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Hey Nick,Just wondering.. did you mention bone spur to OS #2? I have totally different knee problems than you so I don't have any experience with it but it just strikes me that having the bone spur in there has to be causing some sort of problem?Hope it all works out for you!Phoebe
18/02/16 19 Months Day 582 Post OpAlready 19 months post-op and no better off than I as pre-op to scope#2, I would say my right knee feels worse with pain, discomfort and instability then any of the two previous scopes. The report was done by the Registrar on 23/12/15, seen him each time I attend the clinic.Mr Clarke returns to clinic with flare up of his right knee. I reviewed him today in the presence of Professor Snow. He was doing very well after the previous surgery until a couple of weeks ago when he started to experience more anterior knee pain during physiotherapy. He could not return to running.Had to re-correct the red highlighted lettering as I have never really seen improvements since the surgery and have never done really well! I will point this mistake out when I next attend clinic. On examination he has full range of motion, no knee effusion. He points out pain in the patella region. The MRI showed change of signal of the fat pad underneath the patella. Otherwise there were no pathological findings on it. On further evaluation of the MRI one may appreciate a slightly bigger distal pole of the patella with a bone spur which may be affecting the fat pad; however the signal of the tendon is normal. In addition Professor Snow was a little concerned about developing of patella Baja after surgery.Professor Snow explained all the problems and symptoms to Mr Clarke. There is not much we can address surgically at this point as Mr Clarke’s rotational CT showed normal alignment and the MRI scan did not show an obvious pathology. Therefore Professor Snow injected Mr Clarke’s right knee with Kenolog and Marcaine and hopefully this will give him pain relief. We will see Mr Clarke back in clinic in 3 months’ time.Yours sincerely, Mr *** **** Senior Clinical Fellow to Professor M SnowHave already explained in my last post what I think should happen next when I am next in clinic on Wednesday morning March 16th. It is now hindering me on my daily lifestyle, being restricted in what I can and cannot do! With spring around the corner with longer warmer days will become agitated if I cannot go for regular long distance walks etc. I will decline a 4th cortisone injection that I doubt will be offered to me again! It is obvious now that it’s not really working and of great benefit in resolving the knee pain and discomfort. Extracorporeal shock wave therapy (ESWT) is another none invasive treatment, it’s a cheaper/safer option to go for? It might not work, the last option would be surgery! I doubt rest will solve the patella tendonitis that now looks more chronic rather than an acute condition. Scuba, I am glad to find an understanding PT that knows how to go about getting my knee right again unlike the one I saw shortly after pre-op. He made me do too much PT; this made my right knee even worse! I am now paying the price for it![email protected]
18/09/15 14 Months Day 427 Post Op14 months post-op after AIR surgery and hope I am 3rd time lucky in 5 days when I finally get to see Prof Snow. Lucha, you are right that it a good that the hospital are making sure I am seeing the best! My right knee problems has not been a straight forward fix as originally planned. It will be a big stress and release finally knowing what going to be happening next and no longer trying to guess? I am not going to let a bigger surgery than the previous two get me down after googling 'rotational osteotomy' kids under the age of 9 have had this procedure done think mainly because they have ’rotational deformity!I will type out the report and as far as I can see and from what the Registrar told me that my CT scan came back looking ok but he was under time pressure!Dear Dr ****I have reviewed this gentleman in clinic today, with the results of the CT scan. His TT-TG on both sides is 13mm and there is approximately 37 degrees of external rotation of the distal tibia with respect to the proximal tibia on the right, and 42 degrees on the left.I discussed possible treatments with rotational osteotomy, I explained all the pros and cons of the surgery, however I would like Professor Snow to consult the patient before listing him for further surgeries. I asked him to come back in four weeks’ time and we can decide about his further treatment.Yours sincerelyMr *** **** I do know that 13mm is within normal range and nothing to worry about. What I am not so sure about is the 37 degrees of external rotation of the distal tibia with respect to the proximal tibia on the right, and 42 degrees on the left is something to look at as it matches with the term ‘rotational osteotomy’Could the wrong angles cause excessive maltracking problems to such an extent that the a knee realignment surgery of rotational osteotomy is required! PT has not helped my PFS is at a chronic level that it now having a daily impact in my daily activities. I am not a expert as I am only guessing what could be wrong! I would think an exploratory scope or a lateral release surgery would be a less drastic form of surgery that often not a successful surgery! I will not say anything or suggest to something else. I will leave it to the capable hands of experts to decide what happens next. Why did he say surgeries in his report that could well be a grammar error! It could be for hardware removal if the procedure in the report was to go ahead.[email protected]
My 2014 MRI Scan Feedback on my right knee:20/03/14 Diagnoses: Anterior knee pain right knee previous Botox injection facia lata.This gentleman returns to clinic. He has not really had significant relief following Botox injections and IT band stretching and as such we went onto perform and MRI scan of the knee. This has shown medial femoral condyle bone oedema which I think probably represents cartilage degeneration.He also has an abnormal signal within the fat pad but this is probably representative of his previous arthroscopy and scarring because he did suffer with stiffness.It is always difficult to know exactly why people develop medial facet or medial trochlea disease as usually it is the lateral compartment of the patellofermoral joint which suffers from maltraking.He does have a low TT-TG distance which may explain this and he is slightly varus. His IT band is still tender today but exquisitely painful and his popliteal angles were very good.I think the only step forward I could go would be to undertake an arthroscopy to assess the medial trochlea, potentially there is scar tissue or band which is rubbing on this area which could explain the oedema but similarly it could well be a control lesion.If it is small we could treat this at the same time with a microfracture but if it is larger we may need to return to use a different technique. He is fully aware of this.Nicholas states that his pain is now impinging on his daily life and would like to consider intervention. I have listed him for a knee arthroscopy and will see him in due course.There not much else I can do; I will leave it in the expert hands of Mr Snow that I have 100% confidence. Mr Snow is there to help me that I fully appreciate, I will try best to remain positive Pre Op; it is just unfortunate that I have maltracking, bowed legged and a low lying patella that has started to wear the knee out, I may have to think wisely is it sensible to do run distance running in the future post op?Mr Snow suggested cycling instead of running; I can see his point of view as it is the closest you can get to running with minimal impact on the knees. It just hard to get use to the idea at the age of 35 that I may never run competitively again long distance that was something I was rather good at.I can only blame myself as I ignored the knee pain while running and also ran at a too quick pace and now I am paying the consequences for my actions. 9 miles in just under an hour I have proof of, that is of some credit. Also have an even better reason to help and support children with special needs instead of manual labour jobs like gardening and greenkeeping. It will just make my knees worse; doing a complete career change is a wise move and my dream job.Bad things happen in life for a reason![email protected]