I've got a few questions regarding rehab and wondered if anyone would be able to offer some thoughts, comments, suggestions.
Background to my injury/surgery: 19th February fell off pony and hit the outside of my left tibia and femur on the pole of the jump, it REALLY hurt at the time but just felt like a hard knock. Went to walk and it was painful to put my weight on my knee. Everyone insisted I 'got back on' - as horsey people do! which I did, with the help of a very high mounting block. Rising trot was just far too painful and it was the end of the lesson anyway, so got off and took pony home. Spent next 2 weeks resting, icing, compression and elevating, very poor ROM, doctor sent me for an x-ray 29th February - nothing showing.
At this point I carried on with my life, working and riding etc with a significant limp, but could at least function, not in any particular pain, just could not bend my knee.
I'm in UK with private health care, so was finally referred for an MRI mid April, this showed significant bone bruising (8wks after impact) - OS was quite impressed that I hadn't broken anything! plus some minor indications that he wanted to explore further - but nothing major on the MRI except the huge white areas of bone bruising on the femur and tibia, he booked me in for an exploratory and clean up arthroscopy on 30th April.
I am now 3 weeks down the line from the surgery, the following is copied from the letter from my OS to my Dr:
The arthroscopy revealed an area of Grade III chondral damage in the weight bearing part of the medial femoral condyle measuring about 1.5cm x 1.5cm. The loose chondral flaps from the edges were shaved followed by microfracture technique for the damaged chondral surface. The lateral tibial plateau itself was slightly irregular and on probing it was clear that the articular surface over the lateral tibial plateau was mobile indicating delamination between the articular surface and underlying subchondral bone. OS said this was not a good prognostic sign. The anterior fat pad itself was quite prominent and this is often the cause for stiffness of the knee and hence this was debulked using a shaver.
The OS also performed EUA and regained full range of movements from 5o of hyperextension to about 130o of flexion, apparently the knee was quite stable.
PT had me weight bearing as soon as I'd had my first cup of tea and biscuits!!! and I was discharged the same day.
I've since had 2 PT sessions and my ROM has gone from 105 on day 9 to 125 on day 17.
My queries are regarding the pain and ability to achieve the ROM. Everytime I begin my exercise regime my ROM is poor, it takes several minutes stretching, massaging and manipulating to get it all moving again. I can use a static bike with the seat on the highest setting, although getting that first revolution takes a while and hurts for the first few.
Although I can 'force' the ROM, I can't make my leg do it by itself, my brain tells it to bend and my leg just seems to ignore it. I am doing quad exercises as well as many others.
I do between 4 and 5 PT sessions a day and am up to 10-15 mins static bike with some resistance during each session.
I have always been very active, am 48yrs old and miss my horseriding, especially as the sun has recently come out and I could get a ride in after work. If only I wasn't worried about twisting my knee and damaging the microfracture area, and if it wasn't so painful to put my foot in the stirrup to mount.
Should the ROM go back to 'poor' within half an hour of a PT session? Is there a way to avoid this? I'm not convinced all of the swelling has gone down, would this be causing the pain and lack of 'natural' ROM?
I also still walk with a significant limp is there a way to rectify this? I'm not due for my next PT session for about 10 days.
I know in comparison to many on this forum my 'issues' are pretty insignificant, however, I would really appreciate any thoughts, comments, suggestions and of course your time for having got this far.