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Author Topic: ACL+meniscus repair+menisectomy  (Read 261 times)

Offline ozzy1000_0

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ACL+meniscus repair+menisectomy
« on: November 23, 2017, 02:32:47 PM »
hi,
I'm 40 and until very recently have always been very fit and involved in many different sports. During my early 20's I was surfing a lot, racing MTB and working as a tree surgeon, so pretty fit. Around this time I fell when messing around on a skateboard and tore the lateral meniscus in my right knee, it was very painful and would catch and inflame easily so I had arthroscopic surgery to clean and trim things, then surgeon removed some of the meniscus, how much I'm not sure. from then on it healed fairly well, for years afterwards it would be but achey at times, and/or when cold. Then about 10 years ago, aged 30, I started road cycling a lot again. Initially my knee would get painful if I did too much, but over time and my leg got stronger and more stable my knee just got better and better to the point where it was no more prone to pain than my other knee.
  Fast forward to now... Last year I was super fit, for context; 70kg at 5'10", cycling about 200miles a week and last August I rode over 300miles (just shy of 500km)  in less than a 24hr period, (17hrs ride time) and could out sprint guys half my age... then distaster stuck; again messing around on skateboards with my kids I fell in an almost identical way to the last injury, landing heavily and pivoting on my right leg with my knee over extended. My knee went backwards and twisted at the same time snapping my ACL and destroying what was left of my lateral meniscus, tearing in half my Medial meniscus and damaging the articular cartilage quite badly.  After the initial stay in hospital I was sent home with morphine, tramadol, a leg brace and a sheet of paper with some physio exercises on (no surgery and a knee like an elephant that wouldn't bear any weight, let alone bend even 1mm). So I did some research and found a knee surgeon with good reputation and booked myself into see him. 2 weeks later I had a ACL reconstruction (hamstring graft), he repaired my medial meniscus and removed most of the rest of the lateral one (20-30% remaining). Post op he has said a few times now "Remember this is a bad one, its not a normal ACL injury, you have a lot of meniscus damage and we need to see how it is a year from now, then maybe think about further surgery".... So..... my surgery was May 10th, its now the 23rd  of November, so 6.5months post opp', I was on crutches still up until about 4.5-5months post opp.. but currently the pain is still pretty bad, I've not got back on my bike yet, my quads have vanished, there's no way in hell I could even consider a 1 legged squat, my leg is so unstable and weak that I can't even get up an average step with that leg, so I'm going up stairs one leg at a time. I feel like I'm in catch 22; it's too painful and unstable to allow me to do the level of activity required to get some stability back. I do try and do my physio, probably every other day on average, I've been recommended to do mini dips, 2 legged squats, lunges, step ups (if I can). but when I do them, my right knee is grinding and crunching so loudly that my wife can hear it and has to leave the room... and it hurts.. and I really struggle to get enough weight over it to do anything that feels like it might make a difference, some how my body just biases back onto my good leg (even with lunges!?!?)... anyway, I'm rambling now... any advice would be very welcome, is it normal to have this much pain and difficulty after nearly 7months? I've put on a stack of weight and I've never been this unfit.. its depressing..

kind regards,

Owain

Offline Hill Girl

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Re: ACL+meniscus repair+menisectomy
« Reply #1 on: November 23, 2017, 07:32:34 PM »
Hi Owain

Skateboards?! Sounds like me and downhill skiing ... which I no longer do!

I'm 8 months post-op hamstring ACL (and last year medial meniscetomy), nearly 50 yrs old. I can't comment on the meniscal repair side of things but know that is an additional factor that has to be taken into account in your rehab programme. It's hard to tell but although on paper you are a fair way into the rehab period, given the level of damage/surgery your knee has sustained I wondered if the exercises you have been set are too extreme/going too far too soon?  The fact that you are trying to do these after being on crutches for so long (when you will have lost as you say so much muscle mass) is what rings alarm bells for me, though of course I am not qualified to say! At a later and more healed stage than you I am still wary of some of these and have been given other ways of building strength etc.

You need really carefully-supervised physio, by someone with particular experience of the surgeries/injuries you have had (and, to help with the psychological side of things, who is also understanding of your sporting background/goals).  I have been working very hard on my rehab but it has been carefully tailored to suit me specifically where necessary, rather than standard-ACLrehab - that has meant NOT doing some exercises that others might be doing, or doing them at a later than average time. 

I paid for private physio after NHS physio ended and although it has cost money I don't begrudge it one bit.  (NB With a previous injury I got an equivalent level of service on the NHS but it does vary by area and can be luck of the draw or depend on your tenacity in tracking the right people down/finding a way in). My later-stage physio has taught me new things, as well as ensured I remain motivated (I get regularly updated, clear weekly programmes so that I balance out the different areas of work/activity over the week, which now takes into account my gradual return to sport).  It has also helped psychologically to know that someone is "keeping an eye on things" as you can feel quite lost and "cast out" when the NHS quota runs out but you've still got a long way to go.  I wouldn't have paid money for physio without the confidence that this person had specific experience and I would urge you to look into this option if that is not already the case.

On specifics, a gym bike was crucial to my recovery and to my sanity.  Although I had a turbo trainer for my road bike I couldn't get on and off this for some time and a stable, proper gym bike (now on long term loan to me by a friend) made the world of difference and I still use it for warm ups or if I haven't managed to get any other exercise that day.  A stable bike with a more upright position than my road bike on turbo also means that I can read etc whilst pedalling away, which whiles away the time/makes it easier to juggle work etc and rehab.

