Author Topic: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair  (Read 3960 times)

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #30 on: November 21, 2016, 12:36:44 AM »
Started sleeping without the brace on Friday the 18th. Itís been fine without it. I still wear the brace outdoors. Recently, the left knee has been giving me troubleÖ Not sure how Iím going to deal with it yet. Since itís gotten to the point where itís hard to keep track of all my exercises, Iím going to post which exercises Iím currently doing:


Quad sets 30 seconds, 30 reps
Prone Quad stretch, 2 minutes
Ankle inversion, eversion, and flexion (opposite of gas pedal), 30 reps each
Long Arc Quads 5 second hold, 20 reps
Prone Hamstring raises sets, 5 second hold, 20 reps
Hips: front, back, side, 30 reps each, 5 lbs ankle weights. Make sure that hip is even to the ground and when doing the side, can bring the leg a little bit to the back
Calf raise onto big toe, shift weight onto little toe, come back down, and then reverse direction back onto big toe and go back down. 30 reps
Lateral Weight shifts 15 seconds, 30 reps
Front weight shifts 15 seconds, 30 reps
Move laterally around bed through weight shifting
Foot dangling, hamstring sets from 90 degrees to higher. Hold for 15 seconds at top
Calf stretch by putting foam roller onto wall and putting ball of foot onto the round part of foam roller. This helps stretch the top part of calf
Quad stretch (really good for vastus lateralis) with foot dangling off of table by using left foot to push my right foot inwards
Roll ball around piriformis muscle. Push ball down first on the muscle and hold. Then move up and down muscle and then roll in circle
Roll ball around vastus lateralis in same fashion
Patella mobilize side to side

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #31 on: November 24, 2016, 02:08:46 AM »
PT examined my walking and said it looked good. He didnít notice any wobbliness, but stressed that I should wear my brace only when walking long distances. For the Bike, I am about height 15 and I could go onto level 5 for resistance. He also tested out a 1 lb ankle weight while I did the Long Arc Quad and it was still ok to do. He did manual therapy on my hamstrings mentioned that they were tight. I mentioned that when changing directions during my gait, there is some pain on the lateral side. He said that this could be stress on the lateral ligament.


I was given two new exercises, Side to side along the wall with slight knee bend, and a new one that is like side to side, but zig zag, so each movement has a diagonal movement rather than just pure side to side.


Quad sets 30 seconds, 30 reps
Prone Quad stretch, 2 minutes
Ankle inversion, eversion, and flexion (opposite of gas pedal), 30 reps each
Long Arc Quads 5 second hold, 20 reps
Prone Hamstring raises sets, 5 second hold, 20 reps
Hips: front, back, side, 30 reps each, 5 lbs ankle weights. Make sure that hip is even to the ground and when doing the side, can bring the leg a little bit to the back
Calf raise onto big toe, shift weight onto little toe, come back down, and then reverse direction back onto big toe and go back down. 30 reps
Lateral Weight shifts 15 seconds, 30 reps
Front weight shifts 15 seconds, 30 reps
Move laterally around bed through weight shifting
Foot dangling, hamstring sets from 90 degrees to higher. Hold for 15 seconds at top
Calf stretch by putting foam roller onto wall and putting ball of foot onto the round part of foam roller. This helps stretch the top part of calf
Quad stretch (really good for vastus lateralis) with foot dangling off of table by using left foot to push my right foot inwards
Roll ball around piriformis muscle. Push ball down first on the muscle and hold. Then move up and down muscle and then roll in circle
Roll ball around vastus lateralis in same fashion
Patella mobilize side to side
Side to side with slight knee bend along wall
Side to side diagonal with slight knee bend along wall

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #32 on: December 03, 2016, 09:27:01 PM »
Got to 128 degrees passive flexion today. PT showed me how to do quad stretch lying on the side pulling on my ankle with my right hand.

Started doing the lying down squat machine with resistance springs. Feet shoulder width apart. Making sure to load the weight on my left leg first, position legs so that there is slight bend not greater than 90 degrees. Then with more weight on left, go up but never to full extension and down not past 90.
A new exercises are the terminal knee extension with ball behind the joint, the foot should be flat, but the weight should be on the heel. This builds the VMO.
Another stretch is the hamstring stretch with the heel on a surface such as a small table or chair.

