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Author Topic: Am I done?  (Read 2108 times)

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Offline bsegraves

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Am I done?
« on: October 17, 2005, 10:27:01 PM »
I am struggling with whether or not to have another surgery.

My goal is to get back into taekwondo. I really enjoy it. Do I have any chance of ever returning to the sport I love?

I had an ACL reconstruction on my right knee in June, but haven't shown any progress in ROM over the last month and a half. Iím fairly certain I have scar tissue build up inside the knee. I plateaued at 120 flexion, but I am now at 100 cold, 110 (barely) warmed up. My extension has been pretty consistent throughout Ė the back of the knee is about 1Ē off the floor, but I can push it down with minimal effort (first thing in the morning takes the most effort).

My knee has recently started to click when I walk, but itís pretty minor and I donít notice it unless I look for it.

I can walk fine. Any limp I may have goes away once the leg warms up. I can go up stairs fairly easily. I can also go down the stairs, but the limited flexion pretty much requires the use of the handrail (or I can waddle back and forth Ė which is what I do if Iím carrying laundry).

From reading over many posts in this forum, it seems like most people see some improvement if they go ahead and have surgery to treat their arthrofibrosis. The recovery, though, is prolonged and brutal.

For me, my knee is mostly functional for day to day activities. To be honest, I feel lucky. If I didnít want to return to taekwondo Iím pretty positive I wouldnít go for another surgery.

I think my flexion would have to be at least 130 to be effective, ideally closer to 140. Would I have a good chance of achieving at least 130? Or is it more like 50/50? Or less?

If I were single Iíd probably roll the dice, but Iíve got a wife and two young girls. Going through with this surgery would mean more time away from them (Iíd probably go to Vail and see Steadman), a lot of money that we canít afford right now, and lots of time off of work. I only have two sick days left as it is thanks to my prior surgery, and I donít think theyíd be too keen on my missing more time.

I know all that shouldnít matter, but it does. Especially if Iím looking at a pretty small chance of ever being able to effectively return to taekwondo. I want to return to sparring Ė itís so much fun. Iím not a violent person Ė in fact most people are surprised that I enjoy martial arts Ė but itís so much fun. The thought of losing this is hard to swallow (I honestly feel like crying half the time, ridiculous as it sounds), but it doesnít make sense to put my family through another surgery if I have a minimal chance of returning anyway.

Any advice? Is my view skewed because Iíve mostly been reading about everyoneís struggles and not their successes?

   - Brendan
« Last Edit: October 17, 2005, 10:29:01 PM by bsegraves »
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection

Offline Heather M.

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Re: Am I done?
« Reply #1 on: October 18, 2005, 08:08:00 AM »
The problem with scar tissue is that it seldom stays at the liveable but impaired stage.  Scar tissue hardens, tightens, and shrinks as it ages--it becomes more fibrous, from its rubber-band-like state when it is new.  Mature scar tissue, at say 6 months post op, can often cause way more problems than pliable scar tissue at a couple months post-op.

If I were you, I would go see Steady right away.  You have an excellent chance for a full recovery--those who have their scar tissue treated *properly* within 6 months of onset often go back to their pre-op activities.  There have been studies done on this subject, and those who had the scar tissue demon dealt with inside of 6 months had knees that were comparable to control participants...those are NORMAL KNEES.

Honestly, I understand about the family obligations.  But the choice may be taken out of your hands--and so if you must have it dealt with, it's much better to do it sooner rather than later.  Dr. Steadman might have some suggestions of what's going on in there, and they may have nothing to do with surgery--you can't second guess.  But if I were in your position, I'd go get that opinion.  I wish I had done so...when you read about those of us having multiple surgeries, it's usually because we weren't treated by an expert early on in the process.  Those who were have left the board....points to ponder, eh?

You have to believe you will get better and get back to your activities, and not settle for good but not great.  Unless you have permanent arthritic change in your knee, there's no reason you should be impaired.  Believe it and then make it happen--it works for a lot of people.  I know there are considerations like logistics and time away from family...can they come and make it a vacation?  Can they do without you for a week or three or four?  Can you live with your knee no better than it is, and perhaps a lot worse, for the rest of your life?  All important questions that only you can answer.

