The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: Durden on February 25, 2005, 02:09:29 PM

Title: Any info...completely destroyed knee
Post by: Durden on February 25, 2005, 02:09:29 PM
Hey everyone, this will be my first post here so i would just like to say hi to you all :). 

anyway, heres what happened and the ensuing problems: back during winter break, a buddy thought it would be funny to jump on my back and i stumbled, dislocating my knee and literally tearing every important ligament in my knee.  I had one surgery, a repair of the lateral collateral ligament (forgive me if i dont have the terms down yet, im still reluctantly learning) and the MCL, as well as the meniscus that rests upon the top of the tibia.  the ACL and PCL were torn completely through, and the capsule was completely shreaded, making reconstruction of these two ligaments impossible at this time (1/13/05).  now, i am waiting to go in for reconstruction of these two ligaments as well as a whole slew of other strange ligaments connected to the tibia/femur/patella with very obscure names.  the whole problem stems from the problem that i have to get the knee to bend freely up to 90 degrees.  i can bend the knee comfortably up to ~60 degrees but after that, the pain is SO intense that i cannot continue.  i have been going to pt regularly, and the therapists/surgeons have assured me, using mri imaging techniques, that the pain is due only to scar buildups and possible minor other tears and can be worked through.  they have also told me that if i cannot get the knee to bend up to 90 by surgery time, that they will have to do a 'manipulation'...knocking me out and bending the knee while im floored.  i really really dont want to do that!  My question...does anyone have any ideas of how one may circumvent such debilitating pain?  the pain is so intense that it seems near impossible to make any progress.  also, i dont have a low pain tolerance at all, but this is horrid.  any ideas how to get this knee to bend more so that i can get that surgery, recover, walk again someday and get back to surfing would be GREALY appreciated.  right now i am at a loss as to what i should do about this whole thing.  also, painkillers are out of the question, they seem to be useless.  anyway, sorry for the long post.  thanks for any help any of you may be able to provide me  :D

Title: Re: Any info...completely destroyed knee
Post by: beckyc on February 25, 2005, 03:28:52 PM
Welcome to the board. I just have to ask, is this person still a buddy? JK, I'm sure they feel guilty as h*ll. I have found that heating up the tissue before PT helps. It seems to me that I can get to a certain point comfortably and then the pain hits. What I usually do is inch past that point and maintian for a minute. Usually my pain tapers off alittle bit and I inch it a little bit further. After a couple cycles of this I will straighten my leg to a point where it is comfortable. Usually you can build your pain-free ROM like this and eventually it will come. If you have to move even centimeter by centimeter it is still progress. Try gripping something with your hands to maybe take your mind of the pain even slightly. Wiggle your toes on the other foot. Do something elsewhere in your body that requires concentration. Try singing the alphabet when you start and OK the first time I made it letter C before it got to be too much, next time I will make it to D. Play your favorite music and sing along as loud as you can. Get a picture of your "buddy" and focus all of your pain onto them. Maybe it will even make them feel a little bit better that even thought they caused the damage they are now helping you work towards recovery.
Good Luck to you,
Title: Re: Any info...completely destroyed knee
Post by: Janet on February 25, 2005, 03:30:04 PM
So sorry you are having so many problems. It sounds like you had a horrible injury. Usually the doctors will intervene if you cannot bend to 90 degrees. But I wouldn't let them do a manipulation (MUA) to break up the scar tissue without first doing an arthroscopy to clean out the scar tissue, then gently bend the knee to regain ROM. Go down lower on this board to the "Soft Tissue" section to find out more about scar tissue problems. You can also search this board for "MUA" or "manipulation under anethesia" or "scar tissue" to find more posts about this issue. It is best to learn as much as you can so you can ask your OS appropriate questions about your care. Good luck.

Title: Re: Any info...completely destroyed knee
Post by: hottubpam on February 25, 2005, 03:59:03 PM

Please, please, please take Janet's advice and read all the horror stories from people on this bulletin board (myself included) who have had an MUA to deal with scar tissue.  It is a barbaric and tortuous procedure and generally causes the scar tissue to come back!!!!!  The only exception I can find is if you have had a total knee replacement (TKR) and then maybe MUA's will work.

It sounds like you have a ton of scar tissue, a condition called arthrofibrosis.  There are only about 10-12 orthopedic surgeons (OS) in the country that are well respected for dealing effectively with scar tissue and they do NOT perform MUA's!!!!!  For lack of a better word we have dubbed them "arthrofibrosis specialists".

Unfortunately I did not get to one of these specialists until AFTER I had an MUA.  The protocol developed by some of these
specialists" is to never, ever, never have an MUA for arthrofibrosis.  In my case (like yours) I formed a ton of scar tissue from the original accident.  My original OS performed ACL reconstruction on me when my flexion was only 90 - BIG BIG mistake.  You need full ROM before attempting ligament repair, especially if you are prone to scar tissue formation.  My current OS says if he had been treating me he would have done arthroscopic surgery to remove the scar tissue and deal with that before even attempting to reconstruction the ACL.

Again, my MUA was so traumatic I was bruised from my hip/butt to my ankle and within 3 weeks of the procedure the scar tissue had grown back with a vengence. 

There is hope if you can find an OS that has dealt effectively with this condition.  My OS has given me a 70-75% chance of getting back on the mountain to ski, pretty good odds.  If you must see your current OS again, ask him how many patients with arthrofibrosis has he treated and what were there outcomes???

Do your research and take control of your treatment if you want to return to surfing.

Good luck,

Title: Re: Any info...completely destroyed knee
Post by: Heather M. on February 25, 2005, 08:13:46 PM
Ditto Janet and Pam.

If you read up on arthrofibrosis, you will find a distinct trend.  Most of us who had the arthrofibrosis go undiagnosed or were treated with a procedure like an MUA (I was--didn't work), were treated by wonderful, well-intentioned surgeons with high skill levels who worked with pro athletes.  I'm not going to say my previous surgeon (who takes care of World Series Champion baseball team) is a bad doctor, because he absolutely is not.  But he wasn't the right doctor for my condition.  I didn't believe that, and let him do four scopes and an MUA in 10 months...yeah, I'm a little thick.  Actually, at that time there wasn't even a soft-tissue healing problems section of this board, and only one other person had excessive scar tissue (though Janet and I were both struggling to get diagnosed at about the same time).  Anyway, after doing a lot of research on the far corners of the internet, I decided I wanted to see a doctor who knew how to treat the problem, and who didn't believe in aggressive PT and traumatic procedures like an MUA. 

A knee forms excessive scar tissue for a lot of reasons--but usually because it is traumatized.  An MUA is a pretty barbaric procedure where they knock you out and aggressively bend your leg, trying to deliberately rupture all the bands of scar tissue that pull tight and hurt when you try to bend.  The problem is this:  1) a manipulation doesn't actually remove any of the scar tissue from your knee, so it just stays in there....following the MUA, the knee usually swells up further, and this fluid gathers and can glom back into bands of scar tissue all over again.  2) MUA doesn't improve extension--it only takes care of scar tissue that is blocking flexion (bend) of your leg.  3) an MUA is a very traumatic procedure...why treat a traumatized knee with further trauma?  4) when scar tissue stays in the knee and gets 'mature' (meaning it starts to get rope-like and contract like a skin scar does), it can actually be stonger than other structures in the knee that it is stuck to.  This puts you at risk for having structures like ligaments and tendons ruptured due to the extreme force required to break up the scar tissue.  People on this site have had some of the worst complications from MUA--these are rare, but they have happened.  Some have had femur and patella fractures, patellar tendon ruptures, quad tendon or quad muscle ruptures, and so forth.

Anyway, read up on scar tissue on this site.  It's a pretty rare problem, and man OS's haven't really dealt with a severe case of it.  Most think they can handle it, though, and give it a try.  Sometimes it works...sometimes it backfires.  This is what happened to me, and several other people here.  Now I'm not saying it's going to happen to you, I am just putting the information out there for you to read.  There are multiple articles in the soft tissue healing problems section that have been written by doctors who have spent a lot of time researching and treating knees with arthrofibrosis.  If I were you, I would try to seek out the opinion of one of these doctors--most are also multi-ligament specialists, because that is one injury often associated with arthrofibrosis.

