Author Topic: Suggestions for pain-relief for my knee condition following ACL Reconstruction  (Read 341 times)

ksm91

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Hello Members,

This is my first post online for my knee issues and I hope I can learn from some of the experiences of the members here to help take a decision. This post is a bit long as It is a long standing issue now. Please bear with me.

I am from Hyderabad, India. My knee problems first started with a two-wheeler accident in January 2015. I went to a reputed hospital where the orthopedic doctor first diagnosed me with a tibial spine fracture and an ACL tear in my Right Knee.  They scheduled me for a Tibial screw fixation but later informed me that they will be performing a diagnostic arthroscopy to clean out the Hemarthrosis from the joint. The MRI scans identified a completely torn ACL and a partially torn LCL. Post the diagnostic arthroscopy, my knee was immobilised for six weeks. After recovery of ROM, I was supposed to undergo ACL reconstruction after 4 more weeks.

However, after the removal of the immobiliser, my knee became quite stiff and it required nearly 3 months of regular physiotherapy to recover most of my ROM. A mistake from the hospital with some documentation and a misunderstanding with the insurance company also led to insurance related issues which delayed my ACL reconstruction by 9 months from the date of accident.

I took a second opinion from a sports injury and arthroscopy specialist as I waited for the insurance problems to be solved. He was of the opinion that the first diagnostic arthroscopy was totally unnecessary and the subsequent joint stiffness will cause problems in the long-term. He refused to do an ACL reconstruction until my joint stiffness was gone and the knee movement was back to near-normal. It was during this 9-month wait that my knee began to develop grating noises and associated pain which was quite bearable at that stage.

Once my insurance problems were solved and the joint regained the motion, the second doctor posted me for an ACL reconstruction and also diagnosed a PLC (Posterolateral Corner) injury due to my partial LCL tear which did not recover. He was of the view that an untreated PLC injury will lead to a high failure rate of the ACL graft. The surgery was done successfully with a tripled gracilis and doubled semitendinosus ACL graft taken from my right knee hamstring. He used a doubled semitendinosus graft from my left knee to do a PLC reconstruction. After the surgery, my physiotherapy and rehabilitation went well for the first couple of months but the grinding noises in the knee worsened and so did the pain.

Due to exams, I was unable to continue regular physiotherapy and once the habit of the physiotherapy broke, I was unable to resume it and it resulted in sporadic sessions. The knee grinding noises and pain got worse. As a result of the pain, I put more load on the left knee, which already began to show degenerative changes and began to pain a lot. The surgeon diagnosed me with bilateral chondromalacia patella and asked me to do low intensity exercises like cycling.

Since any amount of exercise aggravated my condition, I took a second opinion from another reputed surgeon in a reputed hospital, who ordered an MRI. The MRI findings showed the following.

1. Intrasubstance signal abnormality of PLC graft at its fibular attachment - likely a low grade injury/sprain.

2. Normal signal, alignment and bulk of ACL graft and rest of PLC graft with normal morphology of corresponding bony tunnels.

3. Small osteochondral lesion in patella, focal thinning of ligamentum patellae at its patellar attachment.

4. Partial thickness injury of the native fibular collateral ligament at its fibular attachment.

5. Susceptibility artefacts are noted around the knee due to previous surgical procedure.

6.   Infrapatellar fat-pad shows a linear artefact - likely metallic hardware related.

Based on these findings and the review of the MRI images, the third surgeon concluded from the sixth point that there is a loose body behind the patella which is causing my grinding noises and pain. He dismissed the "likely metallic hardware related" finding of the radiologist as there was no metallic hardware in that region. (Note: I do have an XObutton in place near my femur for the ACL graft). He recommended that I undergo another knee arthroscopy to remove the loose body, whatever it is, and he also said that he will treat the lesion in the cartilage of the patella with a stemcell therapy injections.

Surprised by these findings, I went back to the second doctor, who did the ACL reconstruction. He reviewed the MRI Images and after consulting a senior radiologist, he came to the conclusion that the artefact was nothing but scar tissue from the surgery. He also said that the MRI findings prove his diagnosis of Chondromalacia. He wanted me to adopt a patient approach and added that there was no loose body or any other issue which warranted a surgery at this point. He also added that the stemcell therapy injections (PRP injection) suggested by the third surgeon had very limited evidence of any success. He said that if I wished I could get a PRP (platelet rich plasma) injection but cautioned against an arthroscopy. He said that if over a long period of time, my condition does not improve, then he will think about surgical options.

