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Author Topic: Open Debridement and Proximal Z-plasty  (Read 183204 times)

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Offline RyanPete

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Re: Open Debridement and Proximal Z-plasty
« Reply #30 on: November 25, 2007, 03:51:47 AM »
I first wanted to thank everyone for their posts.  Going through this issue is some what concerning since it is so rare.  Also, if anyone is in need of a knee surgeon and is in the central Oregon area Dr. Bollom is excellent.  Dr. Bollom has by far some of the best bed side manners and is very highly recomended by his peers. 
Anyways, I had my ACL reconstructed using my hamstring and my PCL repaired as well.  In addition I had microfracture surgery as well (all from the same injury).  Four weeks after my initial surgery my doctor decided to do debridement surgery. 
I stayed 48 hours in the hospital and had great ROM in the hospital 5 degrees to 120 degrees.  Upon release from the hospital and four days after surgery my knee is extremely tight.  My ROM is equal to that before I went in for my last debridement surgery.  I've been to rehab only once since then and will begin 3 times a week starting this week.   Did this happen to anyone else?  If so what is ahead for me?  Thanks again for all the info so far.
Ryan

Offline Jaci

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Re: Open Debridement and Proximal Z-plasty
« Reply #31 on: November 25, 2007, 08:18:01 PM »
Hello Ryan,

If I remember correctly, Dr. Bollom did a fellowship at Steadman Hawkins in Vail, CO a few years ago. Dr. Steadman is considered one of the experts in treating arthrofibrosis. While doing a fellowship with him is no guarantee that an OS will have been trained to treat AF, it does increase the odds that he will at least have some knowledge of the condition. (I'm not at all surprised by the statement about Dr. Bollom's bedside manner. Dr. Steadman is the same way.)

Have you found the tutorials and other info on KNEEguru's main website? Here are some links to get you there:

Dr. Millett’s article

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

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

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

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

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

Also, you may want to start your own thread; that way responses and advice to you won't get mixed up with those to Pam. Just go to the to the list of subjects for the arthrofibrosis board-- you should be able to get there by using your browsers 'back' arrow. Then look in the upper right-hand side of the border just above the list and you'll see a button "new topic," click it to open a new window that you can post your message in. The easiest thing would be to just copy and paste your message from above.


best wishes,

Jaci

« Last Edit: November 28, 2007, 07:05:59 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 missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #32 on: November 28, 2007, 03:20:46 AM »
7 week post-op appointment

I had my 7 week post-op appointment today in Cinci and not the news I was wanting to hear. It turns out that the burning ,pain and tenderness is from scar tissue. Scar tissue has returned and is compressing several areas, on my nerve. The doctor found several trigger points that caused me to hit the ceiling with pain, when he pushed on them. He sure knows where to find these points. This is in a different area from the compression and resulting surgery I had in 2006 . This starts from way over from the medial side , goes across the front of the knee and below the patella. It is one of the branches  of the saphenous nerve. I got 2 cortisone shots to the knee today and I am on double dose celebrex for a week. If that doesn't help, then medrol dose pak and placed on lyrica. If I don't feel improvement, then more surgery to open the knee and remove the nerve. I am back on 2 crutches when I am out of the house. Got script for PT renewed but once again PT progression is solely based on knee reaction. My flexion today measured 107, which was not satisfactory. My PT felt the patella was a little tight. We are also going to be doing ultra sound treatments and a weekly email update to my PT in Cinci.

So the arthrofibrosis battle continues on. I never know where it will show up next and never know when it will end, if ever.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline NotEnough

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Re: Open Debridement and Proximal Z-plasty
« Reply #33 on: November 28, 2007, 04:45:08 AM »
Oh my god, I just read through all your updates and descriptions. What you're going through sounds miserable. I'm so sorry.

You must have tremendous strength to keep working at it like you have been.

I don't know how any of you do it. I read these signature lines and want to curl up in fetal position and cry. I can't imagine how hard it must be.

I hope things improve and you start seeing satisfactory results.

4/07: LR
9/07: MUA, LOA, LR, MR
2/08: LOA, MR
11/08: LOA, Partial menisectomy, Chrondoplasty
6/09: Notchplasty, LOA

Offline Jaci

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Re: Open Debridement and Proximal Z-plasty
« Reply #34 on: November 28, 2007, 06:01:15 AM »

Arrrrgh!!!!

Pam, this latest news just breaks my heart. I can't believe it.

I hope the medications resolve the problem so you don't have to go through another surgery.

I'm keeping you in my thoughts and prayers.


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 Janet

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Re: Open Debridement and Proximal Z-plasty
« Reply #35 on: November 28, 2007, 02:56:44 PM »
Pam:

I'm SOOOO sorry this is more bad news for you. It just seems to never end. At least there is a plan of action, and hopefully you'll be able to avoid more surgery. Take it easy, girl, and try to keep your chin up.