I would say go for it, but I'm prejudiced because I didn't get appropriate treatment in time.  So I always push people to do so, and you are in the best of hands with Dr. Steadman.

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
http://www.flickr.com/photos/hmaxwell

Offline bsegraves

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Re: Am I done?
« Reply #2 on: October 18, 2005, 05:19:16 PM »
Heather, if you were trying to scare me it's worked :) I can live with my knee where it's at, but I'm not thrilled at the thought. If it gets any worse, then that would greatly affect my ability to use stairs.

It's good to hear that having the surgery early improves the likelihood of a successful outcome.

My wife and I discussed this and I'm currently trying to work out the logistics to see Steadman or one of the other doctors at his clinic. Ktee, thanks for the travel hints!

   - Brendan
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection

Offline bsegraves

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Re: Am I done?
« Reply #3 on: October 20, 2005, 10:26:23 PM »
This may not come as a surprise to regulars of this forum, but I'm already seeing progress since jetissoning the rehab protocol from the PT I was seeing and instead adopting the rehab protocol outlined by Heather and others.

From my PT the mantra was always, "Muscle strength, muscle strength, muscle strength." They were never worried about my continued swelling - they just thought it was odd. Nor were they overly concerned about pain in my knee. "You're young, you're fit, why are you complaining?" They also never mentioned anything about heat in the knee. I never even knew to look for this. At least they backed off when I started developing patellor tendinitis.

I'm finally seeing flexion gains for the first time in over a month. My extension is still limited, so I don't think all my problems are about to disappear, but it sure is nice to see some progress for once.

Here's what I used to do: one legged squats, total gym squats at highest level going as deep as I could go ("work through the pain"), stomach ankle pulls (lie on stomach and pull on towel tied around ankle), knee cap mobilizations, and one 15 minute rep of a wall slide.

What I do now (stopping if painful): wall slides (20-30 second reps), knee cap mobilizations, 20 minutes of total gym squats set at mid level (surprisingly, my knee doesn't seem to mind this at all), quad sets, and hanging leg off bed.

There's no way I'm going back to my prior PT, so I've ordered one of those flexion measuring devices so I can track my progress. I assume the progress will plateau, but I want to be sure. As I mentioned I still have a slight extension deficit (I'm guessing around 5 degrees) and my knee cap is catching some when pushed toward the other leg.

So thanks guys, your advice is working!

   - Brendan
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection

Offline IndyCelt

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Re: Am I done?
« Reply #4 on: October 20, 2005, 11:09:22 PM »
Brendon,

It is great that you are gaining on flexion, but if I have learned anything from working with Dr. Shelbourne, it is that the extension loss is a far bigger problem than the loss of flexion.  Without hyperextension, your quads have to work much harder when you are standing and you don't want to go around the rest of your life with a limp, however slight).   You may be able to improve your extension on your own via the hanging leg, towel stretches, propping your heel up, etc..  I made lots of improvement on extension, but eventually plateaued out and had surgery 2.5 weeks ago.  Shelbourne's Mantra is extension first, flexion next, but only if it doesn't mess up the extension.  Once those pieces are in place then it is time for strength work. 

Deciding to have another surgery is a big step, but choosing one of the experts is the way to go.  Good luck.

Cheryl

2-1-2005 Exise of bipartite patella
2-21 and 2-23 clean out for Strep infection
10/3/05 Scar tissue resection

Offline Nick_Knack

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Re: Am I done?
« Reply #5 on: October 21, 2005, 12:30:48 AM »
Brendan,

Where do you live? So someone can recommend a surgeon based on proximity to you.


Nick
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline bsegraves

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Re: Am I done?
« Reply #6 on: October 21, 2005, 01:10:15 AM »
I live in Austin, Texas.

When I checked the list, it looked like Steadman was the closest, though if anyone knows of a closer specialist (who probably has a shorter wait time) that's be great.

