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Author Topic: (((Danielle))) - Wow!! - What is this pain??  (Read 2313 times)

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shadehawk

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(((Danielle))) - Wow!! - What is this pain??
« on: May 18, 2005, 02:50:27 PM »
Hi,  I cross-posted this as I am not sure that it is my MCL - I won't be seeing my OS until December......

I have been wearing a brace to stabalize MCL & walk again to build up more strength in my legs.  Well, I can only walk for approx. a mile & then get bad pain in tibial tubercle area  & my knee is still slips.  This makes me nervous because that is why I had to stop walking on the trails last autumn.  I spent all winter building up quads and bought a recumbent bike to help out. 

I can't walk without limp & it is not due to pain, I have limped since the fall 14 months ago - hubby says that when he watches me walk my right leg thrusts from medial to lateral side at the knee joint whenever I take a step.  Would this be my MCL causing more problems? A trail - bike friend says my leg acts like his did when he tore his acl & mcl - sure hope that he is wrong about this.  He also watched me walk and mentioned this knee thrusting. 
Anyone have or had these symptoms??   Curious as to how you managed to cope while waiting for surgery.....................

Since my surgery will not be until at least December and might not be until next February - I feel I should keep walking even though some days it does cause alot of pain.  Heck my horse accident was 8-9 yrs ago and the last fall that caused this MCL problem was 14 months ago....Sorry to run on, it is just so frustrating that my MCL did not heal right when most people do not have problems with this ligament after 6 - 8 weeks of bracing.

Thanks for any input

Shade
« Last Edit: May 22, 2005, 02:09:02 PM by Shade »

shadehawk

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Re: Wow!! - What is this pain??
« Reply #1 on: May 18, 2005, 08:44:18 PM »
Just me again.........

Anyone out there have Medial Plication surgery???  Maybe I am not getting any responses as not many people have this prolonged MCL problem and such a long wait for surgery.

Just thought someone might have something similar and I could find out what you did to help get by until surgery.

Shade

Offline Beauzer

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Re: Wow!! - What is this pain??
« Reply #2 on: May 18, 2005, 09:15:03 PM »
OH!  ME!  ME!  One MCL plication, at your service. ;D

Typically MCL's heal without any problem (as I'm sure you know).  I tore mine (along with the medial joint capsule and medial mensicus) two weeks postop from my pulled-out screw removal so my knee was still pretty swollen.  My OS thought that's why mine didn't heal.  We rehabbed for a year before we fixed it.  We initially didn't think that was the problem, but finally came to that conclusion when I pointed out that whenever I stood, the knee was so unstable medially that I could actually SEE the joint opening up.

I have also had a lot of experience with medial instability recently as my MCL plication went kaput (got stretched all to heck) from my unloader brace.  Fortunately the ligament brace (Donjoy Playmaker) corrects it completely.  So as long as I wear the brace, I didn't have instability.  Mind you, that meant that I wore it ALL the time.  We're hoping that after the OATS arthrotomy (or as my OS puts it, the "big A** incision" in the joint) that the capsule will scar and tighten up.  If not, I'll either have to go back in the brace or have my MCL reconstructed (allograft or autograft from other leg - fat chance on that second one) after I am walking again.  He didn't think it felt as loose in the OR as it has for awhile, so maybe I'll get lucky.

I'm not sure what to tell you.  If the brace helps, WEAR IT!  The pain in the TT isn't related to the MCL.  Also, work on your quad strength and hamstring strength (especially the hammys) because they also help with medial stability (The fact that my hamstring was borrowed to replace my ACL caused my OS more consternation as it is further weakening the medial side - bleah).

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

shadehawk

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Re: Wow!! - What is this pain??
« Reply #3 on: May 18, 2005, 09:45:23 PM »
Danielle,

Hi there again, thanks for your response.  Guess that I am just sick of waiting, waiting or maybe waiting.......

Good luck with your OATS arthrotomy.  Hope this helps your condition.

