Just this week, I've been able to get out on my bike more, both because of the weather and because the weeks of laying around doing nearly nothing has helped the knee enough that it's not a throbbing mass of pain all day, every day. Now, it hurts pretty much only when I'm on it, and the area of pain is smaller. Last weekend, I rode 28 miles over two days, and then on Thursday, I rode 20 miles. The pain begins almost immediately when I start my ride and builds as I go along. To help combat this, I do take one of my prescribed narcotics with an anti-nausea pill right before I start the ride so that it has kicked in and is helping the pain by the time that I'm done. I also schedule the rides so that I can immediately go home to ice and elevate my leg for a few hours; I can't do much of anything after I've been out for a ride. I'm doing this because 1) I love my bike and 2) I need to do something so that my muscles don't waste away, and biking hurts much less than my PT exercises.

I should point out that I've been told by my surgeon that more biking is not going to hurt the graft at this point; I've even started to ride some very short/small inclines (small enough that I can't really call them hills). I can do whatever is possible, as long as I can work through the pain. It's not a ton of fun, but I've really been struggling with feelings of depression since I had my setback nearly three months ago and have been unable to do much. So biking does improve my mood and mental health!

I saw a different surgeon yesterday for a second opinion about what's going on in my knee. All parties (myself included) don't necessarily think it's my patella that is causing the issue. The new surgeon did say that there is a spot in the DeNovo graft that is not growing (right at the apex of my patella), but since that doesn't hurt, he's not worried. He mentioned there is considerable signal abnormality in the patellar tendon when he was looking at my most recent MRI. He also took x-rays and showed me a spot of bone that didn't look like the rest. He's ordered three more scans to see what the spot is and to try to determine if that could be what's causing the pain. Because of insurance, I'll need to schedule through my primary OS, which is totally fine with me because I like the people there. It's just going to take a bit longer to schedule.

He also asked if I'd had a lateral release during my surgery when he was looking at the MRI. I said, "No, not that I was told anyway." But when he did the physical exam, he showed me that he could move my right (bad) knee cap in ways that he could not move my left (good) knee cap. He said he's almost certain that I had a lateral release. So... I guess that was a surgical freebie? I don't know that it means anything...

So that's what's what. Tiny tangible improvement with being able to bike. Granted, it's with pain, but I'll take it! It's something that allows me to be a bit more active, and that just makes a world of difference.

I hope all my fellow knee geeks are doing well!

Cheers,
lk

Hi Sune,

My knee actually doesn't swell all that much, just enough to feel. It gets a little hot and stiff for a day or two, but then it settles down. The pain lingers for a day or two as well before it goes back to the baseline level of pain. I always make sure to do nothing but rest the day after I bike, but I was able to bike 20 miles again yesterday and that was only one day of rest between the two rides this week.

How are you doing?

Cheers,
lk

Oh, Sune! I'm so sorry to hear that you're still suffering through the setback. I hope that the doctor can find some answers on your MRI. Please keep us posted!

And just a note on the bitter/depressed feelings... It's entirely OK that you're feeling that way. I think everyone has those moments, even when recovery is going well. Some days, I get so tired of hearing from the people around me, who all mean well, that it's "just my knee." Or that I just need to "work through" this. I don't blame them because it's hard for someone without knee problems to understand what I'm going through. But that's why this forum is so great; there are lots of people who understand what you're going through and the feelings of frustration that come when something goes wrong. It's also hard not to second guess yourself (or others) when things go wrong. I'm working really hard right now to just let it go, accept where I am now and move forward. Of course, that's easier said than done. :)

Hang in there! I'll cross my fingers that you have a good appointment with the doc and come away with answers and a plan to move forward.

Cheers,
lk

Today marks eight months since the DeNovo and TTT surgery. Eight fun months. :)

I finally had the news scans done--2 bone scans and a CT arthrogram--and a follow-up appointment with the second opinion doctor. He didn't really say anything that I wanted to hear. He indicated that the only thing that will fix my issues is more surgery. A revision of what's already been done and additional surgery to address a chondral defect on the lateral tibial plateau. There are both fissures and a defect there; I'd only know about the fissures previously, so one of them apparently grew. Disappointing news for sure.

It was an odd meeting with this doc. It was only the second time that I'd seen him, so I have little on which to base my assessment, but I did not get the impression that he really had any interest in helping me. He said he'd send his notes and suggestions for treatment to my primary OS so he could help me. Which is fine. It was more the way he was talking to me and that he got up and left before I was done asking questions. I left with a very bad taste in my mouth, and I'm not sure if I want to see him again.