IndyCelt: Yeah, I am worried about my extension. That's why I'm still considering surgery, though hoping and praying that it won't be necessary.

   - Brendan
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection

Offline bsegraves

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Re: Am I done?
« Reply #7 on: November 09, 2005, 09:18:30 PM »
Thought I give you guys an update.

There's actually a local doctor (Cunningham) in town who did his fellowship with Steadman. I saw him this morning and he immediately told me that I wasn't being neurotic with my knee and that I definitely need to take some quick action to avoid surgery.

He recommended that I go see his PT. The group he's with hired their own PT staff and they are literally right down the hall - so if the PT staff has any questions they can go grab your doctor for a second opinion - sounded similar to Steadman's setup.

After looking over the notes of my knee and doing an examination, he doesn't think that the original doctor did anything wrong. He said that about 5-7% of patients over 35 (I'm 36) get arthrofibrosis, which he said I have. He said that it tends to be a little more common with patellar tendon autografts, but he still thought that the technique was worthwhile given the strength of the tendon (though at my age he actually recommends the hamstring, though we didn't get into details as to why).

He said that the tendon in my knee is actually healing quite well, faster than he expected. On the downside, I also have some posterior scar tissue. He has some faint hope that with a better rehab protocol (and bracing at night) I can avoid surgery. He said we should know in 3-4 weeks.

Boy am I praying...

   - Brendan
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection

Offline Janet

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Re: Am I done?
« Reply #8 on: November 09, 2005, 09:56:53 PM »
Brendan:

That sounds like good news. I'm glad you were able to find a doctor close to home. Good luck with his PT. Keep us posted on your progress.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline bsegraves

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Re: Am I done?
« Reply #9 on: November 10, 2005, 09:12:26 PM »
Saw my new therapist today.

She was encouraged by the progress I've made at home on my extension and thinks I may not need the dynasplint after all. She wants to check back on Monday, but she thinks there's a good chance I can regain my full extension without surgery or splinting.

She measured me at 3-95 cold. After some gentle manipulation, she was able to increase my flexion to 118. She also said that there's no hard stop when she reaches 118 - my pain is causing her to stop. She said that often times with arthrofibrotic knees she'll feel a hard stop, so she's encouraged that we may be able to increase the flexion even more. It was so nice to finally talk to a PT that's actually seen arthrofibrosis before.

She also said I have slight patellar baja - she's a little concerned, but after working with it she saw some improvement so she's not worried yet (or at least she's not telling me she's worried).

She also heard the loud click in my knee. It's quite pronounced when doing the clutch press. She's a bit worried about the clicking and wants me to tell her as soon as it starts hurting (right now it's just discomforting, but has zero pain associated with it). And obviously I should stop doing the clutch press if it starts to hurt.

She was surprised at my knowledge of my condition and asked where I had learned my information. I told her about KNEEgeeks and she said, "Yeah, I've been to that site a few times". So thanks everyone for your help - it really works.

In case anyone's interested, here's the PT regimen she has me on:

  • Seated straight leg raises, once a day. Start at 10 reps per set. Increase to 30-50 reps as I'm able.
  • Quad sets, hundreds per day.
  • Clutch press (wrap band around foot and push heel to floor), 30-50 reps twice a day.
  • Prone hangs for 2 minutes, twice a day.
  • Continue with the total gym, doing two-legged squats for 20 minutes once a day. Just watch the knee for any complaining. I have mine set to level 4 (out of 6 levels).
  • Continue with the wall slides. Currently I do 20-30 second wall slides for 30 minutes, once a day. I try to get in wall slides twice more each day, but I can't do it for 30 minutes because I'm at work.


   - Brendan
6/29/05 - ACL recon with patellar autograft
11/1 - diagnosed with arthrofibrosis
12/1 - aspiration and steroid injection
3/7/06 - steroid injection
5/23 - debridement
8/14 - passed sports cord test, ok'd to begin light jogging
1/24/07 - steroid injection















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