Janet

PS: Jaci, it's good to be hearing from you again!
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline skibum9

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Re: Open Debridement and Proximal Z-plasty
« Reply #36 on: November 29, 2007, 12:37:38 AM »
Pam

I can't believe scar tissue is back. You have been doing everything right with your rehab and just can't seem to catch a break. Hopefully, the meds will help get things under control.

Hang in there.

Sharon
11/06 - ORIF left patella
1/07 - wire removal with MUA
2/07 - LOA with MUA
3/07 - diagnosed with AF, patella baja
5/07 - scar tissue removal
7/07 - z-plasty patella tendon lengthening & reconstruction
1/08 - hardware/scar tissue removal
3/09 - scheduled for TKR

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #37 on: November 29, 2007, 05:40:14 AM »
Jaci, Janet ,Sharon and Not Enough,

Thank you very much for the kind words.....I couldn't have done anything more "right".  Once PT was straightened out, it went exactlly according to how the knee reacted, Iced, e-stemed, patella mobes, anti-inflamms, crutches, etc.  You couldn't have a more compliant patient.

This morning was a nightmare. I was awaken at 5 am with horrific pain in the knee. It was on the far medial side near the joint line and pinpointed on the nerve before it branches out across the front of my knee. It was an unrelenting sharp throbbing pain. Very painful to touch. I could not sleep, I took percosets, celebrex and used ice machine. It barely touched it. Pain levels were a 10. IF I WAS A WILD ANIMAL, I WOULD HAVE CHEWED MY LEG OFF !......it was that bad. I couldn't wait for the docs office to open. This was surgery day, so no Doc or Fellows would be there today. I talked to the head PT. They had me come right in and tried using the e-stem on the continuous current for pain. I did one 2 electrode program for 20 min with the gameready ice/compression machine on and then did a 4 electrode/cross current program, for another 20 min. After the first program , I was skeptical because I could still feel the pain , but after the second program , the pain was gone. I could not believe that this helped so much. I was delayed traveling home for several hours and even thought we might have to hold over one more day. If the pain had not cleared up with the e-stem I would have had to stay overnight. I would not have been able to travel 10 hrs in a car with that pain. The pain control from the e-stem lasted 2 hrs , it did come back, but on a more managable level. It is still very painful to touch.

Tomorrow it is back to hometown PT and explain this new problem, treament, and PT

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline skibum9

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Re: Open Debridement and Proximal Z-plasty
« Reply #38 on: November 30, 2007, 12:47:50 AM »
Wow Pam, I hate to hear about that description of pain. I will quit complaining about mine getting to an 8 lately. When my knee pain gets to a certain point, I start clenching my teeth to the point where my jaw, neck and head hurt more than my knee. I now realize that I'm doing this when I'm awake, however, I must do it a lot when I'm asleep based on the level of pain when I wake up.

Did PT program your home stem for the pain mode so that you can do the 2 electrode or 4 electrode/cross pattern at home? They did this for mine and I have had to use it on several occasions to get the pain under control.

I really hope that this settles down soon.

Sharon
11/06 - ORIF left patella
1/07 - wire removal with MUA
2/07 - LOA with MUA
3/07 - diagnosed with AF, patella baja
5/07 - scar tissue removal
7/07 - z-plasty patella tendon lengthening & reconstruction
1/08 - hardware/scar tissue removal
3/09 - scheduled for TKR

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #39 on: November 30, 2007, 02:48:59 AM »
Hi Sharon

Don't ever discount the intensity of your pain....I know what you have been thru !!!!

I have a high pain threshold from 7 yrs of this crap. Very, very few times has it brought tears to my eyes ( hanging weights and pushing down, came close !!), but this time it did.

Yes, I do have the programming done to my e-stem. I plan on using it alot. I hope it is as effective as the big machines in PT. My ins pays for e-stem when I have it done in Cincinnati, but back home in KC, they don't pay for the PT e-stem , but they did pay for my home unit.

I had PT today and PT did well. He goes along with what I say I can do or need to do. We did do ultra sound today. I am extremely tender to touch and just feeling the ultra sound wand go over the affected areas, was hard to do. I am getting short periods of burning, periods of needle like sticking and throbbing. I am waiting for this cortisone to kick in esp with 2 shots.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #40 on: December 13, 2007, 03:32:48 AM »
9 weeks post-op

It's now been 2 weeks since double cortisone shots and the double dose celebrex ended last Wednesday. The cortisone shots knocked the heat out of the knee, so that is good. However, the nerve pain during that time, was off and on, but not totally relieved. I've gone on to have 4 more bouts of very intense pain. The latest bout was coming on at the end of Monday's PT session and continued to get worse and worse thru the night and all day yesterday. It didn't let up til 11 pm last night. All I could do was sit and suffer. This pain is all on the medial side and goes across the front to below the patella. The pain is a mixture of horrible, sharp, never ending throbbing, intense burning and periodic sharp needle like jabs. On top of that when it flares like this, I can't stand to have anything touch it or lay on that side. Nothing really relieves it. The e-stem/TENS I use helps a little but not for long. I probably could run it all day. Pain meds don't touch it much either. Unlike the knee pain I am used to having, this nerve pain, when it happens ,is unrelenting and really wears you down quickly.