Quad sets 30 seconds, 30 reps
Prone Quad stretch, 2 minutes
Ankle inversion, eversion, and flexion (opposite of gas pedal), 30 reps each
Long Arc Quads 5 second hold, 20 reps
Prone Hamstring raises sets, 5 second hold, 20 reps
Hips: front, back, side, 30 reps each, 5 lbs ankle weights. Make sure that hip is even to the ground and when doing the side, can bring the leg a little bit to the back
Calf raise onto big toe, shift weight onto little toe, come back down, and then reverse direction back onto big toe and go back down. 30 reps
Lateral Weight shifts 15 seconds, 30 reps
Front weight shifts 15 seconds, 30 reps
Move laterally around bed through weight shifting
Foot dangling, hamstring sets from 90 degrees to higher. Hold for 15 seconds at top
Calf stretch by putting foam roller onto wall and putting ball of foot onto the round part of foam roller. This helps stretch the top part of calf
Quad stretch (really good for vastus lateralis) with foot dangling off of table by using left foot to push my right foot inwards
Roll ball around piriformis muscle. Push ball down first on the muscle and hold. Then move up and down muscle and then roll in circle
Roll ball around vastus lateralis in same fashion
Patella mobilize side to side
Side to side with slight knee bend along wall
Side to side diagonal with slight knee bend along wall
Terminal knee extensions with small rubber ball behind knee. 10 reps, hold for 10 seconds each, 3 sets, twice a day
Hamstring stretch with heel on elevated surface

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #33 on: March 09, 2017, 07:38:06 PM »
December 6, 2016
Only got to 126 degrees today. Did Ultrasound for scar tissue in front.

December 10, 2016
Ultrasound for scar tissue, did squat machine with resistance springs.

Got new exercises. One exercise is having the resistance band ďversa-loopĒ a little bit above the knees with shorts on (so that it doesnít rub on skin) and with slight knee bend and legs apart (so that there is already some spring force) move laterally, making sure to never bring the legs too close together (want to maintain the initial position).

Also used the resistance band to do the hip exercises. When doing the front, make sure that right heel starts at the left toe. When doing the back, make sure that the right toe starts at the left heel.

12-21
No ultra sound today, but flexion was 133 degrees. New stretch for front hip flexor since my gait is now limited by my hip tightness. The stretch is to put leg to be stretched behind other leg centered about other leg. Other leg should be bent so a little like lunge position. Keep posture straight and while holding posture and shoulder position, use ab muscles to tilt the pelvis about an axis pointing into the pelvis from left to right. The angle should be such that it pelvis is a bowl of water, the tilt should cause the water to pour out behind me. The stretch should be at the front hip flexor.

Another exercise is to balance on one leg. Both left leg and right leg isn't able to last very long doing the stand on one leg on a pad catching the ball.

12-30
Flexion was only 130 degrees today.
I have been doing the ground hopscotch ladder (ABC Ladder) training these past few PT sessions. I canít go very fast, and PT has been pushing me to go faster. Usually start off with weaving and then hopping over skipping one step and going onto the other side. I started doing minisquats and now moved onto full squat not past 90 degrees but making sure that the knees track more laterally.

Today, after PT session, I noticed more swelling in the anterior part of the knee.

01-06
Got a new hip stretch exercise where i kneel on the leg to be stretched on a cushy surface like in a lunge position. Then tilt hips back to get the stretch.

Today, PT did ultrasound, but did a little too much on the medial side, so there was some pain and uncomfort.

PT tried to work on Popliteus muscle, but said it is very deep inside, and when he tried to push into it, it hurt most likely because there are alot of nerves and arteries in the way.

01-14
From the last PT session, got new exercise for practicing going down stairs. Get small step and step down with left foot very slowly. When Left foot touches the ground, come back up slowly bringing the left foot back onto the step.

Standing on single right leg and balancing while catching the ball has gotten easier, can do it on a foam platform and go for 10 tosses at a time.

Also tried Star taps on a foam roller. Going front, lateral, behind, and wrapped around planted foot.

Went out on Friday night. Stood from 10 PM to 1:40 PM with some dancing from 1130 PM to 130 PM. Saturday morning, knee is pretty achey when walking or standing up. Otherwise pain is not persistent while at rest. The pain is at the front bottom of the knee cap, mostly on the lateral side, but also on the medial side. There is some clicking.

