in order for him to rule out any other possibilities for the cause of pain and to measure and check out this lesion.
We did the scope last week and it turns out it is not 2 lesions but one large one - about 18mm x 8mm under my patella more central than medial. It is kinda like a flap that is moving and about to go! And he confirmed that I do need a lateral release that there is a lot of pressure there.. that he does not feel would affect the medial side of the patella as the other doc thought. - and I have a bit of a shallow trochelar groove..
Doc #3 advised that he would perform a lateral release at the time of De novo surgery in order to gain better access to the patella, so did not do it at the time of the scope.
He called me the night I came home from the scope to see if I was okay and had any questions, and he mentioned an osteotomy along with the De novo, he said he is not 100% certian that I need it, that he offers it to his patients since it unloads the joint and gives a higher rate of success - and the patient decides whether or not it is right for them, and we will talk more when I see him for the recheck..
After thinking about it all week and discussing with family and friends.. I may choose to hold off on the osteotomy, and do it only if the de novo fails.. I believe I do have some tilt that may have caused this (how I wish I would’ve done the lateral release 2 years ago!! But my doc tells me not to think like that bc you never know what/why could’ve happened)
The osteotomy scares the **** out of me –I have a slight tilt laterally, and my Q angle is normal.. And that surgery seems pretty extreme.. But then again if it increases the chances of the de novo working maybe I will re-consider it. I still have some time.
Doc #3 gave me the contact info of a patient he did De novo under the patella on 8 months ago.. we talked on the phone and he answered a bunch of my questions and even sent me an email with his surgery pics. What a fun bunch we are! Haha he hurt himself playing basketball, and had a failed microfracture.. He chose not to do the osteotomy/AMZ . Says at 7 months he was walking fast (like a New Yorker), doing elliptical and bike. Not yet running or playing bball again. but says is doing well.
**I saw Doc #4 I juuuuussst incase.. He is a well-known cartilage doc in NYC.. he looked at my pics from the first scope ( I hadn’t done the 2nd scope with doc #3 yet) and said he s not sure that I have any cartilage pain but more of a nerve misfiring.. since I said it is a burning pain.. he told me to look into CRPS – and prescribed Lyrica. The prescription never got approved and I called the docs office and spoke to the assistant about 10x..they never got back to me.. Anyways I looked into CRPS and it doesn’t match my symptoms.. since it is more of an ache than an external skin sensitivity burning.
** after this visit I agreed to the 2nd scope with Doc # 3 and the pain is less.. still there.. but less and heightened with activity.
thank you for reading- its okay if you skimmed that was a lot to digest!
tried to keep it short but wanted to give all of the info that is important!
.. I plan on keeping tabs here while I go through this, and let me know if you have any thoughts. Thanks!