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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282819 times)

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Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
27/07/14 Day 9 Post Op

Thanks Tez for giving me some good and helpful advice about what to do with the dressings, it's common sense that the dressings needs to be removed if they been kept on since the day of surgery 9 days ago.

I will have a shower tomorrow morning and would be a benefit for the surgical incisions to get some fresh air and sunlight that will help aid the healing process. Good idea to use small round plasters over the incisions sites if it required still. Hope you are right and the AIR surgery has been a success and can get back to long distance running again in Spring 2015.

Know it still only 9 days post op and have myself to blame for the swelling to increase as I have been doing physiotherapy exercises of leg raises mainly. I find bending my knee up and down while sitting up on the bed challenge as the swelling makes the exercise uncomfortable.

I also yesterday walked down my local high street and my knee slightly give way and I nearly tripped over twice! I now realise I need to slow down and take it easy, I am at home again since yesterday afternoon. I am of course ice and rest, sit with my right leg elevated in the back garden while the weather is sunny and warm.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
28/07/14 Day 10 Post Op

Had a letter today from the physiotherapy department of the Birmingham ROH for this coming Friday 1st August at 1pm.as expected bruising at the bottom of right kneecap and side of the leg with swelling that should gradually settle back down again.

I had my 1st shower today 1st one post op, the 9 days before I had to use warm soapy water and a flannel to keep myself clean. I thought it best to have a bath 1st they that I did last night before going to bed in warm plain water. It did not take long for the dressing to absorb the water and came away with ease. Felt so freshening my 1st post op shower.

I then dried myself down and all 3 incisions are healing up nicely. The medial side larger than lateral that expected after having AIR. The Incision above the knee is about the same size as the medial. I have placed some water proof plasters over the 3 portals that still need some protection.

Saying at my sisters house in Leeds till Thursday afternoon to unwind and relax.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
29/07/14 Day 11 Post Op

Bruising is starting to fade slightly and I am taking less paracetamol and ibuprofen, hopefully can reduce the swelling. I cannot drive yet as much as I would like to my right knee is not stable enough to drive safely so have to rely on my mum as a taxi service.

When driving up to Leeds I find even with the front passenger seat fully extended that my right knee aches and feels stiff so we had to stop at service stations so I could get out and stretch.

I kept the waterproof plasters on, is it really necessary to cover up the portals till my PT appointment on Friday. The air and daylight might be beneficial to the 3 incisions during the UK heatwave.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
30/07/14 Day 12 Post Op

I did a fair bit of walking yesterday in the Market Town of Skipton on the edge of the Yorkshire Dales and my right knee felt ok and managed to walk and stand in the shops for over an hour. I then stopped for a cappuccino with my mum, on way back to the car my right knee gave in twice that could be quad weakness as the majority of the swelling is above the kneecap.

I took of the plasters yesterday evening and the incision that seem to be healing well on the medial side followed by the lateral side that is darker and slightly larger that left slight bleeding on the plaster padding. The incision above the knee is still fairly larger bad is fairly larger and wider compared to the other 2 portals that left the most breeding on the plaster padding.

What is the reason behind having a 3rd incision above the kneecap, is it to drain the excessive fluid to from the knee? It is still unsafe for me to drive as you need to be able to do an emergency stop safely that I would not be able to do with the way my right knee feels.

[email protected]
« Last Edit: July 30, 2014, 09:40:35 AM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline kcknee

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Glad your knee is feeling good, but please listen to it. If your knee is giving out, you are doing too much. Make sure you are doing the basic post surgical strengthening exercises to get your quads to wake up and make sure you are doing patella mobilizations to keep all the area that were just released moving. If your knee heats up, swells up or pain increases then slow your activity level down. Ice and elevate. Despite the little holes, a lot was done in and around your knee. When I had the AIR, the first night I bled through 3 inches of padding and two elastic bandages wrapped around my leg. When I got in touch with OS the next day, he calmly said scar tissue bleeds more than regular tissue and he removed a lot from around my knee. I wished he had told me that earlier. If your incisions are still bleeding, keep them covered and stick with showers over baths until they heal over. You don't want any bacteria getting in. Try to be patient and give your knee time to recover. The physio on Friday should be able to help with strengthening exercises and mobilizations.

Kristin
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline emergRN

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Nick,

The upper portal is usually used for the irrigation cannula.  The bottom portals are for the camera and the instruments.

I also saw that you had a bath.  Please do not soak wounds in water!  You should not take a bath until the incisions are completely closed off and healed.  The last thing that you need is a joint infection.  This is just a tip as well, but when having a shower, it is best to stand with the spray to your back.  Try not to have the force of the spray hitting your incisions!

Good luck with your recovery!  It's easy to overdo, especially when pain levels are low.  Just remember that how ever far you walk, you have to get back!

Take Care!

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
31/07/14 Day 13 Post Op

Yesterday went to Harrogate that a city more then a town and was very busy as on would expect during the summer holiday peak season. Had to park a fair distance from the main heart of Harrogate that is very hilly so was not ideal for my right knee to cope with.

I cut right down on taking pain killers and have not taken any for 24hrs as pain is manageable what is annoying is the knee suddenly giving out that is an unpleasant experience. The main pain and swelling is the top of my knee around the upper portal region and can see that the anterior portal is healing up well and closing up nicely, the lateral portal slight weeping and portal more darker and slightly painful. The upper portal is what causing the majority of pain with a large black scab with swelling around the portal with a slight bump around the portal is the best description!