01-20
Got two new stretches today, the IT Band STretch which is laying on back and raising the leg stragiht in the air with a band wrapped around the foot. Keeping the leg straight, pull the leg across the body until there is a stretch on side of leg, but do not let hips/butt pop off the ground.

Adductor stretch is similar, but bringing the leg out to the side.

Today was more manual therapy. It was tender near the LCL and it could be related to the lateral meniscus.It could mean that the LCL has been strained.

Hamstrings and Calf muscles were really really tight. After working on it and scraping and ultrasound, the skin was really red there.

Did the ABC Ladder but did not go fast. When doing the Foreman squats, the knee hurt every time going down.

01-24
Today while PT was bending knee in prone position, the knee was stiff and after forcing it to bend, there was a loud pop in the knee as it bent. The pop was not painful, but leg seemed to swell up a bit afterwards. There is pain now standing with a straight knee.

02-06
PT Located where the tightness feeling comes when bending the knee. It is actually where the Quadracepts attach to the bone a little lower than the Patella. Since there is alot of fluid and that area is not used to the Quadracept tension, there will be that tightness feeling.

02-14
There was alot of tightness on my IT Band. Basically by pushing on the lower part, the upper part moved stiffly with it, which is a sign of tightness. This is probably due to the flight I took recently

Not much pain at the anterior lateral side of patella, but now alot of pain probably at the quadracept tendon. Quads hurt while doing star taps and the ABC ladder probably due to weakness.

Did the step up and back down with 20 lbs total weight. Want the hips/weight over the knee before stepping so that the weight can be loaded onto the hips and glutes, then load to step up and same loading but reversed to step down.

Weighed self and was 171 lbs

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #34 on: March 09, 2017, 07:44:01 PM »
I saw the doctor on February 15, 2017, and I had these questions and answers:

Can I start Swimming?
Yes, any stroke is fine, but will feel irritation from breast stroke

Cycling on high resistance?
Progress to cycling uphill

What about the Crunching sounds when I bend the knee/straighten?
Normal, may never go away

What are the goals for the next six months?
Jogging in 6-8 weeks
Can do Elliptical, treadmill, biking on flat land

Do I need a Knee Brace?
No knee brace needed, maybe only for skiing

Sitting cross legged good or bad?
Cross legged is fine as long as there is no load

Where is quadracept tendon located on the patella? What does it mean now that it hurts?
It is from muscle weakness that it hurts. It goes along from the top of the knee tightly left and right of the patella and down

Can it be the quadracep tendon that is causing the pseudo locking?
Yes

Last time it was stated that there was still a defect near the curvature that wasnít going to be filled? What does this mean?

There is about 1 cm piece of cartilage that came off on the tibia. This should be OK since the lateral meniscus repair covers it and gives cushioning. This also happens to be the exact location where they would drill to do a Lateral Meniscus Transplant anyway.

Lateral Meniscus - how long will repair hold for if my body does not heal the meniscus back together?
There will be no more healing that takes place anymore at this stage (6 months)

Is there a way to tell if the lateral meniscus actually healed or is just being held together by sutures?
There isnít a way to tell unless MRI. It is good sign that there isnít much pain on the lateral/peripheral side

Is there a way to tell if the cartilage repair failed and there are bits of cartilage floating around?
Pain is one sign of cartilage damage.
Good, healthy cartilage cell arrangement is columnar in structure and filled to the top.
The graft right now is probably around 75% filled, and the cell arrangement structure is not quite columnar yet (it may never be) and is not as firm and more of an S-Shape structure

MRI to see what the progress of healing is?
In 3-6 months if there is still pain, can do MRI to see status

If I want to play it safe and not tear the meniscus and cartilage, what activities should I avoid?
Deeply bent knee with twisting is really bad for the knee
No deep squats (past 90 degrees), but this just means the knee does not go past the toes. Seems that I can only do mini-squats from his demonstration.

Can I go down stairs with both legs now?
Progress to this

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #35 on: March 09, 2017, 07:47:47 PM »
02-17
PT showed me the correct, natural gait pattern today which is impact on lateral side of heel, then S-shaped weight shift onto the big toe and push off with big toe. Though, this has the most forces on the knee, it is necessary for me to accustom my body to this force.

My other method of walking of forefoot striking may be beneficial to long distance running.

Did Treadmill today at 3.0-3.5 speed. Practiced walking, making sure that the pelvis is free to move and my feet are not tracking their own lanes, but sharing a single lane almost.