Read up and remember this:  you are in charge of your treatment.  The doctors can't do anything to you that you do not consent to.  Try working with a very gifted physical therapist--one who understands that you can't force the knee to bend, you have to sneak up behind it and coax it.  Try bending just to the point where it starts to hurt, then immediately back off until it doesn't hurt, but you are feeling a nice stretch.  Then hold it for 2-3 minutes.  Ice often--swelling is the mother of scar tissue, so elevate when you ice.  Painkillers are important--not to help you push through extreme pain, but to help you with the ache and swelling that might come after a bending session.  It should be minimal swelling after, but there will be some--it's unavoidable.  Anti-inflammatories like Celebrex have been incredibly helpful for me.  Anyway, as long as you are making *some* progress in PT, there's no reason to pull you out.  I understand that less than 90 degrees makes a doctor nervous.  But if you are improving, say, 5 degrees a week, then it's worth persevering. 

On the MUA--I didn't have any serious side effects except for muscle spasms that dropped me to the floor.  I should have been using my crutches but the instructions got messed up and I didn't hear that part.  Anyway, I was lucky--no real damage was done, no bones broken or anything.  But my scar tissue came back immediately, because the MUA led to more swelling.  The trauma was exactly the opposite of what my knee needed.  Now my surgeon is different--he has done a lot of work with scar tissue and developed a protocol for treating it with surgery and specialized rehab.  Instead of doing MUA's post-surgery, he does a procedure called an insufflation where the patient is knocked out and sterile saline solution is injected in the knee to fill up the capsule and stretch it out--in the process, this ruptures the bands of scar tissue in the knee.  Then a large needle is used to suck out the fluid AND the wispy scar tissue bits, so that they can't reform.  This can only be done fairly early in the post-op period--maybe up to 6-8 weeks?  I had it done at 2.5 weeks post up from my scar tissue removal surgery with the new doctor.  If the patient is outside of the timeline to safely do this insufflation, he does an arthroscopic removal of the scar tissue instead.

Every doctor is different.  But you are the patient--it is your knee.  It sounds like you are uncomfortable or worried about the proposed treatment--saying that if you don't get to 90, they will do an MUA.  You don't have to consent to anything.  You are fully entitled to seek a second opinion.  Also, keep this in mind--multi ligament injuries are rare.  They require a special touch to effectively reconstruct the entire knee.  Talk to some of the people on here like ATSoccergirl and KJ, who have had serious multi-ligament injuries.  Perhaps they can guide you.  Pam and Jennifer and Sarah--who you will find in the soft tissue healing problems section--have had ligament injuries and arthrofibrosis.  I'm sure there are others, but I'm drawing a blank!

Hang in there.  Ask questions.  Challenge assertions about the 'best way' to treat your problem.  As you deal with orthopedics injuries over time, you will realize that there are no absolutes--just opinions.  You need to find the doctor whose opinions and treatment plan best fits with your comfort levels and goals.

Title: Re: Any info...completely destroyed knee
Post by: Durden on February 26, 2005, 05:28:47 PM
THANK YOU ALL so very much for this information!  I am so glad to know some of these things before i make a possibly horrible and lifechanging decision.  I'll try everything that you recommend on here, you all seem to know a LOT more than i do and i appreciate that so much.  anyway, i am going to talk to my therapist about all of these things as well as the os and see what they both think of it.  thanks again for letting me know what the heck im getting myself into

oh yeah...if someone could show me where to find the pages on soft tissue damage and scarring/arthrofibrosis etc i would be very thankful...this site is huge...
Title: Re: Any info...completely destroyed knee
Post by: Heather M. on February 26, 2005, 06:57:11 PM
Here is the section:

It's five threads below this one, under the 'Rehab Department' heading.