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Author Topic: Remove scar tissue or try cortisone w/heavy duty PT?  (Read 4635 times)

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Offline Inez

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Remove scar tissue or try cortisone w/heavy duty PT?
« on: February 06, 2007, 03:53:14 AM »
Hi...I'm new here, 52 y.o., tore my ACL and medial meniscus 6 months ago. Had ACL reconstruction (allo) and did PT twice a week for about 3 months. Now still do not have full range of motion, surgeon says scar tissue is holding patella in place , therefore he wants to go in and remove scar tissue. He says he's sure it's scar tissue and is not authorizing an MRI. I am not too keen on being under general anesthesia again and having to go through early days of rehab again. My questions are: Is there any other way to get rid of scar tissue w/o going in again? Cortisone? Heavy duty PT,  neuro-muscular massage? Is there anybody who has been through a similar situation? I'm an active person, and am getting quite depressed over this constant pain when just plain walking.  Thanks so much for any feedback!

Offline lgeorge106

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #1 on: February 06, 2007, 12:13:12 PM »
I think it depends on what type of scar tissue you have.   I have had some luck with myofasical release (MFR) type of massage in getting my patella loosened up after surgery.  It's non invasive but can be a little painful.  But definitely worth a try.  I haven't had ACL or meniscus issues, but did have some extra scarring after my lateral release.  MFR has really helped to loosen up the joint and in decreasing the size of the lumps under my incisions.

Good luck!
Lisa
1984 - L knee scope
1985 - L knee LR
12/15/2005 - R knee LR
03/14/2006 - R knee chondropasty and synovectomy

Offline Jaci

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #2 on: February 06, 2007, 06:25:58 PM »
Inez,

Have you taken a look at the info on scar tissue on the KNEEguru's main website? Here are some links to get you there:

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


Myofascial release and scar massage can really only help with surface scar tissue, you just can't get to scar tissue within the joint that way. generally it's scar tissue within the joint that is inhibiting joint motion. I highly recommend that you learn everything you can about scar tissue, what causes it, and proper treatment.

Also, there are hundreds of posst down in the soft tissue healing problems-- arthrofibrosis section. You can learn a lot about scar tissue by reading some of the threads there.

best wishes.

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 sarah1928

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #3 on: February 07, 2007, 05:19:18 PM »
Hi Inez

I don't think you should rush into having another surgical procedure. I had scar tissue build up after surgury and with physio and massage on the area i was able to reduce the problem quite quickly, it may take a few weeks cause nothing fixes over night but give it a go, speak to a physio see what they say it's worth trying instead of putting yourself through another procedure.

Hope it turns out well
Sarah1928

Offline Inez

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #4 on: February 07, 2007, 09:48:51 PM »
Sarah, Jaci, and Lisa,

I really appreciate your responses. Thanks so much to all of you!  They've been very helpful and have sent me in the right direction. I am currently looking for alternatives  (chiropractor) and am getting a second opinion.

I have not found too much info about how helpful Cortisone shots are. If it can break up the scar tissue, perhaps more rigorous PT can do the rest. Also, do you know if manipulations of the knee are a straight forward procedure?

Thanks again,
Inez

Offline Jaci

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #5 on: February 07, 2007, 11:12:32 PM »
hello Inez,

How far off full is your range of motion? Are you able to straighten your knee completely? Can you bend it as much as your other knee?

Cortisone injections do not break up scar tissue. They can reduce swelling, pain and inflamation and allow better movement that may break up adhesions if they are still in the 'filmy' state. Scar tissue starts out sort of wispy, then it becomes denser and more fibrotic over time.

If you have a significant motion loss at this point, it's extremely important to see an OS who has experience treating excess scar tissue-- a condition called arthrofibrosis. Dr. Noyes and the other OS who researched and wrote about the condition stress over and over again that it's imperative to see an experienced OS and to have scar tissue properly treated in a timely manner. As the adhesions age they can cause shrinking of the joint capsule, ligaments, and tendons, and lead to permanent mechanical changes. I don't mean to alarm you, I just want to make sure that you don't take a lackadaisical approach to this.

Remember also that adhesions outside the joint capsule-- like the lumps under the incision sites that many people on the board talk about-- are not the same thing as scar tissue that is internal and inhibiting motion. So you want to make sure you know what kind of scar tissue people actually had when you read their responses.

Also, would you please clarify what you mean by "manipulations of the knee." Are you referring to chiropractic manipulations?

Please take some time to throughly read through the information at the links I posted above. If you have a significant loss of motion, you'll want to arm yourself with information so you can get the best possible care to remedy the situation.

best wishes,

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 Inez

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #6 on: February 08, 2007, 11:25:26 PM »
After my exercises and hot baths, extension is pretty good. I might be off by about 1-2 degrees, not more. Flexion is also pretty good.  I don't know what kind of scar tissue I have. The OS never told me and also doesn't think an MRI is necessary. How would he know without an MRI?

I have heard of OSs putting patients under and "manipulating" the knee, meaning extending it to where it should be able to go. This procedure apparently breaks up the scar tissue and makes room for the knee joint to have its regular ROM.

I am waiting to get authorization from my insurance to get a second opinion and am also massaging it regularly in addition to exercises and strengthening the quads.

Thanks, Jaci for your warning about not taking scar tissue too lightly. and all your support! :)

Inez


Offline Jaci

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Re: Remove scar tissue or try cortisone w/heavy duty PT?
« Reply #7 on: February 09, 2007, 07:20:51 PM »
Hello Inez,

MRI is not a very reliable test for scar tissue, sometimes it shows and sometimes it doesn't. Scar tissue can be diagnosed based on a thorough exam, history and symptoms. An OS may use an MRI to determine if there are other issues at play that may be interfering with your joint motion. X-rays can be useful because they allow you to look at the graft position-- misplaced graft is one of the most common causes of scarring and motion loss after acl recon.

The manipulation you're refering to is a procedure called 'manipulation under anesthesia' MUA. If you read through the medical literature you'll find that MUA can be effective if it is used very early post-op, like within the first several weeks, and that very little pressure should be used. If performed too late and with too much force, it can damage other tissues, such as ligaments, tendons, articular cartilage, and even break bones. I had an MUA with an OS who told me he was going to perform a scope and MUA. I figured he'd do the scope first to get out as much scar tissue as possible then manipulate it. WRONG! He did the MUA first, could get barely any movement, he actually grab a hold of my kneecap and forced it to move around. The result was that I had severe post op bruising, my knee looked like an eggplant, and scar tissue regrew within a few days post-op. What I later learned is that any procedure done to treat scar tissue must be performed in an 'atraumatic' manner. Scar tissue formation is the body's response to trauma, so the OS must do the surgery in a way that tricks the body into not knowing that a procedure was performed.

Along with the massage that you are doing on your knee, you may want to do patellar mobilizations. They're described in part 2 of the arthrofibrosis rehab tutorial. It takes a little practice at first, but  it's worth it because they are one of the most important things to do to keep the patella and surrounding tissues mobile.

The most important thing at this point is to educate yourself as much as possible on post- ACLr motion loss. As I mentioned previously, there's a lot of info on KNEEguru's main site and a wealth of information in the soft-tissue healing problems-- arthrofibrosis board.

Best wishes,

Jaci

« Last Edit: February 10, 2007, 03:06:53 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