Should now start doing Star Taps, 3 sets of 10. Mini squats 3 sets of 10. Step up and step down 2 sets of 10.

For Star Taps, remember to keep the knee tracking laterally.

02-18
Star Taps are ok, sore in the quads

When trying to do mini squats with focus on rotating the knees (knee varus) laterally/externally, there is a huge sharp pain at the peripheral of the knee (where the lateral meniscus scar is). Without knee varus (and not really any valgus either) a full depth squat can feel normal.

02-19
Minisquats with Varus without pain on lateral/periphery of knee, however there is pain at the anterior part probably patellar tendon.

02-21
ABC ladder got alot easier. Did step up/downs on a much higher platform now, without any weight. Walked at 3.8 speed, understand now that i want the feet to share somewhat the same lane because that makes the lateral heel to big toe natural.

Now knee has been popping really loudly after each step. Not very painful and no swelling, but the popping is really loud. The popping can be localized to the spot of cartilage graft and only pops when there is bending. The pops are very strong and uncomfortable.

For Star taps, keep in mind that the heel should stay planted and there shouldnít be leaning forward. To attain this, can lift toes off ground.

02-24
Alot of popping during ABC Ladder. Physical therapist said it could be one of two things:
-Quadracept Tendon is snapping over it, which would mean the quads are tight
-Meniscus fluid (since it started after doing the step down with the big block)

It should get better by next week, but I should keep stretching it, stop doing the step up/down, and keep doing mini squats, cycling etc.

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #36 on: March 09, 2017, 08:07:13 PM »
03-03
On 02-28, had major breakthrough. Now there is no more catching, no pain, no popping. ABC ladder is alot easier.

The breakthrough started in the morning after waking up, still had popping and knee felt unstable too. After driving to clinic, got out of car and the popping was gone. The minor instability is probably due to muscle weakness/tightness. I also started doing some Quad stretches that I found on the internet. One of them involved placing a small lacrosse ball a bit above patella and lying prone on the ground, extending and bending the leg. Also did this with the lacrosse ball trying to find the spot between the Vastus Lateralis and the IT Band. On the night before the major breakthrough, it seemed that doing 1 leg squat did not cause any popping, which was a good sign, but two leg squat was causing catching.

03-07
Went fast on ABC Ladders. Got new stretch for Glutes, which is to bring Knees to chest or knee to opposite shoulder while lying on ground. Also started to do single leg Foreman squat with 3 resistance springs.
« Last Edit: March 09, 2017, 08:09:00 PM by icarus »

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #37 on: March 09, 2017, 08:08:04 PM »
03-08
Started to get Popping again at around 6 PM maybe from sitting all day. The popping this time feels like it happens on the medial side in the back, but only sometimes when I straighten the knee. Feels unstable at times, but the frequency of this occurring is low. Maybe once every hour after sitting or doing exercises that require knee bend.

Current exercises I am doing at home:
Standing Quad stretch, 2 minutes
Hip Stretch kneeling, 1 minute
3 sets of 10 Star taps (1 star tap is 4 directions)
3 sets of 10 squats
3 sets of 10 Step up/Step down
Long Arc Quads with 5lbs no hold, 20 reps
Standing Hamstring sets with 5lbs no hold, 20 reps
Hips: front, back, side, 30 reps each, 5 lbs ankle weights. Make sure that hip is even to the ground and when doing the side, can bring the leg a little bit to the back
Calf raise onto big toe, shift weight onto little toe, come back down, and then reverse direction back onto big toe and go back down. 30 reps
Calf stretch by putting foam roller onto wall and putting ball of foot onto the round part of foam roller. This helps stretch the top part of calf
Side to side with slight knee bend with resistance bend along wall
Hamstring, IT Band, Hip Adducter stretch with a belt lying down
Piriformis stretch, Glute Stretch

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #38 on: March 14, 2017, 10:59:25 PM »
03-10
Did an ankle stretch where pt took thumb index and wrapped around ankle while I lunged forward kneeling on left leg. While sitting, pt takes the thumb and index and wrapping around ankle et's pt pull the heel upwards and stretch the ankle. Today did 10lbs each hand weight for lunges, small step ups (shorter than stairs at home), and ABC ladder (going diagonal through center of box to top and bottom, running for one step, then jumping onto right leg into box and back out, then short hop which is 2 steps, and through steps laterally). For ABC ladder, hold the weights to chest.

