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Author Topic: post op day 1(help w post timeline)  (Read 2008 times)

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Offline Discgolfer

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post op day 1(help w post timeline)
« on: December 30, 2005, 01:00:49 AM »
well i had my surgery this morning and all i can say is OW this HURTS. My doctor found some cartlidge tears and his opinion that my cartlidge is weak(?). Anyway the doc did the chondroplasty. I was directed to try to use 10lbs (toe touch) with my crutches do leg lifts, etc. Right now i hurt really bad but trying to follow directions. I have a brace from thigh to toe with a huge bandage underneath. I knew something was wrong inside although the doc and his PA believed otherwise. This is bittersweet on onehand i am glad i was right and had surgery but i wish i would have been wrong.

Does anyone know how long it takes to recover from this? I have a job where i stand for about 12hrs a day and I know it will be awhile before i can do that, but i would like to have some sort of idea of what i am looking at.

The doc said my days of playing sports are over? Is this true? I would believe that with conservitive rehab and time i could make a full recovery.

Any help and support would be great.

Offline Discgolfer

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Re: post op day 1(Day 2 -help please)
« Reply #1 on: December 30, 2005, 09:44:49 PM »
Slept pretty good, woke uo several times but was able to go back to sleep.

I have a little pain while reclining or laying down.

I have tremndous amount of pain when standing w crutches.

I have read so much about people walking right after surgery, but i feel i am awhile away from not useing crutches.

I was also told not to remove my brace( The brace goes from upper thigh to the ankle) and just do leg lifts.

I am doing those pretty well.

Again i ask the question How long am i looking at as far as recovery, from what i am seeing this more  like a meniscal repair?

Offline Heather M.

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Re: post op day 1(help w post timeline)
« Reply #2 on: December 30, 2005, 11:00:37 PM »
I'm not completely clear on what the doctor did--chondroplasty is smoothing of the articular cartilage that coats the bones in the joint and helps everything move smoothly.  Meniscus problems are unrelated to this, except that when you have prolonged cases of meniscal deficiency you will often begin to see damage to the articular cartilage, also known as wear and tear or degeneration.

So anyway, I'm not sure what procedure you had beyond the chondroplasty from your description.  If this is the only thing that was done, your recovery cannot really be compared to a torn meniscus removal, i.e. do not expect to begin walking pain-free a few days after surgery!  You are in a large brace, it sounds like, so that will also prolong your recovery.  I would guess it would be a minimum of 2-3 months before you even begin to forget you had knee surgery.  And that would assume that the problem that caused your damaged articular cartilage in the first place does not return...what did the doctor say about this?

From your description, it sounds like you had a 'clean up' scope or debridement of rough/tattered articular cartilage.  Cleaning the stuff up is often a good way to get the knee moving more smoothly again, but that is just addressing the symptoms.  You'll have to talk to the surgeon about the root cause--what made the cartilage get tattered and ruched up in the first place.  It could be muscle imbalance/weakness, tilted patella, blow to the knee, accelerated wear and tear from pounding sports...it's important to figure out what's going on and what caused the damage.  Because that will have a huge impact on your recovery timeframe.

Here's an overview of articular cartilage damage (I'm assuming you've already read the Kneeguru site's info on this topic--if not, go to the main page and bone up on cartilage defects).  http://www.steadman-hawkins.com/knee_chondral/overview.asp  This indicates the recovery time for debridement/chondroplasty is a minimum of 4-5 weeks.  You'll probably start to feel a lot better within a few weeks of the surgery, once the soreness begins to recede.  That's assuming you only had a chondroplasty, though.  "Only" being a relative term, because of course this is surgery, after all, even if "only" done with a scope.

Good luck.  You might want to check out the patello-femoral joint section for posts on "chondromalacia" and debridement.

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 kendra

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Re: post op day 1(help w post timeline)
« Reply #3 on: December 31, 2005, 09:41:03 PM »
I just got past my first 2 weeks of surgery and like you, I am in a huge brace and on crutches.  I will be that way for 4 more weeks.  I had bone work and graft work done, as well as meniscus stitching and am looking at 6 months for a full recovery.  Even then I'm going to go easy and work on building up the strength that I've lost - I've gotten too skinny.

Standing is awful for the first week.  I'm assuming you are keeping your leg elevated and pretty much stationary (ie: not swinging from any chandeliers).  I found the sensation of all the swelling and blood rushing down my leg when going from the leg-horizantal to the leg-vertical position to be quite uncomfertable.

