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Anyone have experience with Tibial Bone bruising?

Bone Bruise
5 (83.3%)
Meniscus Tear
1 (16.7%)

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Offline paddletennis

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Tibial Bone Bruise
« on: June 27, 2006, 06:05:06 PM »
Hi there.  I had meniscus surgery back in Dec 06 for a simple meniscus tear. Well, it's been almost 7 months, and I am still in pain. I can't play tennis (which I played 5 times a week before surgery). The OS says I have a bone bruise, and for some reason it will not heal.  I tried to hit balls yesterday, and today my knee hurts. I  have not done any weight-bearing exercise for over 2 months, and just the fact that I hit for 5 mins yesterday and my knee still hurts is VERY depressing.
Anyone have any words of encouragement - or a "Magic Pill"?

Offline emphatic

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Re: Tibial Bone Bruise
« Reply #1 on: June 27, 2006, 07:00:56 PM »
Bone bruises, especially on weightbearing areas, can hurt like hell. How did you bruise it? How did your surgeon arrive at the diagnosis of bone bruise? Did he see it during your scope? Did it show up on MRI?

Did he offer any treatment plan to help it heal? Is he the one saying it just won't heal, or is that your thought after having dealt with it for so long?

Were you ever completely non-weightbearing (totally on crutches) for any length of time?

Sorry for all the questions... it's hard to know whether you're still not completely recovered from the meniscus tear, or if the bone bruise is the primary problem.

Either way, this is probably an excellent time to go back to the doctor and tell him exactly what's going on. If the bone bruise is really the primary problem and it's not healing, he might choose to offer primary treatment for that (which often means a period of non-weightbearing to let it heal).

Unfortunately, there's no Magic Pill. The best I can offer is that lots of us have been there before (and some of us are still in the middle of it) and lots of us have recovered and returned to activity, so it does happen... it often just takes longer than we had in mind!

Good luck... let us know how you do with the doctor.

Meg

Offline paddletennis

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Re: Tibial Bone Bruise
« Reply #2 on: June 27, 2006, 08:47:25 PM »
Hi Meg, and thanks for responding.  I must have brusied it prior to my meniscus tear back in November. I didn't feel the bruise, just felt the tear. It showed up on my first MRI. Had the meniscus surgery in December, felt fine after. I was walking normally 2 days post-surgery, and didn't do any particular PT. I started hitting and playing tennis about 6 wks after surgery, which is how I probably aggravated the bruise.  I laid off a bit, but played more than I should have, until April, when the pain below my knee was too intense with any weight-bearing use. I had another MRI in April which showed significant bruising and fluid behind the knee (still can't squat all the way down w/o pain behind my knee). So I laid off until this past weekend, and tried to hit, just to test it out. I didn't do any running, but still feel some pain, although not in the original area (more on the top and center of knee, which I find encouraging!).  I saw my OS last week, and  he said it could take another 2-6 months for it to heal completely. Bone bruises work at their own schedule. However, I am VERY frustrated, and miss exercising.  I know I have to discipline myself, but I thought I'd be better by now. The meniscus is fine; it's all the other crap that's keeping me from my regular sports routine. I'm a 50 year old active woman, and this ain't fun at all!

Offline emphatic

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Re: Tibial Bone Bruise
« Reply #3 on: June 27, 2006, 09:03:25 PM »
It sounds like your doctor told you exactly how to treat it. Rest.

I totally understand that it's incredibly hard not to do your normal activity. You do have a choice -- you can rest it and try to find other, safe ways to handle your activity needs, or you can push through the pain and take the chance that you won't have a further injury which might end your activity completely.

There are other, non-weightbearing or less-weightbearing activities you could try -- swimming, weight lifting, certain cardio machines in the gym, cycling -- to name a few.

This is one of those "pay now or pay later" situations. Only, the price later is going to be much higher than the price now.

