KNEE ARTHRITIS - Clearing inflamed joint lining :
Synovectomy - - Posted by SarahSmile (SarahSmile), 9 January 2004
Hi everyone, I am new here
I have had TERRIBLE problems with my right knee for years... I am only 25. I was extremely active and involved in many high risk sports injuries, leaving me with pretty much no function in my right knee.
The first time I tore my ACL was in gymnastics- I fell 12 feet off the high bars. I had a ACL reconstruction, using the patellar graft. I fully recovered and returned back to ALL sports. 7 years later I was playing soccer, ran into a large man, and twisted my body & my knee snapped. Tore my ACL again - in the same knee. It was never the same after that injury. Had a 2nd ACL reconstruction, using hamstring graft. ROM never was restored, it is now currently lacking 20 degrees in extension and goes to about 120 flexion. I have been severly limping for 3 years now, which has caused problems in the rest of my body, including a ruptured disc in my back that I now have to treat. I had a notchplasty & manipulation 2 years ago, no success. I found a knee surgeon recently that is an expert and is going to perform a synovectomy on me in 2 weeks, and another manipulation. They want to avoid a knee replacement since I am only 25, however, they think it is inevitable. I am in constant pain and wonder if I will ever be able to straighten my leg out. ?? Anyone have similiar problems? Why can't they straighten the knee out fully? Will a synovectomy help my pain? Any success stories? I need advise!!
thank you SO much I empathize with all of you so much!
Posted by hmaxwell (Heather M.), 12 January 2004
You should check out the "soft tissue healing problems" section above. It sounds like you are dealing with over production of scar tissue, a condition called arthrofibrosis. It's most common to find it after someone has had ACL reconstruction and/or multiple knee surgeries.
If you go to the section I mentioned, there are many, many discussions started by people in your same situation! Also, in the Cruciate Ligaments section you'll find threads by people with tight ACL grafts and arthrofibrosis as well. We all have the same problem (adhesions or tons of scar tissue) but many of us got here by different paths.
Have you been evaluated for conditions like chondromalacia, patella baja, and other complications of scar tissue? They can cause some of the symptoms you are describing. Also, an excess amount of scar tissue can sometimes form behind your kneecap and under/around your patellar tendon--this would prevent you from having full extension. It's a mechanical problem--the scar tissue attaches to different structures in your knee. As the scar tissue gets older (or matures, as the doctors say) then it tends to shrink down and get more fibrous, so it is like a rope, instead of being pliable like rubber bands (which is how younger or newer scar tissue is described). Anyway, as the scar tissue matures and hardens, it tends to pull on anything it's attached to--it puts constant, unrelenting traction on things like ligaments, tendons, kneecaps, and so forth. This alters the way your knee moves, and causes uneven wear and tear on the cartilage (like bad tires on a car with poor alignment). This cartilage damage eventually can become arthritis, which is probably why you are hearing the words 'total knee replacement.'
There are several of us going through this current situation right now, and all of us are younger than fifty! I just turned 34, and my knee looks like a 70 year old's one in an x-ray. There are several people your age as well, all fighting the demon scar tissue.
Why don't you go to the soft tissue healing problems section and read through a few arthrofibrosis posts? Also, I posted a link in a thread (should be on the first page) to an article about arthrofibrosis and the methods for dealing with it.
I'm sure you'll have lots of questions. The other arthrofibrosis patients have been very helpful.
Posted by SarahSmile (SarahSmile), 16 January 2004
Thank you SO much for all the detailed info and help!! I really appreciate it!! It's nice to hear from some people who can relate and have the same type of problem!!
Yes, my dr did say that my MRI revealed "severe arthrofibrosis" and metal debris all over & inside my knee.
So, if they clean it out, basically they still wouldn't be able to straighten my knee because of the permanent changes? The dr's told me that it will never be straight. I guess I just don't fully understand that concept!! If they remove the obstruction, why couldn't it straighten?