11/6/05 Grade 3 tear PCL/MCL in horse accident, tore both menisci
12/15/05 PCL/MCL recons, menisci fixed
3/28/06 Finally over the hump in rehab, things are lookin' good!

Offline Discgolfer

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Re: post op day 1(help w post timeline)
« Reply #4 on: December 31, 2005, 10:27:46 PM »
thanks for the comments, I myself am unsure of what the doc actually did. He told my wife that i had cracked cartlidge that had raised up in some areas and that all my cartlidge was weak. I guess i will find out more at my post op. My wife believes he said he removed some cartlidge as well. I will find out tuesday I guess.

Offline Discgolfer

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Re: post op day 1(help w post timeline)
« Reply #5 on: January 03, 2006, 06:54:39 PM »
Day 5 post op update.

I hope everyone is haveing a great start to the new year. Night before last and yesterday i felt really well, I only had to take my ibuprofen for pain, I did not push my movement i still kept myself elevated and took it easy, then last night the pain returned like the thunderstorm we had, I broke out in a sweat and could not get to sleep, I went back to my pain meds which knock me out and stayed on them today.Then pain is still there so i really have limited my movement. I also have noticed that in the last couple of days my foot has started to "fall to sleep" or become numb when in certain positions, is this normal?

Heather thank you for the insightful reply, After re-reading the post i asked my wife what the doc told her after my surgery, She said that what she remembers the doc saying was that i had "cracked" cartlidge that was raised up in areas which was he believes was given me my pain. He also said that my sport playing days were over which i just will not accept.

So is torn articular cartlidge worse than a torn meniscus? (not that any injury is a good injury)

I have My post op this evening so hopefully i will get some more answers and find out exactly was done.

I also have a great PT i was going  to before my surgery so i hope to get to go back to her ASAP.

Anyone else who has gone through this please let me know how your post surgery days have been.

Offline blackbeltgirl

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Re: post op day 1(help w post timeline)
« Reply #6 on: January 03, 2006, 08:44:29 PM »
Whether or not you get back to sports depends on all sorts of factors.  Your age, the type of sports you want to play, the amount of damage, the part of the knee with damage..... Lots of questions, that only your OS can answer.  But one thing I've learned, overall, is this.  It is yoru doctors job to help you reach your goals.  If your goals include getting back to high impact sports, a good doctor will help you reach for that goal.  It may be that the damage your knee has already sustained makes that a very foolish choice, likely to lead to more extreme surgeries in the future.  But you need to tell the OS what you expect, and he needs to do his best to help you achieve it.

As to better/worse types of damage - younger patients with small meniscus tears often have no lasting impact, once recovering from surgery.  (Younger means under 40).  Articular cartilage damage is less concrete.  The size of the damaged area doesn't have a correlation to the amount of pain we feel.  Some people have small focal lesions, like a pothole in the knee, the size of a tic tac, and they're in agony.  Others have larger lesions with less pain.  Some people have problems with loose bodies, as the cartilage wears away, affecting the mechanics of the knee.  Some people have bone spurs, as the body tries to heal itself (these can be painful in their own right, in addition to the pain from the original damage.)

Ask a lot of questions.  The best thing you can do for yourself now is to become an informed patient.  One of my favorite resources for learning about articular cartilage health is www.cartilagedoc.org.  Go to patient resources, knee for lots of great articles about articular cartilage health, maintenance, treatment, etc.

Good luck-
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Heather M.

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Re: post op day 1(help w post timeline)
« Reply #7 on: January 03, 2006, 10:13:07 PM »
Jess pretty much covered it.  The links I gave you should also go over what your options are.  By 'cracked' cartilage, I understand your doctor to mean fissures and cracking in the articular cartilage.  This is usually called grade I or II chondromalacia, depending on how extensive the damage is.  Here's a brief blurb describing one method of 'grading' articular cartilage damage; keep in mind that there is little standardization in the definitions, just trends.  So your doctor may do things differently, but here are the most common definitions of the grades:

Quote
Grade I - The cartilage "blisters" and becomes soft in the earliest form of damage.
Grade II and III - As the condition worsens, the cartilage may become fibrillated (it has a shredded appearance). The grade of injury depends on the size of the involved area and how much of the cartilage thickness is worn down. Noise as the knee bends, called crepitus, may be present.
Grade IV - The cartilage may wear away completely, leaving the underlying bone exposed in small or widespread areas. When the involved areas are large, pain usually becomes more severe, causing a limitation in activity.
From http://www.steadman-hawkins.com/knee_chondral/overview.asp