PT program at this point is:

calf stretches
hamstring stretches
patella mobes
SLR with 4lb weight
long arc leg extension with 1lb weight
standing hamstring curl with 1lb weight
standing one legged balance 20sec/x10
ball squeeze
mini squat
recumbant bike
ultra sound
e-stem/TENS
ice machine/gameready
crutches outside the house

Had just added the leg press for isometrics and the cable column the past 2 weeks, but have now stopped because of irritation to the knee causing a flare up of the nerve.


I called the doc's office . It looks like I'll either be going on Neurotin or Lyrica. I'll find out tomorrow which med it will be.

Pam
« Last Edit: December 14, 2007, 11:54:42 PM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Janet

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Re: Open Debridement and Proximal Z-plasty
« Reply #41 on: December 14, 2007, 03:26:43 PM »
Pam:

I had a similar pain in a similar spot following my TKR. My OS and pain management doctor said they would treat it like RSD, although they didn't think I actually had it....but my brain was interpreting all signals from my leg as pain. So they blasted at the pain from different angles. The narcotic pain meds, neurotin for the nerve pain at the smaller nerve level, and amitriptyline (which is an anti-depressant but it also used for pain management). I was also on a very strong anti-inflammatory. I was very "drugged," and felt it!! But the pain stayed under control....barely at times, but better than before. I hope you get this figured out. This kind of intense pain is so hard to deal with.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #42 on: December 14, 2007, 05:50:24 PM »
Hi Janet

Sorry to hear you went thru such horrible nerve pain. Thanks for the pain management info. I'm glad you got relief from it, instead of continual pain. I just called the doc's office and found out I am going on Neurotin. I start with 1 pill , twice a day for 2 days, then go up to 1 pill, 3 times a day. They want to try this next. I take this also with the hydrocodones and a few more percosets I have left. I take benedryl for sleep, so I can do that too. I just finished high dose celebrex and double cortisone shots.

How did the neurotin affect you in the beginning ? Any problems with it ?

The scar tissue neuroma I had in 05-06 was very painful , but this is off the wall with pain when it flares. When it's not flared up its all the same pains , just a lower intensity. I guess it makes sense it would be worse this time since Dr located several areas along the nerve this time. I told my husband on Tuesday, during that bout of pain , that if someone stabbed my knee with a knife, it would have provided welcomed relief !!!!!

Hope the medication is ready for pickup before our snow storm.  :o   I hope I get some relief.

Pam
« Last Edit: December 14, 2007, 05:52:33 PM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Jaci

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Re: Open Debridement and Proximal Z-plasty
« Reply #43 on: December 15, 2007, 11:45:02 PM »
Hello Pam,

Nerve pain is just awful. I was not diagnosed with a neuroma, but did have nerve entrapment early in my AF treatment. A pain doctor prescribed a drug called gabitril, which I've heard is similar to neurontin, it did nothing for the pain. Dr. Folk had me try Zostrix creme (it's a capsicum product) to try to 'burn out' the nerve pain. The creme really burned if I used more than a little speck of it, and it didn't seem to help the nerve pain. Lidoderm patches helped to lessen it a bit. There was another KG a while back who had good relief with Lyrica, a drug that is used for neuropathy. (Sorry I can't remember who it was.) Lyrica might be worth checking into if the neurontin doesn't help.

I hope you are getting some relief.

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 missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #44 on: December 16, 2007, 04:15:12 AM »
Hi Jaci

Thanks for the feedback.  ;D   I started the neurontin today and have had a pretty bad headache all day, I also went thru a period where I was losing my balance. One pill isn't enough to notice anything relief yet. I still have the burning, sensitivity. I hope I don't get any of those flare ups like I've been having. If I have to feel like this all the time on this med, then I don't think I want to take it.

Dr N did mention the Lyrica along with the neurontin. In fact, I thought it was going to be Lyrica. I guess they decided to try neurontin first. If I don't get any results or feel horrible on this, I'll call and maybe they will switch to the Lyrica. I read where they put patients with shingle nerve pain on neurontin.

I've searched thru old posts and it seems more people were NOT helped by these nerve meds than those who were helped.  :(

The zostrix creme you used sounds really strong !!!  Nerve pain is really difficult to treat. When I have the bad flare-up, it goes deep.

Thanks Jaci  ;D

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions