Bone breaks around the knee :

scar tissue - - Posted by Joy (Joy), 11 January 2004

I have a band of tightness around my recently repaired patella that I feel is preventing me from using my knee.  I fractured the knee into three pieces in early November, had surgery and am presently in rehab. Is this tightness and stretch that I feel scar tissue?  I haven't yet spoken to the OS about this. Joy
Posted by hmaxwell (Heather M.), 12 January 2004

Joy,

Why don't you head down to the section titled "soft tissue healing problems" and read up about scar tissue (also called arthrofibrosis when it is very serious or when the body produces so much that the knee joint mechanics are altered).

What you are describing *sounds* like the textbook definition of scar tissue, but only your doctor can say for sure.  It could be swelling or plica or hardware in your knee or any number of things.  With your injury, scar tissue would certainly be a suspect.  But the problem is that scar tissue symptoms can mimic a lot of other things, so it's often impossible to tell for sure unless the doctor goes in again.

If you do have scar tissue bands that are causing problems, it certainly wouldn't be a surprise considering what you did to your kneecap.  You should keep working on rehab and I bet you will start to see improvement.  If you don't, there are several options the doctor has--but your'e still pretty early in the recovery phase.

Definitely speak to your OS and tell him about your concerns.  Scar tissue is not the end of the world for most people--in fact, it's a perfectly normal and desireable response to trauma!  In some people (like me and others with arthrofibrosis) the body doesn't know how to shut off the healing process and makes tons of scar tissue--that's where we get into trouble.

Heather
Posted by Joy (Joy), 12 January 2004

Hi Heather:  I was at PT today and the therapist told me the tightness is probably swelling.  I'll accept that for the time being because the same tightness was apparent both below and above the knee and is no longer with me.  Neither is that area of the leg swollen at present.  Thanks for your input.  Joy
Posted by Kimby (Kimby), 23 January 2004

Hi Joy - I am familiar with a person who broke his kneecap into 27 pieces in a motorcycle accident.  Believe it or not, the police officers on scene managed to pick up all of the pieces of his knee off of the pavement (ugh, huh?) and the doctors wired them together for him.  OK, 27 pieces are a lot different than 3, but the concept is the same - the pieces are wired together (presumably that's what happened to you) and then you get severe tightness in PT - partly due to the "it hurts" thing and partly due to the wire which will not give the way muscles, tendons or cartilidge will.

This brings me to the point - scar tissue is a consideration, but also think about the fact that you are trying to bend something that isn't necessarily "made" to bend - thus, your body will fight it and consequently, you will have swelling.  Swelling is your body's way of fighting an infection and frankly any kind of inflammatory behavior or invasion.  But note, too, that if you are having swelling (and presumably pain with it) that you have your therapist take it real easy with you - that you don't try and play the "no pain no gain" game with yourself.  When it hurts, make the therapist back off - because hurting it more will only cause more inflammation and thus more swelling.

Ice is a good thing to use, too.  Ice it several times a day even if you're not in therapy and not necessarily in pain or having swelling.  

Good luck!  Hope things go well....


Kim
Posted by Joy (Joy), 23 January 2004

Hi Kim:

Thanks.  I am so inexperienced in this field and so unfamiliar with all the complications that everything I feel becomes a question for me.  I have never before experienced a fracture nor have I known anybody who has ever broken a kneecap so I have nobody with whom to compare notes.  

Thank you for your input and support.  

Joy
Posted by Kimby (Kimby), 24 January 2004

Joy, as long as you have a great deal of faith in your orthopedic surgeon, you'll go a long way.  The knee repair process is a lengthy one, no matter what you have done surgically and injury-wise.  It's a joint you use all the time - when you sit, stand, walk, run or whatever you're doing, the knee is involved, so while it seems to take a while to heal patience is one of the best thing you can have.  But having a good doc is probably top of the list - as you read through these postings, you'll probably see as I did several people who have had inexperienced doctors (or therapists) who have messed them up even further.

Hope things are going well !

Kim
Posted by Joy (Joy), 26 January 2004

Hi Kim:

I have come to the conclusion that what I am feeling is scar tissue. It seems to be softening.  For that I am grateful.  

I believe I had a very good OS who is willing to answer all my questions, but alas, I speak to him only on the phone.  He told me I didn't have to return unless I feel the need.  I do feel the need and so I will see him tomorrow and ask him questions.  Truth is, I seem to be improving and am walking easier and straighter than I have been.  I just wish this scar tissue would loosen its grip on my knee.

I had no idea it would take this long for the knee to come back.  The lengthy rehab period is driving me crazy.  I have no patience.

Thanks, Kim, for your wisdom and your input.

Joy
Posted by Kimby (Kimby), 26 January 2004

Hi Joy  - I think I mentioned earlier that massaging, while it won't "take away" the scar tissue will certainly help break it up.  Ultrasound does this too.  So, every excuse to sit down and massage the area is a good thing to do (I even paid the kids to do this - it's easy for them for the most part if they're old enough and it feels even better if someone else does it!).  It's a good thing that your doctor will get on the phone with you - a lot of orthopedic surgeons wouldn't do that and would put you on the phone with a nurse first, so it certainly shows he cares.

I wish you all the luck!

Kim
Posted by Joy (Joy), 28 January 2004

Thanks, Kim.  I seem to be improving a little bit each day.  However, I still can't walk the stairs with both legs.  Applying pressure to the bent knee on the stairs is extremely painful.  I don't know whether this is due to scar tissue or weak quadricep muscles.  Forgot to ask whether I'll ever be able to walk the stairs properly.   J
Joy

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