03-14
Last night, biked locally on a hybrid bicycle. 4.6 miles and 410 feet of elevation difference was the route. Could not make it up on the last hill, but all other hills were bikeable on Large gear 2 and middle setting on small gear. The only pain I had was when I was walking up the hill and after bending the knee I took a step with straight leg and there was alot of pain. After taking a short break there was no pain and no swelling. The knee has been feeling good today.

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #39 on: April 07, 2017, 12:30:40 AM »
03-30
Did elliptical on setting 12 today for 8 minutes. Did all the usual exercises as well. This time, squats with 10lbs dumbbells. PT said next time, we would start jogging for a minute maybe. This is OK since OS said 6 to 8 weeks from last visit to start jogging.

For lunges, the idea is to always move forward, when I come up, I should move the back foot forward without a pause. My back knee doesn't have to touch the ground.

03-17
PT says that there is still tightness in the capsule, so it is better to hold off on running. Need to wait for the knee capsule to normalize itself. I can start doing lunges at home. 4-8 sets of lunges, each leg 5 reps.

03-15
Did same thing in Physical Therapy today as last time. No more Ice, now just heat to help break up the tissue more since there is no more swelling. Should ask the PT when I can start running.

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #40 on: April 07, 2017, 12:32:22 AM »
So, I achieved a new milestone this week. I am starting to jog now!

04-06
Jogged today starting at walking pace on treadmill for 1 minute 30 seconds, then to 4.5 speed until 3 minutes 30 seconds, and then 5.5 speed until 10 minutes 30 seconds.

There was some pain on the lateral side of the knee, but the pain came and went.

04-03
Jogged for the first time today. Treadmill setting was 4.5 speed for 5 minutes. Felt good. PT said to focus on lateral forefoot striking because heel striking is not sustainable for knee health. It's OK for heel to touch the ground, but want to focus on lateral forefoot strike. I was striking correctly and it feels good to forefoot strike, heel striking has always been uncomfortable for me and I've always forced myself to do it. Two problems he noticed was that my right foot was laterally rotated. My left foot was completely straight and good. I just have to focus on making the right foot medially rotated to be straight. Also my feet are in their own lanes right now because I'm not using enough hip rotation. By using hip rotation, my feet can be in the same lane.

PT did manual therapy on the hamstrings of left leg this time. Didn't do star taps, didn't do ABC ladder.

Offline BarefootPilgrim

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #41 on: April 07, 2017, 03:49:04 PM »
Wow that must have been a good feeling!

Very impressed with how diligent you are with your exercises. Keep it up!

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #42 on: April 18, 2017, 03:18:24 AM »
Wow that must have been a good feeling!

Very impressed with how diligent you are with your exercises. Keep it up!

Yes, it feels amazing mentally to know that I can jog, but, physically it doesn't feel good whenever I re-introduce any exercise. Eventually as I get used to it more, there will be less and less pain.

Thanks for the encouragement! I find that if I don't do exercises, the knee will get tight and the muscles aren't ready to provide full stability

Offline cameronlyon3

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #43 on: August 10, 2017, 01:08:15 AM »
Hi I had the denovo procedure done under my patella about 7 weeks ago... I have some of the same grinding/clicking you had. Inhavent done much with the quad other than what PT allows me but it's concerning. Any advice??? Thanks

Offline icarus

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Re: 2nd knee Surgery. ACL Reconstruction. Denovo. Hopefully Meniscus Repair
« Reply #44 on: August 16, 2017, 08:42:47 PM »
Hi I had the denovo procedure done under my patella about 7 weeks ago... I have some of the same grinding/clicking you had. Inhavent done much with the quad other than what PT allows me but it's concerning. Any advice??? Thanks

Hi cameronlyon3,

The grinding/clicking is much better now. For me, it gradually went away. I still get a little bit of grinding/clicking, but that is to be expected since not all the scar tissue will go away (also I am still at about 60% of my non-surgical leg).

My advice would be to not overload the knee with alot of weight. Hopefully it is just scar tissue that is causing the grinding/clicking that you have, and the best thing for that is to progress with working towards walking with proper gait. As long as the grinding/clicking is getting better every month or so (even if it's just a little progress), I wouldn't worry about it.

 

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