I really, really get where you're coming from. I'm 40, and just about 9 weeks post-op on my 11th surgery on my right knee -- a lateral unicompartmental replacement this time. I'm hoping with every fiber in my being that I will be able to return to playing ice hockey -- my sport of choice after losing every single other sport I've played over the years due to knee problems. My life is currently about 85% lying on my back with my leg elevated and 15% (if even that) carefully directed physical therapy exercises. My team starts summer practices in two weeks and I won't be there.

No, it isn't fun. It's just how it is. Hang in there... it will get better. It has to!

Meg

Offline paddletennis

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Re: Tibial Bone Bruise
« Reply #4 on: June 27, 2006, 09:20:49 PM »
WOW - 11 surgeries?  Geez, what am I moaning about???  I am not familiar with your current surgery - is that a complete knee replacement?  Which, I hear, has done miracles for many.  How hard this must be for you.  Has your knee gotten better, than gotten worse, or are these 11 surgeries, one right after another?  The hardest part for us both is being active people, and then having that activitiy taken away. But you are right: just hold on, be patient, stay disciplined, and channel the energy elsewhere.

Offline emphatic

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Re: Tibial Bone Bruise
« Reply #5 on: June 28, 2006, 04:35:36 AM »
Oh, I didn't tell you about my 11 knee surgeries to make you feel sorry for me. No need to feel sorry for me! I just wanted you to know that I've walked my talk, and it does get better in time. Been there, done that, got the entire collection of t-shirts. 11 surgeries in just about 20 years. My brother joked that my body's warranty expired in my early twenties.

This last one was a partial knee replacement. The lateral half of my knee was replaced, and I had synthetic cartilage plugs placed in the trochlea (middle part, under the patella).

Quote
just hold on, be patient, stay disciplined, and channel the energy elsewhere.

Yuppers! Easier said than done, but that's it.

Meg

Offline LaughingBuddha

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Re: Tibial Bone Bruise
« Reply #6 on: July 01, 2006, 01:32:10 AM »
paddletennis,

I've been in a similar situaion for the last 4 months. Used to be a runner. Can't wlk 10 steps without the bone bruising flaring up. I can see flicker of light though.

Background
2 LK medial mensectomies over 2 years. Hardly any left.
Injury after 2nd one that caused articualr cartilage damage and tibial bone bruising that won't go away.
Sports Phys. prescribed rest for 6 weeks. Didn't work
Then on FOSAMAX for 8 weeks. Didn't work.
Then on ultrasound bone growth stimulators for 3 weeks. Didn't work.
Now cortisine shot. Worked a little and on to PT with a reputed phsio.

Light

In 2 years my brain had switched off the use of some of my glutes because of the pain in my knee and the slight limp.
Bio mechanics and forces through the knee are not optimal because of the brian "switch off" and the loss of cartilage.
Phsio is retarining me to use the glutes with excercise and building up the VMO etc so that the forces through the knee change.
All this will get my muscles to do their job again and unload off the tibial plateau where the issue is.
Seems to have started working very slowly. Another 8 weeks to the next milestone.

Have given myself 1 year. Just doing the excercises and PT sessions is a psych realease coz now I am taking action to address it.

Get your OS to refer you to a goos sports Pshyc. or Physio and get started on a recovery programme.

Hope this helps.


Offline emphatic

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Re: Tibial Bone Bruise
« Reply #7 on: July 01, 2006, 04:23:43 AM »
Phsio is retarining me to use the glutes with excercise and building up the VMO etc so that the forces through the knee change.
All this will get my muscles to do their job again and unload off the tibial plateau where the issue is.

I think there is a good deal of merit in this approach. It's certainly worth a shot.

I'd have one concern, though. It would be important to understand exactly where the bone bruise was, and what muscular loading forces impacted it. So, you'd have to make sure you weren't inadvertently stressing the contusion by misunderstanding what muscles were loading where. Odds are, you'd know simply by an increase in pain, but that isn't always a totally reliable indicator.