Have you had any luck with your surgeries? Did they give you more range of motion or just create more scar tissue?
I am getting a synovectomy in 2 weeks (not even sure what that exactly means!!) and a manipulation. I will be in the hospital overnight and taken home with a CPM machine. Have you tried this and has it worked for you? Any suggestions? I will definately post on the other board as well.
Posted by Rosa (Rosa), 16 January 2004
dont know if this will be of any help to you - I had a lateral release and partial synovectomy (this done as a result of all the adhesions and scar tissue which had built up in my right knee). This was in Sept 2002. Before the surgery I was suffering from severe swelling and shooting pains, and couldnt straighten my knee out fully. After the op, my surgeon told me that the space within my knee was filled with tissue which was 'blocking' full extension of the knee. When he had cleared it out, he was able to fully extend the knee while I was still under the anesthetic.
1 1/2 years later, and I am still suffering from fluid on the knee, but in general things have improved. I am able to straighten my right knee, but cant quite get it to hyperextend an equivalent amount as the left knee. Also, at times of greater swelling I cant quite get it straight.
My surgeon explained that due to me not having been able to straighten my knee for well over a year, certain muscles would have tightened, and it would be difficult to get these back to normal. He also explained that the other thing about not being able to straighten you knee is that it is in the last few degrees of extension that your quad muscles are working the hardest, and so not doing this weakens these muscles. I'm still working on these - but the swelling I have inhibits the working of the muscles also.
I would say that removal of my adhesions helped greatly with the pain, and improved my ability to straighten my leg. I hope it helps you too. I still have problems with swelling, but I think that is just me!
Posted by hmaxwell (Heather M.), 16 January 2004
Rosa explained it pretty well. The excess 'synovial' tissue or synovitis is also called scar tissue by other doctors, since it's essentially the same type of rubbery stuff.
Whether you ever get full function of your knee back is often dependent on how long you've been the way you are. In my case, the scar tissue encased my patellar tendon and caused serious damage to it when it shrank down and contracted. The changes in the patellar tendon are permanent, and they remain long after the scar tissue is removed. The only way to deal with it is to either learn to live with it (yeah, right!) or to go to a salvage surgery. This in my case would be a Maquet procedure, which would move the insertion point of the tendon to compensate for the fact that it's shrunk down to half its normal size.
I did have improvement after the arthroscopic surgery to remove the scar tissue, but only the last time. That's because I had a very specialised doctor who really knew what he was doing with the scar tissue. If you read through the post-op reports I made (along with the ones by Janet, Margaret, and some other) you will see that there's a whole specific post-op protocol. If you don't do this, it's often not worth it to have the surgery because the scar tissue will just come back. A lot of the things we had to do go counter to the standard knee protocol after surgery, so I really recommend that you find a good patello-femoral specialist who is very experienced dealing with arthrofibrosis.
Where do you live? Maybe someone can recommend a doctor. My first doctor here in my city was a wonderful surgeon--one of the best in the state. But after four scopes I was worse off than when I started, and he admitted that he didn't know what else to do. That started the great knee surgery oddyssey for me, one that still hasn't ended.....
Posted by SarahSmile (SarahSmile), 16 January 2004
Thanks again for all the helpful info!! I will definately check out your post op notes so I can ensure I am on track and getting this terrible scar tisssue under control!!!
Unfortunately, I've been living with this problem for 3 years, which is a long time for the scar tissue to do its damage. I lack 20 degrees of extension- which is ALOT, if you can imagine. I am DETERMINED to get better and to fight this, yet I am not expecting any miracles at the same time.
I live in the bay area, Dr. Dye is doing the surgery- he's supposed to be one of the best. He is extremely intelligent and knows almost everything there is about knees- he is VERY passionate about knees, which is very important!
I am crossing my fingers for ALL of us!!!!
I guess the main thing is to never give up!
Updated Thu Apr 29 2010