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Author Topic: Big Decision!! Should I go for a 2nd surgery??  (Read 981 times)

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Offline AndrewC

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Big Decision!! Should I go for a 2nd surgery??
« on: January 17, 2005, 10:36:18 PM »
HI ALL

I need some advice/comments from you fellow knee geeks on a big dilemma I am currently facing..... PLEASE!!

OK, as some of you may/may not know I had a big tear to my Lateral Meniscus repaired in June 2004.
My leg was stuck at an angle of -25 degrees extension and would only bend to 90 degrees flexion. Had to wait 4 weeks for emergency surgery!

This cost me some serious atrophy to my Quads so I have been working REALLY hard at physio and going to the gym etc to get back to fitness....

The problem??
Well, my knee is no way 100%. I went back to see my original surgeon 2 months ago and he said it looked good, he thinks the repair has healed and that I need to give it "more time and physio"......Fair enough I thought.....and worked extra hard at my gym work (4x per week) and physio (1x per week)...

Anyway, improvement was limited and although I (luckily thank the lord) don't have actual pain in my meniscus....I do still have problems....

Being:
-Large bakers cyst at the back of my knee has remained since surgery (swelling due to irritation/or trauma to meniscus--Is meant to go when all is ok I think!)

-Still get tightness  in the LCL area of my leg and sometimes at the postero Lateral corner (rubber band feeling??)

-After being stood for say an hour or two my knee gets really tight (elastic bands again!) and feels just REALLY strange...If I sit for a bit it starts to feel better...until I get up again??
Also (surprise!) knee feels MUCH better after a nights sleep!

Anyway...I decided to get a 2nd opinion from a TOP knee surgeon here in the UK as I was getting really concerned at my lack of improvement...I saw him 2weeks ago.

He said "I can find no abnormailty in the knee joint whatsoever" (upon physical examination) BUT he thinks their could be some tethering of "minor" scar tissue in the postero lateral corner of the knee causing tightness.....and/or the meniscus tear although he is sure is mainly healed, could have healed incompletely.

His advice was intense physio for 2 months with friction massage to the affected areas and if no improvement by Mid February...then he wants to do another arthroscopy  :o

What should I do?? Is it worth doing this??
I mean I can jog lightly for small-ish distances (the 2nd surgeon thinks I need to build up my confidence in the knee again!!and he's not wrong!) but my knee feels so strange after some types of exercise that I just don't know what to do???

Also, I will be having it done private so this will cost me about 1750 (UK) although I would willingly pay this to get my knee right ;)

Sorry for the long post  ;D but I could really do with some other peoples experiences with 2nd surgeries of this type (preferably good ones!) and if anyone has any good advice relating to what I should do...


Thanks in Advance FOLKS  8)

Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,

Offline kneesurgery

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #1 on: January 18, 2005, 12:56:50 AM »
Hey Andrew,

I say get it done.  The recovery time for the second arthroscopy would probably be much more rapid, and if it fixes your knee then its worth every penny.

BY THE WAY, I am sure I wrote you last.  Been waiting for a reply for sometime.


Offline AndrewC

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #2 on: January 18, 2005, 02:26:24 AM »
Hey there Kneesurgery...

Hows it going!!
Ive written you an IM  ;)
Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,

Offline sienna

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #3 on: January 18, 2005, 02:48:25 AM »
Hi Andrew,
Hmmm.  Tough one.  Hard not to colour it with my absolute desire never to go under again!!!
But having said that, it seems that the new os wants to try some non invasive therapy first which is always a good thing.  At least he has a plan and is not about just chopping you up.
Obviously you are having probs with rom and this is quite likely from the bands of scar tissue.  And you said yourself that it feels like there are rubber bands in your knee.  My limited understanding of scar tissue is that if it is in the way, it generally needs to go, one way or another.

My advice would be to try the aggressive pt and massage to try to break up the bands.  I wish you well in this.  But I would think that after all this time,the bands are well and truly stuck to your knee joint and will probably need to be surgically removed.

Always try the non invasive method first.  You never know it might just work.  And you have nothing to lose with the massage.  It won't make things worse.

So I like his plan of attack.

Good luck your your new plan and keep us posted.
Take care,
Tanya
rk posterior meniscus tear. Successfully repaired 10 Sep,03. Now have nerve damage and cps which goes with it.  I want to slap the person who said 'It just takes time....'