At any rate, I think this approach is worth exploring, along with judicious rest.

Meg

Offline xisbum

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Re: Tibial Bone Bruise
« Reply #8 on: July 02, 2006, 01:09:21 PM »
Hey, PT, just so you know you are not alone, I am also a tennis player who had meniscus surgery a year ago and found subsequent playing difficult. My knee, a bit older than yours, has moderate grade 2 and 3 osteoarthritis on the medial side, and the last orthopedic specialist I saw took one x-ray that showed a "spot" on the left femoral condyle that he said was either dead bone or a area with diminished blood supply.

That was all he would tell me; his best advise was to quit everything that involved weight transfer to the affected area and sit back to wait for the inevitable knee replacement in about 5 or 10 years. Whatever I asked was waved off with "it won't help, so don't even try it."

Needless to say, I'm in the process of looking for a new OS (he was my second and not the surgeon of record). Meanwhile, I'm still playing a couple of doubles matches a week at about 70 percent of pre-surgery form - frustrating, but still tennis, I tell myself constantly. Had to adjust my style and learn to take smaller steps that generate less force through th knee, and there are some balls I can't get to because of fear in pushing off the knee (it's my dominant leg, of course). But it's still tennis.

I seem to be in a statistical purgatory where I'm too old for some techniques that might work (microfracture, autologous chondrocyte implantation, etc.) but too young for the knee replacement, even partial, that could help me stay active in the sport I love almost as much as breathing. And I am starting to feel some stress in other parts of the knee that showed no damage in the pre-surgery MRI and in photos from the actual surgery.

For the record, I did not try to play again as soon as you did. I wanted almost 4 months after the surgery before even hitting a ball, and experienced enough pain for the surgeon to try synvisc injections. They worked for a while before the pain returned, and I was surprised the surgeon and the second OS did not offer to try another round.

Hang in there; at your age, you'll probably be offered more options than I was. And it sounds like your doc is at least willing to treat your problem instead of just writing it off.

You'll find a few like souls in this blog who will do whatever it takes to continue their sport. You'll also find some who are more resigned to accepting their "fate," and they mean well. But Meg and I and some others will back you all the way as you try to get back on the court of your choice.

Stay positive and always remember the good shots, no the bad ones.

Rob in Virginia

 
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Re: Tibial Bone Bruise
« Reply #9 on: July 02, 2006, 02:44:28 PM »
Xisbum-  I would really ask your OS about Orthovisc. It has the highest concentration on the market. I am surprised the doctor did not offer another round of injections for you. Have you ever tried an unloader brace ?



Offline xisbum

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Re: Tibial Bone Bruise
« Reply #10 on: July 03, 2006, 08:16:25 PM »
Hey, Deep. I would gladly have tried another kind of injectable, but it was never offered. I guess the statistics didn't look favorable.

And I did try an unloader, with great hope, but it didn't work. The orthotist who fitted me for the custom brace was not familiar with the brand I wanted (Townsend) and even didn't try to show me how to wear it. He told me to just read the directions. I contacted the company and got a local sales rep to come to the office and show me how to adjust it, but it never stopped the medial pain when I took full strides. He was hesitant to adjust the brace further unless he worked through the orthotist, and I never heard back from him.

Everything I've done on the tennis court and the recumbant bike since has been braceless, and as I said earlier, I am starting to feel pressure in parts of the knee that showed clean in the MRI and surgery photos. My sciatic nerve on the opposite side has also started acting up because of the added pressure I put there (subconsciously).

I'm hoping to find an OS who will treat MY knee and listen to MY needs and desires instead of some statistical person who doesn't really exist. But it's not easy to spend the time it takes to find someone like that when you have to work for a living.

I'm to the point where I would even go through the unicompartmental knee replacement pain and trouble even if it only lasted 5 or 10 years.