I really do not think there are problems with my quads and hamstrings.  My PT said that I had mild weakness right after my fall & before she got rid of all the swelling (it took 3 months to get the swelling down), but have not had that problem since June, 2004.  That is why I was dismissed from regular PT and do my exercises at home as she did not know what else to do with me.  My kneecap can not be moved over with pt it always sits medially unless it is braced, that is why the OS plans on thermal shrinking (?) of joint capsule.  I will discuss this procedure with him before surgery.

Anyway, thanks I appreciate the input. 

Shade
« Last Edit: May 18, 2005, 10:02:37 PM by Shade »

shadehawk

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #4 on: May 22, 2005, 02:07:59 PM »
Danielle,  ;D

Just got home from a walk and was surprised to find that my right femur and tibia move right over laterally when going down a slope.  (I have to go down a path to get to the walking trail) 

So, I am thinking that the bracing that I have is not good enough as my MCL must still be awfully loose - I was quite surprised to see this with my own eyes.  I have done all the biking and other exercises this past year to correct & tighten my ligaments, all done with bracing on....& still loose....I am really  :o  :o  :o.

You mentioned a ligament brace, the (Donjoy Playmaker), hopefully when I get things settled with my knee brace distributor we'll be able to discuss another brace, but this is another story and complicated.  I have seen the braces on the net.  Until then - maybe I can wrap a tensor over my current brace to get more knee stability. 

My dream would have been a recommendation for this brace in the first place  -  not finding out about it almost 15 months after MCL tear.  Now you have chronic MCL problems (GP says) - (I must be getting chronic frustration because I laughed when I heard this).   She thought that maybe I should ease back on the walking - I let her know this will not happen (OS recommended walking as much as I could) - doing nothing has not helped (except weight-gain). 
OS, GP & PT all have different opinions.  Guess that is TYPICAL.... ???

Sometimes it is sooooooo tiring trying to find out all this stuff - it should be easier than this...guess it is never too late though & maybe if I can get a good brace - I could help my MCL.  Funny, my current OS did not recommend anything except knee sleeves with stabilizers to wear all day.

I appreciate all the help Danielle - it is nice finding things that have helped someone who has been through all this before.

Good luck to you,

Shade

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #5 on: May 22, 2005, 02:29:13 PM »
Shade,

It certainly doesn't sound like your brace is working very well.  Unfortunately, there are no exercises you can do to strengthen or tighten a ligament.  It either heals right or doesn't.  I'm told that the hamstrings help stabilize the knee medially though.  Other than getting an appropriate (hinged) brace I'm not sure what would help at this point.  Maybe you could ask your GP about it if the OS is not being very helpful.  Even with as loose as my MCL has been, the brace eliminated the instability (how we knew it was the articular cartilage and not the MCL that was the main problem, as the bone pain didn't go away with bracing.)  You can also buy some smaller hinged braces at a sporting goods store.  Those would be better than a knee sleeve anyway.

I know what you mean though.  It's very frustrating.  Even after all this OATS stuff, my MCL may be a problem.  If I still have instability (once I can walk, that is) I either go back into a brace for good or have my MCL reconstructed.  Blah!  I don't really want another surgery.  I don't really want to wear the brace anymore either.  It is nice finding folks who have had similar experiences as they can share some advice.  Unfortunately, I feel like I've had TOO many experiences.  Knee expert indeed. ;D

Good luck,
Danielle

32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

shadehawk

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #6 on: May 22, 2005, 03:59:02 PM »
Danielle,

I agree about the brace + I also have a GII FX - it stabalizes the patella, but not much good for the ligaments. 
Have noticed other braces:  the GII trainer brace (http://www.hitechathleticbracing.com/g2_250.JPG), the Bioskin Hinged knee brace (http://www.kneeshop.com/images/bioskinhinged100.jpg), as well as the Donjoy Drytex Playmaker - so maybe one of these braces would help stabalize my knee until surgery. 

It is not that my OS is not willing to help - (I saw another OS after him for another assessment &  MCL was re-injured during the assessment) - weird I know.  My current OS just lives so far away and is very busy - I just can not drop by for him to see my knee - he lives in another province.   My OS is a very good surgeon - distance is just the hazard.   I'll see if my GP can help me out like you suggested.