Offline AndrewC

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #4 on: January 18, 2005, 03:18:01 AM »
Hi Sienna

Hows it going and thanks ;) for the post.

Funnily enough...my ROM is surrisingly good??!
My physio says it is good and almost the same as my other leg with which I can touch my butt! I can almost with the "bad" one but it feels like the swelling behind the knee that is acting like a cushion and stopping totally FULL flexion  :-[

Having said this I have spoken to a knee geek with scar tissue probs whos ROM is also really good so I don't want to get my hopes up yet!
The only thing I am sure of is that I must be at the MILD end of the scar tissue scale and have not genetically formed it but formed it purely from the trauma of the injury.

Anyway..your advice sounds good about trying the friaction physio for another 6 weeks and then having to have another op....ouch!

Will keep you posted on how things are going

All the best

Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,

Offline Heather M.

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #5 on: January 18, 2005, 08:35:45 AM »
Andrew,

In my experience, it's not the flexion that matters, it's the extension.  If you have pain or difficulty with full extension, that's a problem that isn't going to go away without some serious interventions, because it usually means there's a mechanical blockage--either a meniscus tear, scar tissue band, loose body, etc.

I also have just about full ROM when compared to my other knee...the problem is that it is certainly not pain free.  And I don't have any functional use of it--i.e. I can't utilize my full flexion in a weight-bearing way, as it is impossible for me to squat or kneel.  I also can't straighten my leg while bearing weight on it...my knee just pops forward as soon as I try, and it hurts enough that I see stars.

Anyway, as for whether it's time to intervene or not, that's pretty much up to you.  Were it my knee, I would see a scar tissue specialist to rule it in or out.  Because if you are having problems due to scar tissue, likely they will get worse as time goes on and the adhesions harden and contract.  Also, scar tissue removal (should this be necessary) is best done within about 6-12 months of onset.  Those who are treated appropriately in this timeframe have results comparable to controls--i.e., people with normal knees.

On the other hand, intensive PT with very specialized treatment like ROLF massage or myo-fascial release could be very beneficial.  I find it helps a lot.  The one thing it doesn't help is the horrible heavy and wooden feeling of the knee after I've been on my feet for a while.  I hate this feeling, and it will soon will turn into bone deep throbbing if I don't get off it.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline AndrewC

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Re: Big Decision!! Should I go for a 2nd surgery??
« Reply #6 on: January 18, 2005, 11:12:31 AM »
Hi Heather

Thanks for the info ;)

My extension is a bit of a tricky issue. My physio says I can straighten my leg "pretty much totally" when I am on the physio bench....but when I am walking if I look at my gait in the mirror it seems that my leg is not fully straightening the same as the other one. I know this could be muscle or proprioception related but I would have thought I would at least have got normal walking back after 5 months or so on my feet again??

Also, I sometimes get a nasty "tight" feeling in the lower patella tendon area sometimes (tibial tubercle) when I try and push into hyperextension.

I am concerned that having my leg locked in a totally bent position for 4 weeks has caused me this problem(s). Also, when I first got out of my leg immobiliser and was hobbling for the first time...when i sat down I CLEARLY heard a band of adhesions tearing in my patella region. it sounded like peeling cellotape off shiny wall or something similiar ??! Anyway..

I am totally unable to squat...I can kneel ok (but my knee feels "tight") but if I try and even think about a full squat by pushing myself up and backwards onto my feet from a kneeling position I get a feeling of extreme tightness in my knee well before I get to a crouched position.. :o
It seems to be "around" the back of the knee but when kneeling I also have a bit of a padded sensation under my patella?? Is this normal (for scar tissue?!)

Also, sometimes when I have been stood on my feet a
while I get a strange feeling in the knee (including in the patella region) which I can only describle as a "full" feeling??

I think going with your advice to see a scar tissue specialist is the best plan though from my preliminary (but thorough) research that may be easier said than done in the UK??!
Are you aware of any UK based patients that have found a specialist in this country??

I will defo look into the ROLF massage or myo-fascial release you suggested...hopefully it will help me "fix" this problem although the inevitability of a Second surgery is looming I fear :-/

Thanks &

All the best

« Last Edit: January 18, 2005, 11:19:40 AM by andrewc »
Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,















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