A fourth orthopedic surgeon and sports injury specialist was also of a similar view and opted to treat the patella related issues with glucosamine/natural eggshell membrane supplements and said that there was no need of surgery.


Right now, I am just 25 years old and my knee problems are causing a significant headache in my daily life. If i stand for more than 20 minutes, I get pain. I cannot get up and down stairs without proper support of the railing or putting more weight on the unoperated left knee. My left-knee has also shown early degenerative changes and pains a lot quite often. It has been over two years since I ran or even jogged. There is a lot of weakness in my quadriceps which have atrophied quite a bit, especially my VMO. I am totally confused right now.

I highly trust my surgeon who operated on my knee, but his advice of a long-term recovery and his conservative approach seem like I will be with this pain for quite a long time. However, I am highly apprehensive of another surgery, especially if it involves anything to do with the knee/patella cartilage.

Do the stemcell injections/PRP injections have any evidence of curing my conditions?

Will Chondromalacia ever be resolved or is it something I need to deal with my whole life?

Will regular physiotherapy from now on, help with my condition or has the damage been done already? My surgeon says that quad strengthening is the golden rule for my condition.

Will glucosamine/natural eggshell membrane and related joint supplements show any benefit? My surgeon was not eager to prescribe them as he feels that they are not approved or proven methods of treatment. However, he wasn't against me trying them out as they were available over the counter.

I have my entire life ahead of me and having seen my grandma suffer greatly with arthritis for nearly 30-40 years, I shudder to think if this all leads to early arthritis.

I am also about 15-18 kgs overweight because of the sedentary lifestyle and the knee pain has kept me from doing any sort of exercises on a regular basis. I am trying to lose the excess weight by controlling my diet. I Hope that it will help me.

I hope that the members here can throw some light on my issue and help me set my goals. I am not asking for medical advice here, I just want to learn from the experiences of others and take the right decisions from the options given to me by the doctors in my city.

I thank you for reading all the way to the end and hope that I can benefit from this excellent forum.

Sriram.
Hyderabad, India.

Offline Jordan1

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Hi Ksm91.

I've been in chronic knee pain for 3 years due possibly to having severe chondrumalacia patella (grade 4) as well as lesions under my patella. I have tried supplements, PRP injections, arthroscopic debridement surgery, cortisone injections and bone marrow stem cell injections and none of it has helped.

More recently I started going to Cartilage restoration surgeons for more opinions and all of them want to try a MACI procedure. However, this much pain for so long could also come from a nerve problem that creeped in sometime through all the surgery...and more surgery could make that worse...so that is my current dilemma...I have plans to consult a rheumatologist and and a pain management doctor but also may see an endocrinologist and a neurologist before I commit to surgery to try to rule out any undiagnosed nerve issue. However, I do know the nerves around your kneecap are extremely sensitive, so what some doctors might think is a nerve condition, could just be a extreme temporary nerve irritation from damage/poor tracking/surgery etc. ...that is my understanding based on my own condition and research.

That being said, diet is so important...every extra pound on your body puts an extra 5-10 pounds of stress on your knees. I tried to stick to a paleo diet when all my pain started, it helped me lose about 20 pounds and helped take off some extra stress on my knees. You can also help the inflammation in your knees (and any inflammation throughout your body) by sticking to a paleo or an autoimmune protocol diet. It isn't going to fix damage or pain for good, but it will help just as much as any supplement etc. and will help take off extra weight!

Also, physical therapy. I have found a lot of help with more functional based physical therapy with PT's trained through the Gray Institute...theres a website you can find some stuff on, but its worth spending the time finding a good PT..and doing the exercises as long as they dont aggravate symptoms too bad has help me a ton. Focus on fixing bad biomechanics...theres a really good book called "Pain Free" by Pete Egoscue that I found help through. 