Hoping the OATS works  -  it would be a real bummer to have yet another surgery for your MCL.

You said that there are no exercises to tighten the MCL and physio told me stationery biking tightens the ligaments of the knee  -   ???  -  oh well, for whatever reason I use the bike daily.....

Thanks again.

Hope you have a good day,  ;D

Shade
« Last Edit: May 22, 2005, 04:23:38 PM by Shade »

Offline teach'

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #7 on: May 22, 2005, 04:06:18 PM »
I too had trouble with an MCL that didn't heal properly.

Danielle, did I understand you correctly, a brace actually made your MCL stretch out? That scares me, what kind of brace was it? I have worn a DJ Armour brace since my ACL, PCL MCL injury last July. I just had ACL MCL (Microperforation on MCL to tighten it up) surgery March 29th. My OS says my MCL looks good, but I am REALLY afraid it will stretch out again. I have read that a loose MCL can cause an ACL graft to have trouble. I wear my brace now all the time and am still on crutches.

Before surgery, even with the brace, I was never able to walk long distances. Just functional walking--at work, around the house. I am hoping to be able to do more walking this summer--after my knee has more time to heal.

Susan

shadehawk

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #8 on: May 22, 2005, 04:39:14 PM »
Susan,
 
Hi, I think Danielle said that her MCL ligament got stretched out with her Unloader brace.  Your brace should not do that, do not think your brace is an unloader knee brace.

I have been trying really hard to build my knee strength up so I can get back to walking longer distances, but maybe it is a pipe dream - can only try.  Have to wait till at least Dec - Feb for surgery. 

I feel so bad whining when you have had such a big injury to multiple ligaments and are still on crutches. 

Hopefully, you will be feeling stronger soon.

Shade

« Last Edit: May 22, 2005, 04:45:19 PM by Shade »

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #9 on: May 22, 2005, 05:49:53 PM »
Susan,

Shade's right.  It was a medial unloader brace which stretched out my MCL this year.  I injured my MCL and medial joint capsule after my ACL recon.  It didn't heal and I had such severe medial instability that my OS thought I was at risk for blowing out my ACL graft.  So in 2000 they did a MCL plication, where they cut the joint capsule, fold it over on itself and sew it together really tight.  They tend to stretch out a little bit over time (otherwise you would never be able to flex the knee again). 

But I was in an unloader brace (first a Donjoy OAdjuster, then a GII) starting in 2/04 for bad medial compartment arthritis.  The job of the brace is to force open the medial compartment.  It seems to have stretched out my plicated MCL in the process (which every OS I've talked to has never had this happen before, but all agree in theory that it seems likely). 

According to my OS, at the time of my OATS my MCL was "better than it had been, but pretty darn loose".  So we'll have to see what happens.  If the MCL is still unstable, it puts my OATS at risk.  So, what to do?  Nobody seems to know.  Everybody I've talked to (6 OS now) aren't really sure what to do with medial instability and medial arthritis, because the two usually don't go together.

After all this time, I'm starting to decide that I don't really LIKE walking much anyway (maybe because I can't do it comfortably) ;D.  So I've decided to enjoy stationary biking and swimming instead, seeing as I can actually do those things.

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline teach'

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #10 on: May 23, 2005, 05:11:49 AM »
Thanks for clarifying--I am so new to this knee thing--unfortunately. I looked briefly for the definition of an unloader brace or a picture (briefly being the key) but thought maybe you all could fill me in.

Shade, I did have a break from my crutches between injury and surgery--but still have another month to go before I can even think about walking unassisted. Walking a mile is just a dream at this point. In fact my son is getting married in 6 weeks in CA and we wanted to do Disneyland--but apparently it will be in a wheel chair (I have heard rumors there are advantages to wheelchairs at disneyland--like shorter waits!)  Yes I am learning to enjoy biking--it is way better than sitting at home doing nothing.

