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Author Topic: General Info/Advice Needed  (Read 1393 times)

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Offline max4max4

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General Info/Advice Needed
« on: February 07, 2005, 04:59:00 AM »
Hi, I'm new here.  Here's my story:

Last February I had arthroscopy to fix a torn lateral miniscus in my knee.  I injured it playing soccer while decellerating.  I had the surgery, went through physical therapy, and started playing soccer again in May.  I was okay at first, it was very sore, and my range of motion/strength/balance were pretty bad, but I could still play.  I wasn't nearly as good or fast as I previously was, but I expected it to get better.  I continued playing soccer, and got better.  My strength got better, as did my range of motion.  I struggled with balance, but it was okay.  I got most of my speed back, but not all, and my knee only got sore if I played hard and for a long time (around 2 hours).

 However, a few months ago I noticed my knee got more and more sore.  Eventually I would walk around the mall for a little bit and my knee would hurt so bad that night it was almost unbearable.  I went back to my doctor, he told me to go back to physical therapy.  I went, and the physical therapist told me that I shouldn't be in this much pain and I shouldn't be having a problem playing soccer.  She told me that the Dr. made an incision through the "fat pad" in my knee and that was probably the problem.  She said it wasn't very smart of him to do that, but anyway..  I'm going to a new doctor in a couple of weeks, and I want to know what to expect.  I've been in physical therapy for over a month now, and while my knee is getting better, it isn't getting THAT much better.  Do you guys think I'm going to need another arthroscopy? or is this kind of stuff normal for a lot of arthroscopy patients? Any more info about the incision through the "fat pad"? Thank you very much. 

Offline Ron22

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Re: General Info/Advice Needed
« Reply #1 on: February 07, 2005, 05:21:04 AM »
max..fat pad damage can be tricky..there are many posts regarding others who have dealt with it and also corrective ops..i would reccomend an appt with another os..or the same guy if u feel good about him or her.......fat pad probs can be painful and intense at times..best u can do in the interim is to rice....and rest..try to control the pain if it is too intense...even a script from your reg doc while u get the referral if u need one may help in the meantime...check out the site and u will see u can even do a search on fat pad..check heather m's posts as she is the guru of this site with great info on so many topics including fat pad..i had a bout with it a few yrs ago after yet another open knee reconstruct....tough one....

hang in there and good luck

cheers

ronnie
Surgery #1 ACL/LR/Mdl Mesniscus
Surgery #2 Vascular Repair
Surgery#3 ACL/Ltl Mesniscus/MCL
Surgery#4 Vascular Repair
Surgery#5 Maquet/Bone Graft/Screw/LR/ACL
Arthritis/Knee/Hip
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Offline hondacrazy

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Re: General Info/Advice Needed
« Reply #2 on: February 07, 2005, 10:10:12 AM »
Hey Max - well, I've the exact same story as yourself (except for the fat pad thing, I dont know about that!) I never managed to get back to soccer after my first arthroscopy - just doing the normal stuff was hurting and I didnt get full range etc back - my second scope showed up blistered cartilage (& chunks of scar tissue), so my OS sorted that - slight improvement but still not great (and now quads were completely wasted) so I had a Cortizone injection last Dec and it worked quite well, my knee still isnt perfect & Im not back playing yet but I can do short work-outs in the gym Im sure I will get there eventually!

Id say the 2nd doc will send you for an MRI to see whats happening - if theres not much showing ask about the injection, I know for some people it only works short term but it seems to have worked for me.

Hope this helps!
Claire
Claire :-)
Torn & blistered cartilage in Right knee - 2 scopes Apr & Sept 04
Cortizone injection Dec 04 (RK) Jan 05 (LK)

Offline Linds

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Re: General Info/Advice Needed
« Reply #3 on: February 07, 2005, 10:10:41 AM »
hi Max,
My OS makes incisions through the fat pad when I had a scope and Lateral release on both legs.  I didn't have a problem with this except for one portal on my second knee done 6 months ago and it's still a bit sore but it's improved alot.  ANyway... i'm not sure what else to tell you about that.

It's good to see another Doc, another opinion can never hurt, it can only help.  Did you know that mall walking is worse for your knees then just walking from one place to another. It causes a phenomenon called museum knee since we walk slower and are looking as we go! Just thought that was  a point of interest.