This last comment is a bit flippant but both my knees make horrid noises so loud music can work wonders (on iPod or, if others are complaining, blasted out through the speakers!). 

Hoping you get some other feedback/good advice from here and professionally (NB that my comments above are not those of someone medically qualified to give them!) - and that, most importantly, you begin to see progress.  All the best with that.
Mar 2006 ACL rupture skiing.  Bone bruise.  No ACLR - lots of rehab got me back to the hills.

Feb 2016 Medial meniscus bucket handle tear left knee, c75% removed.

ACLR (hamstring autograph) 03/17

Patellofemoral/trochlear wear in the other knee

Offline jackson7

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Re: ACL+meniscus repair+menisectomy
« Reply #2 on: November 25, 2017, 09:34:23 PM »
you're not the only one.  Although I didn't have acl surgery, 9 months ago I had a meniscectomy and synovectomy...and, despite some chondroplasty, I still have a nagging defect on my femur cartilage that sporadically catches/snaps against the edge of what's left of my meniscus (very painful).  I also have a defect on my kneecap that usually doesn't bother me...but, if I cycle for even one minute, pain will kick in a few hours later (doesn't hurt during cycling).  I can't do any aerobic activity that involves my legs.

PT didn't work for me and only irritated my knee worse, so I quit after 2 months.  I did some home exercises and a little walking for months after that, but my knee hurt the entire time. 

Ortho said I should be able to do low impact after 8 months post-op, so, last week, I went to the beach and took a few slow walks in the soft sand with no problems.  I also paddled around on my surfboard, but could only ride waves up on my knees.  I left after 2 days with a positive outlook and was all set to ramp up activities a bit at home...

Strangely, the next day, I was out on a slow walk when I tripped on a small anomaly in the asphalt. I landed in soft grass and, even though I didn't go down at any awkward angle, I felt a ripping sensation in both knees (more in post-op knee).  I writhed and screamed in agony for a couple minutes before I was able to stand up and somehow hobble home (no help/no cane).

For a week now, I've only been able to walk with a cane...and even then I frequently lose my balance, which causes a horrible electric shock-like pain in both knees. The "shock" even happens sometimes when I'm lying in bed and just bend my knee to the side wrong.  Every time this happens, I literally cannot walk for about 30 minutes after...like my leg muscles are temporarily parallelized. 

Any confidence I built up in the past few months has been completely annihilated.  Don't know if it's my age (53) or what, but my knee just doesn't want to come back.
Dec 2015: slow speed bicycle crash (wet leaves)
Jan 2016: a zillion x-rays & 2 MRIs only showed tendinosis
Mar 2016: bone scan showed "uptake" in all compartments
Aug 2016: cortisone shot (did nothing)
Mar 2017: diag scope (partial med meniscus resection, med fem chondroplasty, synovectomy)

Offline Brandon123

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Re: ACL+meniscus repair+menisectomy
« Reply #3 on: November 29, 2017, 08:49:59 AM »

Strangely, the next day, I was out on a slow walk when I tripped on a small anomaly in the asphalt. I landed in soft grass and, even though I didn't go down at any awkward angle, I felt a ripping sensation in both knees (more in post-op knee).  I writhed and screamed in agony for a couple minutes before I was able to stand up and somehow hobble home (no help/no cane).

For a week now, I've only been able to walk with a cane...and even then I frequently lose my balance, which causes a horrible electric shock-like pain in both knees. The "shock" even happens sometimes when I'm lying in bed and just bend my knee to the side wrong.  Every time this happens, I literally cannot walk for about 30 minutes after...like my leg muscles are temporarily parallelized. 

Any confidence I built up in the past few months has been completely annihilated.  Don't know if it's my age (53) or what, but my knee just doesn't want to come back.

Sorry to hear about your accident/setback, jackson. How are you doing now?

Offline jackson7

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Re: ACL+meniscus repair+menisectomy
« Reply #4 on: December 08, 2017, 08:51:21 PM »
Sorry to hear about your accident/setback, jackson. How are you doing now?
Thanks for asking.  It's been over 3 weeks and things have improved significantly...swelling has gone down (still a little lingering fluid) and no more astronomical nerve pain out of the blue. 

I can only guess, when I tripped, I bent my knees in a way they weren't used to (had only walked short distances for 8 months prior / no other exercise and no stretching due to pain).  Felt like I sprained all the side ligaments in both knees and sprained my quad tendon in my post-op knee.  Pretty sure I also ripped my synovial scar tissue and may have even bruised my tibial plateau in the post-op knee.

Put myself back on Meloxicam and, for the first 2 weeks, could only walk (very slowly) with a cane in each hand.  Now, just one cane.

Main issue, now, is my kneecap is catching, again (initial catching went away a few months post-op). Not as bad as right after the scope, but still pretty bad/painful right when I start walking after sitting for a while...then, it gets a little better the more I walk, but doesn't completely disappear.  Post-op knee is back to being very tight...difficult to bent it.
« Last Edit: December 13, 2017, 10:52:36 PM by jackson7 »
Dec 2015: slow speed bicycle crash (wet leaves)
Jan 2016: a zillion x-rays & 2 MRIs only showed tendinosis
Mar 2016: bone scan showed "uptake" in all compartments
Aug 2016: cortisone shot (did nothing)
Mar 2017: diag scope (partial med meniscus resection, med fem chondroplasty, synovectomy)

 















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