So, I'll make an appointment with my primary OS to see if he can help me sort things out. If he can't do the surgery himself, we'll have to start the process of petitioning insurance to cover a doc outside the network to do the repair work. And I'll have to decide if I have it in me to face another aggressive surgery and lengthy recovery.

In the meantime, I'm continuing with the cycling. It helps my mind and my knee. I'm still riding several times a week and going anywhere from 20-30 miles at a time. I haven't increased the mileage because I've been adding in some inclines. Doing pretty well! I can now stand and pedal on the hills. That took some work because I was very stiff in the bad knee, but now it's doing really well. The inclines do not make it hurt any worse than just the normal riding, and I get a better workout. I do still need pain pills to ride, and that's why I know that I need to do something more to address the pain.

Hope everyone else out there is doing well!

Cheers,
lk

Hi Sune,

No, I don't take offense! You make some perfectly valid points. I'm just not yet at the point where I'm willing to permanently stop some of my activities (I still plan to get back to competing in equestrian sports). Part of my optimism stems from the fact that the surgeons I've talked with have not told me that it will be impossible to return to my previous life, so I remain hopeful. I do plan to have a very in-depth conversation about potential outcomes for any future surgery. I had very high hopes for the last one, and I think that's part of why I'm struggling to accept that the outcome didn't meet my expectations. If at some point, I had a surgeon tell me that he didn't think certain things will be possible regardless of treatment, I would try to start adjusting my plans/hopes. It wouldn't be easy, so I don't really want to think about it just yet...

I definitely have told my surgeons about my activities and how much pain medicine I take. I probably over share, but I never know what information is going to be important to them, so I spill it all. :) I'd rather them have too much info than not enough to make an accurate diagnosis or solid treatment plan.

I can understand that biking 20-30 miles a couple times per week seems like a lot. I don't feel like it's much because it's all that I do at this point, and it's nowhere near where I was even just before surgery (and certainly not even in the same ballpark as before injury). I'd already phased out most of my PT exercises, and I haven't done any at all in the last couple of weeks. I started swimming for a while, but it wasn't really doing anything for me, and I stopped doing that, too. So, I bike. I don't want to lose the motion and muscle I've worked so hard to gain after surgery. The important part, to me, is that my surgeon has told me that I'm not doing any damage to the graft by biking at this point. Now that I know there is additional damage in there, we might need to reassess because it could be hurting other things in my knee, but I haven't yet had that conversation with my surgeon (I have an appointment in less than 2 weeks, and we'll surely talk about it).

Thanks for taking the time to read my updates and for commenting. I've really enjoyed and been encouraged by the folks who interact on this forum. I hope you're continuing to do well in your recovery!

Cheers,
lk

Last week ended up being a total whirlwind! I met with my primary OS on Monday, made the update here and had another appointment with a new surgeon on Friday.

I mentioned in the last update that my primary OS was going to ask one of his partners if he'd be comfortable doing the surgery that had been suggested by the second opinion doc, but I didn't think it would happen. I was wrong. I got a call three days later that his partner would do the surgery, but he wanted to meet me first and discuss exactly what he'd be doing. So I had suddenly had an appointment for the next day.

I like this third surgeon. He was very open and honest--blunt, really--about what he thought my best options are, and he spent a lot of time talking through everything. He noted that my ROM is good and my strength is pretty good, too. He said that another surgery right now is aggressive, and that it's not going to be fun for anyone. Not me, certainly, and not them because they don't want to have to go in and fix something that's already been done. Plus, the results are less predictable. All good points.

The third surgeon thinks that I should try Euflexxa injections (had those before about a year ago with minimal improvement) and another round of PT with a new therapist. Nothing against my old PT, but he said that each one brings their own experience and ideas to the table, and someone new might have more to offer.

I don't know exactly what to do. Two surgeons tell me that I need surgery. A third says that's a pretty aggressive move. But all three said that the injections are not going to hurt, and they might even help. I feel like that's the path of least resistance, so I got my first Euflexxa injection this morning (first in a series of three). Nothing to it. My surgeon's PA--totally love her--administered it, and she's a pro. A week after the last injection, I will begin the next round of PT. All my fingers and toes are crossed that this time, this will work.

The third surgeon said about the surgery that "doing the same thing and expecting different results is kind of the definition of insanity." Funny because I'd had the same thought when surgery was first put on the table again. On one hand, I'm glad that there's a plan that doesn't involve immediate surgery. On the other, I keep thinking that the insanity definition could also be applied to the Euflexxa and PT. Been there, done that, got the t-shirt. You know? But I'm willing to give it one more try... I think. I'm still trying to muster up some enthusiasm and optimism for this next phase. :)

Cheers,
lk