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Author Topic: Knee stiff and won't straighten out  (Read 5391 times)

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Offline Cindifran

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Knee stiff and won't straighten out
« on: May 18, 2006, 06:06:30 AM »
I am a 55 year old woman. Underwent cartilidge repair surgery and sustained a fall approx 3 mos later.  Left leg slide forward, right leg went underneath me, foot top down and i fell on knee in total bent position.  i know this must be hard to envision.  Anyway a year later.....knee will not completely straighten out, walking (every step) hurts quite a bit, slow and painful to go up and down stairs and the part that i can't understand; my calf muscle kills me.  Sometimes it hurts more than the joint itself.    What is wrong with me? Hope you can shed some light on this. ???

Offline poisson

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Re: Knee stiff and won't straighten out
« Reply #1 on: May 18, 2006, 09:39:17 AM »
If you can't straighten your knee - could you do so after surgery and before the fall? If you could and after your fall couldn't - I suspect you have retorn your meniscus(cartilage). If you were never able to straighten the knee post surgery it may be a fibrosis problem, but if you had full ROM and now your knee won't straighten, there is a good possibility that there is a lump of cartilage stopping it.
Have you been seen by an OS or had investigations on the knee post fall? -
torn ACL and post horn med meniscus Dec 05 - ski accident
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Offline Cindifran

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Re: Knee stiff and won't straighten out
« Reply #2 on: May 19, 2006, 04:12:21 AM »
Thank you Poisson for your reply. Yes I have seen an OS and had an MRI done on Mon. of this week. Am waiting to see Dr. next week. In answer to your question.  No, after surg. knee never fully straightened out again, but it was slowly improving and minimally painful.  After fall (almost a year ago now) it is permanently bent and is the source of considerable pain.  Again, i don't know why calf muscle is so painful.  Sometimes pain also goes up inner thigh muscle area as well. If I walk too much one day, I will barely be able to walk the next day. I have no knowlege of fibrosis.  Can you further explain?  And what can you do about it? I had an MRI done finally 3 months after fall and the OS could not see any additional tears.  But after all this time; without any improvement, i decided to get a second opinion.  This can't be a permanent thing!!! Someone, somewhere has got to be able to figure this out and fix it!  Any insight you have would be appreciated.

Offline Heather M.

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Re: Knee stiff and won't straighten out
« Reply #3 on: May 19, 2006, 08:40:31 AM »
Cindifran,

The term is "arthrofibrosis" and it basically happens when excess adhesions or scar tissue form in and around the joint after surgery or trauma.  Here is a short piece describing the condition:  http://www.casebook.kneeguru.co.uk/index.php/knee/issues/arthrofibrosis_of_the_knee/

As for your fall, I wonder how much it really had to do with your current situation.  I mean, it may be that you simply developed arthrofibrosis as a result of your surgery, and that while your fall wasn't good for the knee, it has little to do with not being able to straighten or bend the leg fully.  This has happened to a group of us on this board, and you don't need trauma--good old surgery can do it, and of course a bad break or fall can do it as well.

Or it could be that the fall caused some damage--like dislodging a piece of meniscus or even a divot of cartilage and bone into the joint--that has made it impossible for your knee to work properly.  A series of x-rays, an MRI, and a thorough hands-on exam should be able to tell you what's up.  A year is a long time to wait with this type of problem--why has it been so long to get to the bottom of this?  What kind of things have you been working on in physical therapy during the last year or so?  What has your doctor had to say, if anything, about the problem you are having?  If he says to keep working in PT or that it's 'no big deal' or something....To me, this says you need a second opinion doctor ASAP.  And not just any doctor, but one with experience dealing with tough cases, one who realizes why it's so important to get problems like yours taken care of immediately.  Because the longer the leg stays in its partially bent position, the harder it is to resolve the problems.  This is because soft tissue, muscles, tendons/ligaments and so forth will begin to become accustomed to the partly bent position of the leg...and they will begin to make adjustments--usually by shrinking and contracting down  A partially bent leg is often less painful for a damaged knee, which is why this is called a 'neutral' position and why many people can only keep their legs in it following surgery or trauma.  Being partially bent just seems to take some pressure off the joint when there is damage in there, and so the body begins to 'solidify' things in this position to spare you from future pain.  This is all completely unconscious and is not a decision made on your part; it's just that our bodies are very good at adapting and adjusting to change--and VERY good at doing whatever it takes to avoid severe pain.

So anyway, soft tissue contracture and reflexive tightening or shortening of muscles and ligaments/tendons can definitely explain the pain you are having in the calf and knee and lower quads/thighs.  It's important for you to find a doctor who realizes the severe impact this will have on your quality of life (pain and lack of function) as well as how this will cause other problems down the road if your leg stays like this--especially in the hip, IT band, calf and quad muscles, and even your lower back, in the long run.  I never had back trouble until I had arthrofibrosis for about 18 months or so--then I threw it out and developed such severe myo-fascial pain syndrome and 'sciatica' in my lower back and hip that I was barely able to walk.

I also got the chronic swelling and pain, especially if I spent more than 20 minutes or so on my feet.  The pain was unreal.  I was able to make significant improvements (like walking without a limp, reducing (but not eliminating) pain, increasing strength, learning new PT methods and techniques that didn't irritate the knee joint, and finally being able to walk my dogs in the evening again).  The way I did this was to get into a formal pain management program**and to see a doctor who had worked for decades on tough knee cases, and who had worked extensively with arthrofibrosis problems in the past.  The fact that at 3 months post-op you weren't able to straighten your leg--even before your fall--says to me that there was something going on in there to block extension.  The most likely cause of that would be scar tissue or a failed repair.  Actually, it would be helpful to know exactly which surgery you had done--you say "cartilage repair" but that's like saying "brain surgery" in that it's not very specific and could mean LOTS of different things to different doctors.  So if you could get the exact medical name for the procedure you had done, that would also help in figuring out what might be going on.

Head down to the Soft Tissue Healing Problems and Arthrofibrosis sections to do more research on this painful, frustrating condition.  You can use the search feature to look up keywords from this post and from any conversations or notes from your doctor--like if he/she has said anything about patella baja or patella infera (lowering of the kneecap due to contraction and shrinking of the patellar tendon) or infrapatellar contracture or synovitis or something like that.

Hang in there, keep in touch and let us know how things go with your doctor.  If you want to post your general region or the city where you live, someone may be able to recommend a good surgeon for a consult.  As for what you can do right now, definitely read up on and become educated about this condition.  It is a sad truth that many doctors have no idea what to do for a patient with severe arthrofibrosis.  If this is the case, then you will often hear them suggest inappropriate surgeries or procedures, or they will say things like "there's nothing to be done for you."  By reading up on this condition and understanding exactle what's going on in yourkne, you will

Heather

PS **When I say "pain management", I mean an integrated program for chronic pain patients, one with acupuncture, ROLF massage/myo-fascial release, medication, physical therapy, water therapy, etc.
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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