I would check out the "KNEE ARTHRITIS - Articular cartilage repair" thread...i've found a lot of good information and people sharing their experiences and pain that has been helpful and similar to my hard to fix symptoms!
Left knee Mensicus repair 2005
Left knee ACL Reconstruction 2005
Right knee ACL reconstruction 2010
Right knee ACL reconstruction 2014
Left Knee Scope debridmt (for chronic pain) 2015
PRP Injections & Bone Marrow Stem cell injections to both knees - 2016
Left knee Chronic kneecap pain 2014 - present

Offline Ayan

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I think its better to keep patience as the doctor suggested.. It should get better with time and regular physiotherapy..also I suggest put on ice pack as many times as day as possible..this will help with the pain..buy one of those cold pumps available which can pump cold water around your knee ...exercise and ice packs will help reduce the pain..

Stay strong and best wishes.

Offline PuneKnee

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Hello Members,

This is my first post online for my knee issues and I hope I can learn from some of the experiences of the members here to help take a decision. This post is a bit long as It is a long standing issue now. Please bear with me.

I am from Hyderabad, India. My knee problems first started with a two-wheeler accident in January 2015. I went to a reputed hospital where the orthopedic doctor first diagnosed me with a tibial spine fracture and an ACL tear in my Right Knee.  They scheduled me for a Tibial screw fixation but later informed me that they will be performing a diagnostic arthroscopy to clean out the Hemarthrosis from the joint. The MRI scans identified a completely torn ACL and a partially torn LCL. Post the diagnostic arthroscopy, my knee was immobilised for six weeks. After recovery of ROM, I was supposed to undergo ACL reconstruction after 4 more weeks.

However, after the removal of the immobiliser, my knee became quite stiff and it required nearly 3 months of regular physiotherapy to recover most of my ROM. A mistake from the hospital with some documentation and a misunderstanding with the insurance company also led to insurance related issues which delayed my ACL reconstruction by 9 months from the date of accident.

I took a second opinion from a sports injury and arthroscopy specialist as I waited for the insurance problems to be solved. He was of the opinion that the first diagnostic arthroscopy was totally unnecessary and the subsequent joint stiffness will cause problems in the long-term. He refused to do an ACL reconstruction until my joint stiffness was gone and the knee movement was back to near-normal. It was during this 9-month wait that my knee began to develop grating noises and associated pain which was quite bearable at that stage.

Once my insurance problems were solved and the joint regained the motion, the second doctor posted me for an ACL reconstruction and also diagnosed a PLC (Posterolateral Corner) injury due to my partial LCL tear which did not recover. He was of the view that an untreated PLC injury will lead to a high failure rate of the ACL graft. The surgery was done successfully with a tripled gracilis and doubled semitendinosus ACL graft taken from my right knee hamstring. He used a doubled semitendinosus graft from my left knee to do a PLC reconstruction. After the surgery, my physiotherapy and rehabilitation went well for the first couple of months but the grinding noises in the knee worsened and so did the pain.

Due to exams, I was unable to continue regular physiotherapy and once the habit of the physiotherapy broke, I was unable to resume it and it resulted in sporadic sessions. The knee grinding noises and pain got worse. As a result of the pain, I put more load on the left knee, which already began to show degenerative changes and began to pain a lot. The surgeon diagnosed me with bilateral chondromalacia patella and asked me to do low intensity exercises like cycling.

Since any amount of exercise aggravated my condition, I took a second opinion from another reputed surgeon in a reputed hospital, who ordered an MRI. The MRI findings showed the following.

1. Intrasubstance signal abnormality of PLC graft at its fibular attachment - likely a low grade injury/sprain.

2. Normal signal, alignment and bulk of ACL graft and rest of PLC graft with normal morphology of corresponding bony tunnels.

3. Small osteochondral lesion in patella, focal thinning of ligamentum patellae at its patellar attachment.

4. Partial thickness injury of the native fibular collateral ligament at its fibular attachment.

5. Susceptibility artefacts are noted around the knee due to previous surgical procedure.

6.   Infrapatellar fat-pad shows a linear artefact - likely metallic hardware related.

Based on these findings and the review of the MRI images, the third surgeon concluded from the sixth point that there is a loose body behind the patella which is causing my grinding noises and pain. He dismissed the "likely metallic hardware related" finding of the radiologist as there was no metallic hardware in that region. (Note: I do have an XObutton in place near my femur for the ACL graft). He recommended that I undergo another knee arthroscopy to remove the loose body, whatever it is, and he also said that he will treat the lesion in the cartilage of the patella with a stemcell therapy injections.

