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Author Topic: 6 months after arthroscopy, still can't run  (Read 1860 times)

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Offline mmerc

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6 months after arthroscopy, still can't run
« on: July 11, 2017, 07:31:36 PM »
In January, I had a knee arthroscopy to address a suspected tear in my medial meniscus due to pain, mostly dull but occasionally sharp, in my right knee while running.  The Department of Veteran's Affairs performed the surgery.  Upon going in, the surgeon apparently discovered an intact meniscus, and determined that instead, the medial plica was causing the problem.  He trimmed the plica and ended the surgery uneventfully.

Prior to surgery, I was running long distance for exercise.  I've always been a runner.  The week before the surgery I put in at least 20 miles.  I have not been able to run more than 10 steps in a row since the surgery without intense pain in my right knee.  Even cycling hurts on the downward stroke of the right pedal, though not enough to prevent me from cycling.  The knee aches constantly in various places; sometimes the proximal medial, toward the quad muscles, sometimes the distal medial, closer to the patellar tendon, sometimes it feels like it's just the kneecap itself hurting.

 My care was transferred to a civilian orthopedic clinic, and the doctor there discovered an IT band issue, which was sorting out by some Voltaren gel and my physical therapy.  After I continued to have knee pain, that doctor gave me me two cortisone injections, 40ml each, into both the medial and lateral sides of my knee, near the surgical portals.  Then I was referred to the clinic's surgeon, who examined my post-op MRI, compared it to my pre-op MRI, and called it "confusing."  He ordered a month of increased physical therapy visits with iontophoresis (which we've already been doing).  He does not feel it's a tracking issue, as his basic examination indicated fairly normal tracking and an acceptable Q angle.

These are other things we've tried in meantime:
- 800mg ibuprofen 2x/day (total of 1600) for 3 weeks
- ice 2-3 times/day (in conjunction with ibuprofen)
- heat 2-3 times/day (in conjunction with ibuprofen)
- Voltaren gel in various painful spots
- physical therapy since February doing mobility and strengthening exercises, ultrasound therapy, and iontophoresis
- physical therapy exercises at home as directed

The two cortisone injections were recent, and I feel they helped to localize my pain symptoms, though I still cannot run.  Yesterday I indicated to my physical therapist that one portal was particularly tender to touch, so she massaged the area with tools and applied an iontophoresis patch directly over the most painful area.  Symptoms did abate some, but are back today just like normal.

I follow up with the new surgeon at the end of July, at which time he wants to try a trigger point injection into the medial retinacular band.  If this doesn't work, he mentioned the possibility of exploratory surgery.  The last surgery has knocked me off my game for 6 months, the last thing I want is more.

I have a new job pending which will eventually require a physical fitness test, including a distance run and a sprint.  This needs to be resolved ASAP.  Does anyone have any advice?

Offline Vickster

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Re: 6 months after arthroscopy, still can't run
« Reply #1 on: July 11, 2017, 07:52:56 PM »
Have you tried an intense course of frequent deep tissue sports massage from an expert therapist if there are tight muscle groups or connective tissue? A least once a week to start, with foam rolling in between

Sounds like a lot of ibuprofen, have you tried a stringer NSAID like celecoxib (with a PPI to protect the stomach)

I presume the physio has done a thorough check of the balance through the whole chain from lower back to feet to check it is actually the knee that is the culprit and not the glutes for example (a frequent issue in knee problems)

Good luck. I would avoid any sort of diagnostic surgery given you've been scoped. Only go under the knife if the surgeon has a clear plan and something to fix

Avoid more cortisone, it can damage healthy articular cartilage (i.e. In a non arthritic joint). PRP or hyaluronic acid are lower risk injections to reduce inflammation

Add swimming in for an all over body workout and exercising in the pool (walking/running as advised by PT)
« Last Edit: July 11, 2017, 08:01:40 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline jackson7

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Re: 6 months after arthroscopy, still can't run
« Reply #2 on: July 15, 2017, 10:14:02 PM »
Depends on the person, but soft tissue problems (plica, synovium, etc) and surgeries frequently take an extremely long time to sort out.  My synovium went haywire with swelling just from walking too much right after i tore my meniscus (this before ever even having any knee surgery).  It took a year for the swelling to go down enough so i could walk a few blocks without my knee blowing up for days after.

I'm now almost 5 months after a synovectomy and am still swollen and icing several times a day.  I had to stop cycling and even walking (other than across the house) because they were aggravating my synovium too much (I can do them without pain, but then my knee bothers me for days after).  I can swim, gently, but that's it for exercise.

Doing too much, too soon just makes it worse and take exponentially longer to heal.
12/2015: slow speed bicycle crash
1/16: many x-rays & 2 MRIs only show tendinosis
3/16: bone scan shows uptake in all compartments
8/16: cortisone jab (no effect)
3/17: diag scope (part med meniscectomy, med fem chondroplasty, full synovectomy)
4/18: Pain finally diminishing. 65% function.