The REHAB DEPARTMENT > Soft Tissue Healing Problems - Arthrofibrosis

Whats The Recovery Time for MUA?

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neilatwork:
Hello all.

You all seem pretty knowledgable about this stuff so maybe someone can answer some of my questions.  I just got a second opinion about my patella fracture recovery which seems to have stalled.  I am stuck at 100 range of motion.  I've already had the hardware removed back in Jan due to the pain caused.  The OS recommended an MUA with arthroscope to cut the adhesions which would follow with use of a CPM.

I was wondering how long the recovery was on something like this?  How long are CPM machines typically used and how long per day?  Is there much pain involved after the operation or from the CPM machine?  How long will I be out of commission after the procedure?  He didn't say anything about PT but I would guess PT would be involved as well.  I assume I won't really need crutches and walking/movement will be good for my knee but you all may tell me otherwise.  The OS mentioned I might be out for as long as 4 weeks but that seemed a little longer than I would have thought for that.

Any information anyone can give me will be appreciated.

Neil

Heather M.:

--- Quote ---Hello all.

The OS recommended an MUA with arthroscope to cut the adhesions which would follow with use of a CPM.

--- End quote ---


Actually, just for accuracy, be sure to look up arthroscopic lysis of adhesions, not MUA.  MUA is the least of your procedure--it's the scope to take out the scar tissue that will be the key to success, and only after the adhesions have been removed will they manipulate your knee to verify full flexion.  But you'll get the flexion through the scope.


--- Quote ---I was wondering how long the recovery was on something like this?  How long are CPM machines typically used and how long per day?  Is there much pain involved after the operation or from the CPM machine?  How long will I be out of commission after the procedure?  He didn't say anything about PT but I would guess PT would be involved as well.  I assume I won't really need crutches and walking/movement will be good for my knee but you all may tell me otherwise.  The OS mentioned I might be out for as long as 4 weeks but that seemed a little longer than I would have thought for that.
--- End quote ---


Your OS is actually being a bit optimistic in my experience.  I've had lysis of adhesions with MUA 3 times, and never recovered in less than 2 months.  The last time was a lot longer.  I know, everyone is different, but here's a summary of my recovery after arthroscopic lysis of adhesions.

My recovery this last time took about 6 months.  Up until that 6 month mark, I was doing PT at least every day, with exercises at home to supplement.  I was in a lot of pain, but I have some underlying mechanical issues.

I was on crutches for about 6 weeks without being able to put much weight onto the knee due to pain and swelling.  I was completely non-weight-bearing for over 10 days, then it was hit and miss for the next 3 weeks.  I was on a CPM for 5 weeks, 18-20 hours a day.  I had to sleep in it as well, obviously.

PT is critical after a procedure like this.  I had my first session within an hour of waking up in post-op.  The next day, I started on PT 2X per day at a PT clinic, and another 3 sessions a day at home.  All of my work was non-weight-bearing, passive, gentle stuff:  straight leg raises, wall slides, patellar mobilizations, bike with no resistance.  No strength training was allowed until full ROM was achieved and swelling was gone.  That was over 7 weeks for me.  It was well over 2 months before I was working again, and I work from home on a computer.

The most important thing is to keep the swelling, heat, and scar tissue from coming back.  That's why this rehab is very different than standard knee protocol.  Some doctors just have their patients do the standard knee post-op protocol, and some scar tissue patients respond okay, while others are made much worse.  I fell into that last category.  It took 3 scopes for that idea to sink through my stubborn skull, then I found a doctor who had a lot of experience with scar tissue and did things completely different.

Heather

hopeful1:
Hi, Neil!

I am still in re-had for my lysis/MUA.  I have been lucky, and did have not had nearly the trial that Heather has had. My OS approved me to return to work, so long as I can Ice, do ROM several times throughout the day, still get a minimum of 8 hours o nt eh CPM machine, and have no swelling or additional pain.  I had my scope two and a half weeks ago.  Today is my first day back - and I'm pretty swollen.  I only work 6 hrs at a time, so it shouldn't have been too bad, but I will not be going in to work for the rest of the week - my kne is WAY too swollen, despite my at-work RICE regimen!

My OS advised me I'd be on heavy pain meds for 6 - 8 weeks, with rigorous PT.  CPM machine hours will be reduced, if not eliminated nextweek. My progress in PT has really soared since the scope - but that is with a TON of hard work and LOTS of pain meds!  This is painful - and my PT keeps reminding me that the lysis and MUA actually causes more global trauma to a knee that any other surgery - it may cause the most benfit, from and ROM perspective, but the re-hab can be pretty long. I am actually a MONTH ahead of my orginal Re-hab schedule - so the lysis/MUA was really helpful!  That doesn't mean, however, that I can function much in the business world under the influence of pain meds.

I still use crutches - I only need one while around the house. But weight bearing has been added cautiously - opting for ROM at the expense of strength training!

Good luck!

L.

Heather M.:
L,

The problem you had with swelling was exactly why I was kept off work for so long.  When you sit at the computer, your knee is WELL below your heart and the fluids pool there.  Since I had a problem with recurring scar tissue (it had been removed three times and come back with a vengeance each time) we were being extra careful.  Still, I think the rule of thumb that anything which causes increased swelling and pain should not be part of the rehab regimen may not be a bad thing.  ;)  Oh, and I totally forgot about the medication-induced fog!  My OS told me he'd expect me to be on a 'regular schedule' for pain meds for 10 weeks or so after my LOA surgery.  Now, I maybe get away with it because I do creative writing hehehehe.  Not so sure if I could have gone back to work at 8 weeks post-op if I'd had to be SERIOUS and business-like LOL.  My sweats don't care if I strap an ice-pack on, but I imagine it wouldn't have gone well with the business suit, nylons, and pumps that I used to wear when I worked in a cube farm.

A lot of the LOA recovery is trial and error.  You try something and see how it works.  Chances are good that you and Neil are not genetically predisposed to forming scar tissue, whereas in my case it's very clear that my immune system goes into hysterical overdrive at the slightest insult and starts forming enough scar tissue to get me through Armageddon.  Again, everyone's case is different, but if you find yourself chronically dealing with scar tissue it's time to change up the old rehab routine.  In  my case, it became clear that I couldn't magically expect different outcomes from the same old scope and scrape and aggressive PT; I had to do something different, and PT was what got changed in my case.  The surgical technique actually stayed the same (anterior interval release and aggressive debridement of fat pad, patellar tendon, lateral and medial gutters, suprapatellar pouch cleanup, etc.) but the rehab change made all the difference in the world to me.

If you've never had a problem with scar tissue, it may not be necessary to go through the life-consuming post-op protocol that I did.  But if the aggressive approach doesn't work, then you can be comforted by the knowledge that there is more than one way to skin this particular cat.  Kind of gross analogy, but you get my drift.

Heather

neilatwork:
Heather & L:

Thanks for the info.  I am generally surprised by the time expected to recover and the amount of pain.  I thought the initial recovery from my fracture was bad as it happened in 9/03 and I was nwb for 6-7 weeks.  So far I've had about 7 mos of PT since the inital accident.  I even had an MUA but no scope when they removed my hardware and I was up and about in a few weeks.  Thinking this would be similar, but I guess not.  If this is what its going to take to get me back somewhat normal, then I'm willing to do it.  I know there are many others that recover just fine (and quickly too) and I am always hoping I will be too.  After closing in on a year soon, I guess the road will just be longer than I expected.

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