But enough about me. I've read your posts elsewhere in this site. How are you doing? You have something I don't - time - which I guess could be a blessing or a curse, depending on how you look at it. Realistically, 10 or 15 more years for my knee looks pretty good right now, while you want and should get considerable more time than that.

Rob
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Re: Tibial Bone Bruise
« Reply #11 on: July 03, 2006, 11:38:26 PM »
Hey X -  My medial joint is collapsed and I am only 36.  Last visit I had with my OS was after the orthovisc injections.  It did take some of the ice pick pain away.  And the cortizone made me a happy camper for two weeks.  This Jersey rain is killing me. My left foot hurts. My right knee hurts. I see the brace fitter on Thursday. I find when I sit down for a long time I feel my bone is being pushed and when I stand up it tries to go back in place.  . Right now I am lidocaine patching all parts of my body  and really feel old again.   I did make it to the store for a big half hour.  NOT enough time to really shop but felt good to be a bit mobile that I was at least able to to tolerate standing in line with a shopping cart.   I have mixed emotions about my knee.  It went to crap real fast. I take another standing xray aug 4. and the words of wisdom from my OS was w e  may just have to bite the bullet. He is not afraid to do someone my age.  He just said we have to look upon  10 - 15 years of pain free as a good thing and deal with revisions when we have to.  So this next xray wil be pretty big .  Its so weird. I had more OA on the lateral side yet the joint space was fine last xray.  back of knee cap is bad.  medial side is toast - its bone on bone with grinding . ice pick pains.

If you are able to get to a tennis court. I think you are one up on me

Offline xisbum

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Re: Tibial Bone Bruise
« Reply #12 on: July 04, 2006, 12:53:04 AM »
You're right, KD. We always think our problems are the biggest ones. I am grateful for the time I get on the court today, because I know it could end anytime. But, since we are all human and I qualify, I think, my thoughts always go back to what I could do before the torn miniscus, and that's my bell curve.

So I guess I'm still in pretty good shape. I can walk through a shopping mall and from the metro to my office with very little pain, just some stiffness. I can play tennis at 70 percent, still pretty decent for my level and still competitive, if I have a good partner. I can do the recumbent bike for 50 minutes.

Didn't mean to denigrate any of your tribulations; believe me, I feel your pain and your angst. And I feel your Jersey rain here in Northern Virginia, and it sucks here, too. I just think if we can put people on the moon and sniff out thousand-year-old DNA, why the hell can't we fix a stupid knee?

Your OS sounds wise and compassionate, like the one I'm looking for. Let me know how the x-ray turns out and what path you will take.

Rob
Baby boomer and tennis nut raging against reality.

Offline LaughingBuddha

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Re: Tibial Bone Bruise
« Reply #13 on: July 05, 2006, 03:07:32 AM »
I'd have one concern, though. It would be important to understand exactly where the bone bruise was, and what muscular loading forces impacted it.

Thanks for the fedback Meg.

Bruising is on the tibial plateau rim.

Manged 10mins on a stationary bike at low resisitance and low cadence.
Some soreness but mostly behind the kneecap. This'll improve as the VMO fires up again.
Woohoo!
Just thought I'd share.

Offline paddletennis

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Re: Tibial Bone Bruise
« Reply #14 on: July 05, 2006, 09:22:45 PM »
Hi Rob.   As one tennis nut to another, it really is hard not being able to play. I actually went out this past Sat and played 2 sets of Paddle tennis, then 3 sets on Sunday. I didn't push myself really hard, but I did still run for a few balls, and the knee held up okay  Knee was a little achey Mon, and hasn't let up, although it's not terrible pain, and it's not where th original bone bruise was (is).  Not quite sure what's going on, but I am still going to give it another try this weekend. I haven't been on the tennis court yet, might hit some and see what happens. I am having my 2nd acupuncture treatment today, and will contine with that.  Whatever it takes. I never knew I could have these kinds of complications from a "simple" meniscus tear surgery.















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