Danielle, it sounds like you too have had a serious injury. You know, I am reallly new and don't know much about knees . . . have you heard of the technique called microperforation? It is suppose to help tighten a loose MCL. My OS said it isn't done much, but he knows the guy who first did it. He did the technique on my MCL along with the ACL hamstring graft. Seven weeks post surgery and my OS is really pleased. Granted--I haven't had a chance to test it because of the crutches, but he says my very lax MCL has tightened to be comparable to my other knee. I suppose very lax is a relative term--if I have my facts right my mcl, after healing 9 months, was a grade 2 with 5+ mm laxity. Apparently he will do microperforation for between 5-10 mm. I am hopefull, yet scared and very cautious especially as I read the many people on this board who have had so many surgeries. My PCL (grade 2)is still unrepaired--I don't know how that will affect my stability.

Susan

shadehawk

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #11 on: May 23, 2005, 11:27:14 AM »
Susan,

Hi again, I find this microperforation surgery very interesting.  Hopefully it will solve your MCL problems.  Good to hear that so far it has tightened up your MCL - that sure is a good sign.

              http://endo.smith-nephew.com/US/node.asp?NodeId=3413

Congrats on your son's upcoming marriage - have fun at Disneyland also - hey, you won't get tired from walking.

Sorry that you'll be on your crutches for another month, wow that is a long haul.

Shade
« Last Edit: May 25, 2005, 12:21:01 PM by Shade »

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #12 on: May 24, 2005, 12:54:04 AM »
Shade

Thanks for the link--in the article. It said to "avoid nonphysiometric strain" any ideas what that might mean? It would be nice to understand exactly what I am supposed to avoid!!!!

It's confusing to me why it is so hard to find info about microperforation. Is it a state-of-the-art technique? or obsolete and ineffective? The latter is scary.

I can't imagine waiting so long for surgery . . .I had to wait, but with the goal of rehab and muscle strengthening--probably also to see how the MCL would heal. But to just wait--I don't think I am that patient!

Susan

shadehawk

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #13 on: May 24, 2005, 01:27:20 AM »
Susan,

Hi, I believe they were speaking about avoiding straining the ligaments.  (Probably why you'll be on crutches so long)  I do not know about this procedure - I just know that not alot of people need MCL surgery - this could be why there is such a small amount of information on procedures. 

I have been having the same problem trying to do research on MCL procedures.  I have been looking at thermal shrinking procedures.  When I first had my knee problems it was in vogue - now the procedure does not look so promising for knees & many places are not recommending this procedure to be done on knees, but still works very well for shoulders.  Apparently, the problem with knees is that the ligaments stretch out again after the shrinking.  Think microperforation seems promising or just the medial plication with stitching.  It will be interesting to see what method will be used by the time I get into the OR......

Yes, I also did PT for quite awhile to try and tighten up my MCL and get my patellae to move back in place (neither happened) so now do PT at home as physio has nothing further for me until surgery.  Waiting times here are very long - nothing can be done about it - you just plod/hobble along & hope you do not do too much damage before surgery.  You do not have any choice but to try and be patient.

I am still trying to walk each day - I pay for it during and after, but it feels so darn good to get out.

Hope that your OS will explain more to you on your next visit. 

Good luck to you,  ;D

Shade

 


Offline Beauzer

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Re: (((Danielle))) - Wow!! - What is this pain??
« Reply #14 on: May 24, 2005, 11:43:31 AM »
My OS told me that the microperforations and plications work, but tend to stretch out some over time.  Whether or not that means they clinically become a problem, I don't know.  A few folks I talked to thought a re-plication might work for me, but my OS said that if he had to do anything with the MCl, he would reconstruct it with an allograft.  Which can also stretch out over time too, but is somewhat more reliable.  The problem is that the MCL provides a lot of stability medially to the knee and doesn't have much to assist it.  So any artificial way of tightening it may not work permanently.

Now that I've reviewed all my OP reports, I know that I actually had two thermal shrinking procedures done to the medial capsule/medial meniscus.  I pulled the capsule off the meniscus and they "shrunk" it back on (during surgery #3) and then closed the tear in the capsule with it during my MCL plication.

I had a tough time finding any info on chronic MCL injuries too.  And as far as recurrent injuries like mine, forget it.

Good luck,
Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05















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