Cracking can sometimes be easier to deal with than a pothole or lesion, as Jess described.  So you may be able to rehab carefully, strengthen the muscles around the knee, take joint supplements or Celebrex/NSAIDs or both, and continue with modified activities.  No one really knows.  Your doctor has the best idea, as he/she has been inside your knee.  Even then, you really will only know when you work on rehab and try to add activities ONE AT A TIME and over a long period of time.  Don't jump back in too early, as you could irritate the knee and set off swelling and pain all over again.

One comment on your remark that you are having increased pain and are "limitingmovement."  I hope that means you are reducing time spent upright or on your feet...but you should still be doing the knee exercises and motion work that your doctor gave you (if he/she did, indeed, give these things to you to do).  It's not usually required to keep the leg immobile after a chondroplasty, unless some kind of repair work was also done.  The goal is usually to do gentle, non-weight-bearing motion work like wall slides (done lying on your back), patellar mobilizations, and even gently rocking forward and back on an exercise bike.  Also, quad sets are usually given in the immediate post-op period.  Now maybe your doctor didn't give you any of those because you're supposed to keep the leg straight or something--that's definitely something to ask about/clarify.  Often patients are given an instruction sheet of exercises to do in the interim betweens surgery and their post-op follow up appointment.  Sometimes, they aren't.  However, IF you've been given exercises to do, you really need to do them.  I know it's extremely tempting to lie still with a pillow under your slightly bent knee and not move to control the pain....but that can lead to stiffness and muscle atrophy and make your recovery challenging in the short and medium run.  So I guess what I'm trying to say is you should discuss the pain with your doctor if it is keeping you from doing post-op exercises he/she intended for you to do...clean-up of damaged articular cartilage can be a fairly painful recovery--you just generally feel sore and achy and if you do anything on your feet (even with crutches) it feels like you grow a throbbing 100 pound weight in the spot where your knee used to be.  Control the swelling with ice and elevation, take your pain medication and NSAIDS to knock back swelling if they were prescribed, but try to do the exercises your doctor gave you for the immediate post-op period at least 4-6 times/day.  It seems counter-intuitive, but they can actually help reduce the feelings of stiffness and pain, as restoring motion to the knee can help reduce the inflammatory cycle and break through the pain.  It is sometimes a case of working through some discomfort (but not severe pain, the kind that makes you throw up or something--that's a problem) in order to ultimately reduce pain levels.

Anyway, I'm just speculating here--assuming you were given some basic motion and quad set exercises to do.   You asked for experiences with chondroplasty--I have had it done five times now (always along with other procedures, so that does change things a bit).  After my first surgery (lateral release and chondroplasty), I wasn't really told to do anything, and it was 7 days before I had a PT appointment.  So I sat around with a pillow under my slightly bent leg, and this allowed my knee to develop a lot of stiffness and swelling...and the fluid just kind of settled in, because I didn't move the leg and keep it moving.  Ultimately, that was a huge mistake for my knee, because I have a unique problem with forming lots of scar tissue (but I also had a lot of post-op bleeding and the blood in the joint was a serious problem for scar tissue formation as well, making my case fairly unique).  Some other folks have delays of a week or even several weeks before starting therapy, and that's exactly what the doctor wants, and they do just fine.  Or your surgeon's protocol may involve complete immobilzation.  Every case is different.  My second surgeon (who did procedures 5-8) has a very different protocol--I was first visited by a PT in the hospital about an hour after my surgery, and was in formal PT twice a day starting the day after my operation.  That's a bit unusual, but I was being seen in a sports medicine clinic that had a lot of Olympic and professional athletes as patients, and they do an accelerated rehab protocol.  I also have serious problems with forming a stiff knee and developing tons of scar tissue after surgery, so I had to have a unique rehab to address that.

Hope your knee feels a little better today.  You should start turning a corner soon and improving little by little.  Often, once you get back to your PT and start doing gentle post-op work and they do stuff like use e-stim or ultrasound on the joint, you get a lot of relief and things slowly but surely begin to feel better.  How widespread your damage is, and how much scraping the doctor had to do to clean out the ragged joint will also determine how soon you begin to feel better.

Heather
« Last Edit: January 03, 2006, 10:24:47 PM by Heather M. »
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