Physiotherapy can take a long time to bring stuff around, unfortunately.  Did they fix the meniscus or remove a piece of it?  It's just a thought, as there is a difference. If they fixed it then you still have your whole Meniscus if they removed the torn piece well, then you aren't playing with a whole pie.  ::)  This can cuase pressure and stress on the rest of the meniscus... Again just a thought. I think you are doing the best you can getting another opinion. It's all well and good for a Physio therapist to tell you, you shouldn't be in such pain, but it doesn't change the fact that you are in so much pain.

You should try checking out the other areas of hte board, you may find some helpful advice in other sections.
Goodluck
Linds
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline max4max4

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Re: General Info/Advice Needed
« Reply #4 on: February 22, 2005, 09:02:23 PM »
Wulp, I just saw the new doctor.  He took some x-rays, no MRI though.  He said the joint itself looked fine, and as the PT said, most of my problems are due to the incision through the painful fat pad.  He called it "fatpad fibrosis". 

He said he could do another scope, but that would create more scar tissue.  He also said he could remove the fat pad completely, but that would probably be bad in the long run.  Cortizone shots would also be bad in the long run.  He gave me a script for 8 more weeks of physical therapy with an emphasis on quad strengthening, and said hopefully it should be desensitized, and if not then to see him in a few months. 

It's kind of discouraging.  I've been in PT for so long with only moderate success and here I am again doing another 2 months of it.  Looks to me like I'll have knee problems for the rest of my life =\ 

Any comments/info/suggestions would be great.  Thanks.

Offline Heather M.

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Re: General Info/Advice Needed
« Reply #5 on: February 22, 2005, 09:58:58 PM »
You might want to dig a little deeper into this diagnosis of scar tissue around the fat pad.  Fibrosis, or scar tissue, is a very tricky issue.  If you have it around the fat pad, you may well have it elsewhere--this is something that should be ruled out.  You can do this conservatively through PT, and that is probably the best way to approach things for now.  But keep in mind that excessive scar tissue (also called arthrofibrosis) is a very, very tough problem.  Some people do absolutely fine with scar tissue in the knee, others are nearly crippled (guilty as charged here).

Another thing you might want to try is acupuncture AND very specialized deep tissue massage that is meant to break up the scar tissue.  This could be myo-fascial release (something most PT's know how to do) or Heller work or ROLF massage--there are lots of different types.  The important thing is to find someone who does this therapeutically--you won't likely find the right person at a spa or gym!  My current 'massage therapist' does myo-fascial release, cranio-sacral therapy, and a modified form of ROLF massage.  And she is a licensed physical therapist!  It's the best of both worlds for me.  She wants me to see a doctor for laser treatment to break down the scar tissue, continue with the tissue work to lengthen and stretch the adhesions, and to do acupuncture to promote healing and reduce swelling.  It's a multi-pronged aproach, and is combined with oral anti-inflammatories, ultrasound and other modalities at PT, home stretching, and so forth.

As you can see, there are lots of things OUTSIDE of PT and the OS office that you can do to help yourself if fibrotic adhesions on the fat pad are your problem.  Most people get significant relief from this, and it may be all that you need.

If not, you may need to see a doctor who is very experienced dealing with complications from scar tissue.  I don't want to alarm you at all.  Our bodies heal with scar tissue--it's the way our systems were designed, and in most cases it's not a problem.  But some people create too much scar tissue.  It's a tough problem to deal with, and I believe many OS's haven't seen a lot of serious cases.  So they may not be up on the latest procedures to treat the problem, and you may here things like "more surgery would just cause more scar tissue" or "you aren't rehabbing hard enough" or even "the pain is in your head, you just need to learn how to trust your knee!"  And that is so frustrating for a patient to hear--believe me, I've been there.  It was only when I sought out a specialist who had LOTS of experience treating tough scar tissue cases that I heard "I've seen this before and I know how to treat it."  What a relief.

As for finding a doctor who has this level of experience...sometimes it can be tough.  I've only been able to identify them by researching journal articles to find ones on arthrofibrosis (excessive scar tissue) and then contacting those surgeons.  I'm sure there are other doctors out there who can effectively treat this condition, I just can't tell you where to find them!  Sorry.  If you happen to live in an area near one of these doctors who has written articles on the topic, then it would be pretty easy to see one.  I had to travel 1000 miles to the nearest/best one for me. 

