Advertisement - Hide this advert





Author Topic: Chondroplasty and medial plica excision  (Read 4805 times)

0 Members and 1 Guest are viewing this topic.

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Chondroplasty and medial plica excision
« on: November 19, 2006, 12:27:39 AM »
Is there something wrong if there is still swelling/pain/inflammation 3.5 months after a chondroplasty & medial plica excision??  Or could I just be a slow healer?

I have a full thickness lesion on the medial facet of my patella and the OS has suggested I have MACI performed.  The thing is I had the lesion before I had the arthroscopy done and my symptoms weren't anywhere near as bad as what they are now.  I haven't gotten over the op yet it feels.  I guess my concern is if I the lesion was there prior to the op is this reallly causing me all my problems now or am I just taking a long time to heal??

My quads are still very weak but I'm working on them... just very slow progress due to the pain/inflammation that I am experiencing. 

Any suggestions would be very helpful as I'm heading back to the OS in a couple of days so I need to decide whether to go ahead with this next op.  The thought of having to go through the big rehab of MACI after 3.5 months already is rather shattering...

Offline Jaci

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 1615
  • Liked: 5
  • User's Text
Re: Chondroplasty and medial plica excision
« Reply #1 on: November 21, 2006, 04:12:14 AM »
Hello,

Having significant swelling/pain/inflammation at this point post-op does seem a bit unusual. I think small amounts of swelling would be expected, but the inflammatory part of the healing process generally subsides within a couple weeks of surgery/ injury.

I know you have expressed concerns elsewhere about the possibility of arthrofibrosis. While syptoms like you're experiencing are often associated with arthrofibrosis, there's really no way for any of us to know if that's why you're continuing to have problems with your knee.

It's probably not a good idea to go ahead with another surgery until you get things sorted out. I know my OS will not operate on a knee that has active inflammation because it can actually lead to scar tisue formation. FYI, my OS is one of the 'arthrofibrosis specialists' that we talk about on the board.

My recommendation is to read through KNEEguru's arthrofibrosis info, learn everything you can about it, and ask lots of questions at your appointment. I've posted these links in other messages, but here they are again:

Dr. Noyes’ arthrofibrosis course and Dirk Kokmeyer’s rehab course

http://www.kneeguru.co.uk/KNEEtutor/doku.php

Dr. Millett’s article

http://www.casebook.kneeguru.co.uk/index.php/knee/issues/arthrofibrosis_of_the_knee/

KneeGuru’s literature review (look under problems with healing)

http://www.kneeguru.co.uk/insights/doku.php



Good luck with your appt. I hope your OS can give you some answers.

Best wishes,

Jaci
« Last Edit: November 23, 2006, 03:14:34 AM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #2 on: November 21, 2006, 08:18:13 AM »
Jaci,

Thanks for your advice.  I went back to the OS today.  He put my mind at ease with a few things.   He said there is no infection and he thinks there has been some improvement since the last I saw him.  He suggested I have a cortisone shot.  I asked him there was any chance the cortisone might make it worse.  He said I'd probably be the 1 in 100000 people for it to make worse, so he wait til next consultation and we'll do it then if it is still troubling me. 

Not sure if I made the right decision there, but I just couldnt handle going backwards!  I guess I went the no risk route.  What does everyone else think about cortisone? 

 

knee deep in Goo

  • Guest
Re: Chondroplasty and medial plica excision
« Reply #3 on: November 22, 2006, 01:07:15 AM »

Here are a few things I thought of when I saw your post.
Cortizone shots: Are they worth it ?
I think if the cortizone takes down the inflamation and helps you build your muscles than its worth a try.   Cortizone is like a wonder drug.  For me the wonder ..was.. I wonder why it only lasts two weeks and than the pain returned.  Also ask your OS if he did drilling when he did the chondroplasty.  I only say this because I was on crutches for Six months.  MY OS drilled into both condoyles. Both in weight bearing locations 

 Have you tried swimming?  Did the doctor take a standing Xray of your knee yet? Ask about Orthovisc shots are they right for you.  I had the shots and with the orthovisc third shot .. I had my second cortizone shot of the year.   and started my unloader brace at the same time..   

I just wanted to let you know not everyone has plica's and they can grow back ( Weird huh ?)

Also  you mentioned MACI- That is a good sign they offered it to you.   Too much damage they will say its not an option. .. I know its hard to start walking and feel not 100% and than go into another operation.


I had my chrondroplasty operation in Jan and will have my knee replacement in Dec.   I saw three OS's  Lets just say .. horrible year will soon end.


Oh also I had long periods of thinking no progress at all.  Bad weather had me thinking my knee was headed downhill .. Knee recovery is strange. It is like a little monster you have no control over.  You are doing the right things.. and still..  we just dont realize that it takes so long sometimes..   Other times you see people who recover fast and are on their merry way.. and you wonder..

Also with cortizone they will limit you on how many injections you get in a year.

Oh one more thing.. If the doctor still has you on pain killers .. drink lots of water.. and I strongly suggest oatmeal.        I had a kidney stone this year and I think they formed as a direct result of being not as active.  ..Water is good anyway..   and the oatmeal will add more fiber to your diet.. I know the pain killers bind me up sometimes.   doing the oatmeal  helps.

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #4 on: November 22, 2006, 05:51:32 AM »
goo... sounds like you've not had a fun year!

I'm tossing up whether I should see if I can go back to the doc to get the cortisone.  Just can't decide. 

Yes I'm swimming every couple of days but can only do a light, straight leg kick.  It's difficult just normally walking in the water... extending my knee hurts heaps and it seems to increase the inflammation. 

No standing xrays... no problems with tibiofemoral joint, just patella.

When I spoke to the doc yesterday, he said he doesn't want to do the MACI op yet, he thinks once the inflammation settles it should be better. 

It's comforting to hear that you had long periods of no progress... I guess we're not all textbook!

Thanks for the tip re extra water.. shall do.

Thanks for the ideas!

To cortisone or not to cortisone... that is the question


Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #5 on: November 22, 2006, 06:20:59 AM »
One other thing... the doctor asked me this question:

When your knee gets stiff is it associated with an increase in pressure and swelling in the knee? 

I answered yes, but have since realised it is not always that way.  Sometimes the knee just feels like there is glue inside.

I'm not sure what he was eluding to with this questioning and I don't know if it is something significant...

Offline Jaci

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 1615
  • Liked: 5
  • User's Text
Re: Chondroplasty and medial plica excision
« Reply #6 on: November 22, 2006, 10:01:03 PM »
Hello,

About the cortisone injections-- They can be very effective for reducing inflammation. I've had a number of them following surgery for arthrofibrosis. In my case, my OS uses them specifically for shutting down the inflammatory process. I think it's worth having it done, but would recommend it sooner rather than later, especially if the inflammation has been present for a while.


One other thing... the doctor asked me this question:

When your knee gets stiff is it associated with an increase in pressure and swelling in the knee?

I answered yes, but have since realised it is not always that way. Sometimes the knee just feels like there is glue inside.

I'm not sure what he was eluding to with this questioning and I don't know if it is something significant...

I think your OS was trying to determine whether your stiffness was caused by swelling or something else. I'm not sure what part you're referring to with "I don't know if it is something significant..." but I think you should let your OS know about the 'glue' feeling and that the stiffness is not always associated with swelling. I'm saying this based solely on my experience, it may not mean anything in your case, but it's really best to let your OS decide.

I don't recall seeing any mention of your ROM. Can you fully bend and straighten your knee at this point?

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #7 on: November 23, 2006, 12:34:19 AM »
Thanks for the advice about the cortisone.  If it actually shut down the inflammation then that would be heaven!  I feel like that is what is holding me back.  If anti-inflammatories don't seem to do much is that any indication as to whether the cortisone will help?

I do have full range of motion, not intiallly but I do now.  I worked very hard to get that back!


Offline Jaci

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 1615
  • Liked: 5
  • User's Text
Re: Chondroplasty and medial plica excision
« Reply #8 on: November 23, 2006, 03:30:11 AM »

Oral anti-inflammatories are completely different from injected steroids, so they are not an indicator of whether or not the cortisone injections willl work. Sometimes I got relief from an injection and sometimes I didn't. However, I always felt it was worth trying; for me the potential benefits far outweigh the chance of side-effects. When oral anti-inflamms and injections failed, my OS went on to oral steroid dose-packs (Medrol). He only does it as an absolute last resort, but in my case (severe arthrofibrosis) it was worth a try-- in a couple situations Medrol was the only thing that stopped the inflammation.

Take care,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline EMANN

  • Forum Faithful
  • ****
  • Posts: 159
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #9 on: November 23, 2006, 05:41:06 AM »
What is a MACI procedure?

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #10 on: November 23, 2006, 06:01:44 AM »
How'd the doc diagnose that you had arthrofibrosis.. did he go in and have a look?  What's an LOA?  Is your knee good now?  I've never heard of Medrol...

I booked myself in for Monday to have the cortisone..  the potential benefits would be just great.  If a cortisone shot actually helped me get my life back.... that'd be brilliant. 

MACI is matrix autologous cartilage implantation.. where they take a small piece of articular cartilage from a non weight bearing part of your knee, send it to a lab where it gets cultured on a membrane for 5-6 weeks, then it gets reimplanted into the defect in your knee.  It is appropriate for localised articular cartilage lesions usually full thickness.  Apparently, 85% success rate for femoral transplants and 60% for patella.

Offline EMANN

  • Forum Faithful
  • ****
  • Posts: 159
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #11 on: November 23, 2006, 03:06:57 PM »
OK thanks MACI is basically an ACI then...got it.

Offline Jaci

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 1615
  • Liked: 5
  • User's Text
Re: Chondroplasty and medial plica excision
« Reply #12 on: November 26, 2006, 04:46:12 AM »
Cadenz2,

The initial diagnosis of arthrofibrosis was made based on physical exam by OS#2. I only had about 50 degrees total ROM so it was pretty obvious that something wasn't right, although my first OS kept telling me the only reason I couldn't bend and straighten my knee was because I was tense. :P  What a bozo! Good thing I wasn't willing to accept that explanation and went to someone else.

LOA is lysis of adhesions, removal of scar tissue. AIR is another abbreviation you'll often see when discussing scar tissue. It stands for anterior interval release. The anterior interval is a space behind the patella, patellar tendon and up into the interchondylar notch (the notch where the ACL attaches to the femur) scar tissue in that area can really wreak havoc on knee mechanics, block knee motion, and cause a lot of pain.

The altered mechanics can lead to damage of articular cartilage surfaces i.e. chondral lesions in a very short time. I went from having 'relatively pristine' articular cartilage to grade 2-3 in about 4 months. I now have significant damage in all three compartments including 'kissing lesions' on the patella and trochlea. Plus, I developed a condition called patella infera (a.k.a. patella baja) where the patella tendon has shrunken thus pulling the patella down lower than it should be; my patella feels like it is constantly grinding away on the femur when I bend and straighten my knee. Scar tissue also caused the capsule around my knee joint to contract, a condition called infrapatellar contracture syndrome, making my knee feel like it has been shrink-wrapped. I've had multiple surgeries in an attempt to control the scar tissue and reduce the damage to my knee mechanics and so on. I know it sounds like my knee is pretty trashed, but it's far better than it was back when I started battling scar tissue. I found KNEEgeeks before I had a name for the condition. I did a lot of research and eventually sought treatment from one of the 'arthrofibrosis specialists.' Some things have turned out far different from what we had hoped; there is no way to predict ahead of time which knees will fall into the 1% that is resistant to treatment that is mentioned in the arthrofibrosis tutorial. I have no regrets about my treatment and know that I have done everything possible to make my knee better.

Medrol is a brand name for the steroid methylprednisolone. It's administered orally so it acts system-wide on the immune system to reduce inflammation. Oral steroids are generally used only after other measures have failed.

Good luck on Monday. I hope the cortisone injection does the trick.


Jaci
« Last Edit: November 26, 2006, 08:33:53 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline cadenz2

  • Regular Poster
  • ***
  • Posts: 54
  • Liked: 0
Re: Chondroplasty and medial plica excision
« Reply #13 on: December 03, 2006, 12:41:12 AM »
Jaci,

Your doc does sound like a bozo - to say that you couldnt straighten your leg because you were tense!!  How's your knee doing now?

I had the cortisone on Monday and it seems to have calmed it down somewhat.  It's not getting as hot and swollen and the pain is more tolerable.  I still have the raw feeling behind my patella when I walk though... hopefully quads strengthening will fix this as I am very weak. 

Thanks for the advice re the cortisone, I'm glad I did it and it is probably thanks to your advice.   Is it possible the cortisone will settle down the inflammatory process for good or is it likely to come back???/