Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :

ACL RECON/ Valves in Saphenous Vein Shot - - Posted by streamwalker (streamwalker), 20 January 2005

After my ACL, MCl and both medial & lateral meniscus trimmed;
swelling and pain has persisted for years.
After a ultrasound; among my scar tissue problems; it seems circulation in my lower recon knee is poor.  I'm told that blood is pumped in but the valves that pump my blood out are not doing the job....and causing a high degree of swelling and pain with activity.  The problem vein is the Saphenous.  Lots of potencial options here; but I can't seem to find anyone that has had this ..or even info on the net.

I would sure appreciate any info feedback regarding the damaged Saphenous valves...and treatment.
Thanks,
Ric
Posted by hmaxwell (Heather M.), 23 January 2005

I'm trying to fully understand what the source of your problems is--because it sounds like you have some kind of problem with scar tissue, right?  That alone could explain a lot of issues you might have.  And I know from personal experience that scar tissue can badly affect the return of blood from the lower leg.  I've been getting a lot of swelling in my lower leg, ankles, and feet--I've now had to go up to a size 10 shoe!

Anyway, your question about the saphenous vein is really specific...I don't know as I've read of any posts with a similar problem.  Just wanted to warn you about that.  And also, to suggest that you read the Soft Tissue Healing Problems section for more information on scar tissue and the symptoms it can cause.

As for treatments for something as rare/specific as saphenous vein damage...I think you will have to put those questions to a doctor.  What about seeing a vascular surgeon?  He/she might have some ideas. Also, an orthopedic surgeon who deals with very complex cases might have some suggestions on how to  proceed.  If the problem is scar tissue, there are some very specific things you can do.  And there are some surgeons with a lot of experience with this condition (called arthrofibrosis or joint scarring).  If you want to post where you live, we might be able to direct you to the closest one.  Severe joint scarring is a pretty rare problem--I had to travel about 1000 miles to see my doctor, but it was worth the trip because I'd had four previous surgeries that hadn't fixed anything.

Heather
Posted by streamwalker (streamwalker), 24 January 2005

It's very possible that my blood circulation problems are the result of excessive scar tissue.  I have made an appointment to see a vascular surgeon.  
I'm finding that depending on the type of doctor and how they are trained; then that's how your diagnosis is affected and obviously the type of treatment.
I too am trying to understand what is causing all this after my ACL
recon.  My first OS Doc gave up.  His video of my surgery showed that while I was having surgery; something fell, hoses broke, nurses screamed " OH God!" And then I could hear on the tape of my Surgery! .....My OS shouting. "Shut that Damn thing Off!"
He was very surprised... I received the tape from his office; and offered ten renditions of what happened, ( claiming Nothing serious) but they changed with each story...So I'll never know.  

I am willing to travel....I live in CoeurDAlene, Idaho ( North Idaho). Distance is not an issue.  I have had 8 surgeries to remove scar tissue from local OS docs.. I work out the knee every day...regardless of the pain.. now it seems I need to wear a Cho Pak (knee strap) to stop from catching or hyperextending.  All I want is to be able to walk without severe pain..... Lots of throbbing knee pain at night and swelling with minimal excercise....

If I were to list several top docs here ...Is one better than another for cases like mine? Dr. Lonnie Paulos, Dr. Richard Steadman, Dr. Noyles, Dr. Scott Gilogly....or any others.......
Thanks Heather, 
Ric


Posted by hmaxwell (Heather M.), 24 January 2005

I have seen Noyes and Paulos, and had surgery with Steadman.  He's wonderful.  They are all very talented and very thorough.

FWIW, Noyes trained Paulos (i.e. Dr. Paulos was a Fellow at Cincinnati Sports Medicine in the past--it must have been well over 20 years ago).

Steadman is the scar tissue expert, in my opinion, though patients of both Steadman and Noyes follow what is pretty much an identical protocol.  Noyes told me that they worked on it together over the years, and that they do conferences, papers, lectures etc. together.

Vail is a lot closer to you than Cincinnati, and I really thought the PT at  the SH clinic was top notch.  The caveat to that statement is that I never had PT in Cincinnati, or surgery, either.  Noyes told me he agreed with Steadman's assessment and was 'sending me back to Vail' for treatment.  They are both fairly conservative, but I have to say that Noyes apparently does more extensive cartilage restoration and patellar realignment procedures.  Steadman is a believer in the least invasive procedure possible for the problem that he identifies, which is a philosophy I like.

Frankly, I don't think you could go wrong with either of them.  I'd only hesitate with Paulos--me, personally, my exact case--because he said he wanted to correct my mechanics and 'worry about scar tissue later.'  Whereas Steadman's approach was that you couldn't know how bad the mechanics were (or weren't) until you had successfully dealt with the scar tissue.  That, for me, was the philosophy I thought fit best with mine, but for another patient it might be totally different.

Basically, the differences between them weren't in skill level, but more in aggressiveness, philosophy, and approach to PT.  So there is no empirical answer about who is 'best,' rather you have to decide who has the approach that most closely represents your point of view and the plans you have for your knee.  There are also some personality traits that may or may not work well with your way of doing things--I can send you a private message on that if you'd like.

What you might want to do is visit http://www.findarticles.com  and using keywords, look up any articles dealing with your condition and diagnosis.  Then you can find the doctors who wrote the articles, and track them down using google.  That's how I found Noyes, Steadman, and Paulos.

The doctors you listed are all wonderful and have a proven track record of dealing with severe scar tissue.  The doctor in Atlanta is more of a cartilage restoration specialist==I think.  I could be wrong, it's happened before

Heather
Posted by streamwalker (streamwalker), 24 January 2005

Wow Heather that really helps!

I would be interested in some "personality traits that may or may not work." I feel these can be important on selecting top docs especially with the number of surgeries we both have and still needing more.
  You can send me an email at: katidid1971@hotmail.com or send me a personal message throught this website.  You have helped to differentiate the strengths of some of these top docs and now I believe I know what I need....first.   I'm of the same philosophy as yourself with less invasive is best.  I'm hoping, it is mainly a scar tissue problem; but with knee procedures, so often there are multiple aspects of knee mechanics.  I'm doing a bit more research; and I'll get back to you.  It's interesting to have information from someone who has some experience with some very well known knee docs....and it willing to share them!  Thanks so much!
Ric


Posted by streamwalker (streamwalker), 26 January 2005

I found some articles on Saphenous Nerve Closure and Saphenous Nerve Entrapment. However very few were recent..

 A Vascular Doc I found...Dr. Reilly...uses high intensity laser light via a needle in the vein to treat the malfunctioned vein. Often the saphenous vein IS mistakenly cut during routine ACL surgeries even though surgeons are taught to stay clear away from it!    The symptoms often mimic other knee problems and can be misdiagnosed for years.   My other knee has no vascular or knee problems(or surgeries) of any sort.  After my ACL recon surgery I had tremendous pain along the medial side but just decided it was due to the surgery.  Now years later; I still have the same intensity of pain; only it gets worse with movement. My family doc feels that many if not most of my knee pain is due to the valves inside the lower leg that have no problem getting blood to them; but have damaged valves inside the leg vein (Saphenous vein) that are not pumping the blood out... hence the swelling and darker color.  This can be checked with an ultrasound and a trained technician.  Made an appointment with Dr. Reilly..
Ric

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