Surprised by these findings, I went back to the second doctor, who did the ACL reconstruction. He reviewed the MRI Images and after consulting a senior radiologist, he came to the conclusion that the artefact was nothing but scar tissue from the surgery. He also said that the MRI findings prove his diagnosis of Chondromalacia. He wanted me to adopt a patient approach and added that there was no loose body or any other issue which warranted a surgery at this point. He also added that the stemcell therapy injections (PRP injection) suggested by the third surgeon had very limited evidence of any success. He said that if I wished I could get a PRP (platelet rich plasma) injection but cautioned against an arthroscopy. He said that if over a long period of time, my condition does not improve, then he will think about surgical options.

A fourth orthopedic surgeon and sports injury specialist was also of a similar view and opted to treat the patella related issues with glucosamine/natural eggshell membrane supplements and said that there was no need of surgery.


Right now, I am just 25 years old and my knee problems are causing a significant headache in my daily life. If i stand for more than 20 minutes, I get pain. I cannot get up and down stairs without proper support of the railing or putting more weight on the unoperated left knee. My left-knee has also shown early degenerative changes and pains a lot quite often. It has been over two years since I ran or even jogged. There is a lot of weakness in my quadriceps which have atrophied quite a bit, especially my VMO. I am totally confused right now.

I highly trust my surgeon who operated on my knee, but his advice of a long-term recovery and his conservative approach seem like I will be with this pain for quite a long time. However, I am highly apprehensive of another surgery, especially if it involves anything to do with the knee/patella cartilage.

Do the stemcell injections/PRP injections have any evidence of curing my conditions?

Will Chondromalacia ever be resolved or is it something I need to deal with my whole life?

Will regular physiotherapy from now on, help with my condition or has the damage been done already? My surgeon says that quad strengthening is the golden rule for my condition.

Will glucosamine/natural eggshell membrane and related joint supplements show any benefit? My surgeon was not eager to prescribe them as he feels that they are not approved or proven methods of treatment. However, he wasn't against me trying them out as they were available over the counter.

I have my entire life ahead of me and having seen my grandma suffer greatly with arthritis for nearly 30-40 years, I shudder to think if this all leads to early arthritis.

I am also about 15-18 kgs overweight because of the sedentary lifestyle and the knee pain has kept me from doing any sort of exercises on a regular basis. I am trying to lose the excess weight by controlling my diet. I Hope that it will help me.

I hope that the members here can throw some light on my issue and help me set my goals. I am not asking for medical advice here, I just want to learn from the experiences of others and take the right decisions from the options given to me by the doctors in my city.

I thank you for reading all the way to the end and hope that I can benefit from this excellent forum.

Sriram.
Hyderabad, India.

Hi Sriram,

The timeline of your and mine injury us quite similar. I did some injury to my knee in Dec 2014 by sudden aggravated running...and then running through pain. Went to Dr Parag at Sancheti Hospital Pune, did RICE and medicines and pain went down. Life was almost (90%) back to normal.

For 2 years I avoid little nuisance in my knee as it appeared nothing major, I joined a gym first time in my life in June 2015, ran and has little to no problem (except little nuisance)

From First week of Feb 2017, i got instability, pain and even unable to walk (More in right knee). Saw Dr Sachin Tapaswi in 28 Feb. Did medicine and physio for 3 months. Things got a little better but not cured.

I did an MRI last week (6 July) and diagnosed with chondromalacia patella grade 4 in right knee. But surprisingly Dr Sachin Tapaswi said that it is nothing major and I will be fine. I advised me to to take:
Co-rosiflex ace
Glucosamine supplement
ShelCal

But I am seeing high crepitus and stiffness after sitting. I am going to see these doctors in Mumbai.
1. Dr Pranjal Kodkani
2. Dr Anant Joshi
3. Dr Dinshaw Pardiwala

Can you please let me know which doctors you met and what was your experience.

 

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