Anyway, let's not put the cart before the horse.  Give PT a chance, and consider adding the 'alternative' treatments I listed above.  You may get significant relief, which would be great.  So you might want to pursue that angle, and see your OS for the oral anti-inflammatories like Celebrex--which is a godsend for me.  You may want to read some stories on arthrofibrosis in the soft tissue healing problems section--but keep in mind that these, for the most part, deal with very severe cases that were treated improperly for so long that serious damage was done to the joint.  That is my current situation, and it is very, very unusual.  So keep that in mind.  Several patients who had focal scar tissue were dealt with properly, partly because they read this board and learned to spot some major pitfalls.  They had appropriate treatment and have gone away, no longer finding it necessary to post because they aren't having a problem!!  That's the best story of all for us.  So please don't panic if you read a large number of horror stories of those of us who were misdiagnosed, mis-treated, even dismissed as having phantom pain.  Just keep in mind that many orthopedic surgeons out there haven't seen a severe case of scar tissue like mine, for example, and they underestimate both the prospects for treating it and the negative impact on the patient's life.

Hope some of this information helps.  It sounds like you have some nagging, stubborn and highly localized scarring of your fat pad.  At least you have one!!  Mine has been slowly and steadily whittled away by repeated surgeries, and I no longer have one. :-\

Heather

Hang in there
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 max4max4

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Re: General Info/Advice Needed
« Reply #6 on: February 26, 2005, 09:53:21 PM »
Thanks for the info, Heather.  I will look into some of the stuff more.

I went to PT on Friday and they seemed as frustrated as I am.  I showed them the script and they already thought it was fat pad fibrosis, but didn't think I should be in PT for another 2 months.  A couple of the PTs agreed that if after two weeks I am not significantly better they will personally call the OS to reccomend surgery.  They said the OS was just hesistant beause I'm so young.  The physical therapists changed my whole workout routine and made it much more agressive, and they're also starting to do ultrasounds on my knee.  Hopefully the PT pulls through, if not then it looks like another surgery for me.  =\

Offline max4max4

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Re: General Info/Advice Needed +UPDATE
« Reply #7 on: April 16, 2005, 07:08:59 PM »
Well, I continued with the physical therapy, and then went back to the doctor.  He once again said he wants to if at all possible not do surgery as it is very tricky and may just cause more scar tissue.  He also said that I can't really cause more damage to it, so I don't have much to worry about except the pain.

He also gave me a cortizone shot directly into the fat pad.  It hurt badly for a couple days, then it felt okay for about 1.5 weeks, and then was back to hurting just as bad as before.

I also am strongly thinking about going back to playing soccer.  I still have a pretty good chance at a scholarship with the coaches I know, but I don't know what to do.  I feel if I go into college level play I'll need the surgery.  Sure, it's just pain, but I definitely feel I'll need it if I play in college.  Should I go back to the doctor and tell him I'm going back to soccer and I feel I need the surgery?  That would probably encourage him some to be more agressive with the problem I imagine.  Any advice/personal experiences with this would be amazing.  Thanks.

Offline hottubpam

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Re: General Info/Advice Needed
« Reply #8 on: April 16, 2005, 09:06:40 PM »
If it is fat ppad scar tissue, I would not go back to the OS you were seeing.  From your earliier posts it does not sound like he has much experience in dealing effecitvely and successfully with scar tissue.  You need to find an OS that has experience dealing with this problem.

Where do you live????  Someone on this board may be able to recommend an OS nearby.

Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline aussie

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Re: General Info/Advice Needed
« Reply #9 on: November 05, 2005, 03:34:54 PM »
Hi Max

I'm interested how your fat pad scar tissue problem is going - you're not Robinson Crusoe as this message board illustrates! I'm a platinum member of this club myself.....

If it helps at this point (hopefully you don't need this by now) electro-acupunture focussed on the point of pain and the VMO helped me a fair bit. Also, fat pad taping as recommend by Aussie PT Jenny McConnell is effective - tape down the top of the patella to lift up the bottom part.

Don't give up - it will come right (if it's not already)

cheers, Aussie