Kristin with 1st hands experience AIR so know how it feels to recover from post op. I should slow down a little as the last thing I need is more scar tissue building up. I have been accepted to mentor children and young adults on the autistic spectrum in September. One to one mentoring giving the parents respite on a voluntary basis once a week for up to 3hrs plus so like my right knee to be ok again by September.

My right knee giving out means I am overdoing it that I did not realise till you pointed it out. Reassured now that bleeding more likely to occur after AIR surgery. Know now that from your personal experiences of AIR surgery it takes time that is a slower recovery process.

W, hope you are doing ok and thanks for explaining about the portals and the upper run is for the irrigation cannula so was not far of guessing it correctly. I rarely have a bath, mostly have a shower only reason I had a bath twice was to loosen the dressings and was only in the bath for around 5 minutes.

If it not a good idea to get the portals wet that have formed a scab then I cannot go swimming yet! I really enjoy swimming that's great PT, often patients recovering from knee and hip replacements go to the hydrotherapy pool to recovery from their surgery. Shall I wait for the portals to close up more as the top portal has a larger scab that might come off in the swimming pool!

nickwclarke [email protected]

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Snowy

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Yes, you definitely shouldn't go swimming until the portals are fully healed. My surgeon was very clear about this after my surgery - swimming had to wait until he was satisfied that there was no risk of infection. If there's still a scab on the portal, it's too soon.

Make sure you talk to your physio or the surgeon about what's okay to do in the pool before you go. I don't know what the restrictions for your particular surgery would be, but I had to avoid certain strokes and be quite careful about how I used my legs to begin with. There were also certain exercises, like water walking, that were encouraged. It's important to be careful about how and when you reintroduce activities after surgery so that you don't compromise the healing process.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
01/08/14 Day 14 Post Op

I just come back from my physio appointment and been told I need to strengthen the quads in my right knee that have become weaker from the surgery and the injury pre that have made the quads weaker. I have to do a few squats of 3 set of 10s to build up the quads again. The pain I am getting is around the portals as I can only bend my knee to a certain angle before feeling pain and tightness particularly around the 3 portals. The upper portal is the most painful with some swelling around the portal and general swelling above and below the knee cap.

The pain around the 3 portals could also be scar tissue that I did not like to hear after my 1st scope had to have friction massage and a cortisone injection to reduce the pain and swelling and was getting tightness as if someone is grabbing and squeezing my right kneecap.

I am now confused yet again! It said on the post op notes that my PT showed me that I have had lateral release surgery? I am convinced that I had an AIR surgery as Mr Snow clearly made out he had to remove scar tissue, would a cannula above the knee not be used for LR surgery? I know I was still under the GA slightly groggy but he did say anterior something release did not pick up interval until I googled it.

I even said to Mr Snow when I did not get what he said just something release so assumed LR and was quick to correct my mistake and even the nurse was not sure what had been done. They almost operated on my left knee and now cannot get what surgical procedure I had done 2 weeks ago.

Thankfully I am seeing Mr Snow on 13th August at 2pm so can clear it with him. The signs and symptoms and if you read my MRI scan report a few pages back looks like AF was the culprit as my left knee needs to have LR more then my right as the tracking is not as good as my right. I am happy to leave my left knee as it is as the pain is not too bad most of the time.

Another thing I noticed is that I am getting pain and discomfort near to where the cannula was inserted in my left hand around the top of my wrist. I follow my main vein down from my hand and can see the vein is sticking out and sore and tender to touch. It lumpy and hard and can move it side to side. I did point it out to the PT who looks fairly young with not many years experience said might just be an inflamed tendon and if I am concerned I should see my GP. The needle is fairly long that goes into the vein so might just be inflammation!

Is it something to take lightly or should I get it checked over as my right wrist is fine in the same region where a lump has formed in left wrist that I only noticed yesterday evening while typing on my laptop with pain coming through slightly.

Thanks Snowy for giving me some useful advice not to go swimming till the portals have sealed up nicely. I will wait to see Mr Snow to go ahead swimming, also is it best not to drive yet as the portals are still tender and tight in a driving position angle.

Sorry for a longer post then usual had a lot to put forward.

[email protected]
« Last Edit: August 01, 2014, 04:07:55 PM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Snowy

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How confusing! Would it be possible to call your surgeon's office just to confirm what was done? Two weeks is a long time to wait to find out, and your rehab protocols might be different depending on whether you had an LR, an AIR, or both.

I'm sure that by the time you see Mr. Snow your portals will be healed and you'll be able to start swimming again. It's definitely better to err on the side of caution with these things though, as joint infections can be very nasty. (I'm not sure if you remember but I ended up with MRSA after my surgery; we were lucky that we caught it early, but it was still a very unpleasant complication.)
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
02/08/14 Day 15 Post Op

Snowy now you mentioned that you contracted MRSA I remember well when you posted about it on KG. Confusing is something that's becoming a regular occurrence since my knee problems began with the NHS. They did a fantastic job on the day of my exploratory scope the medical team from the moment I stepped into the hospital pre op until I walked out post op.

Again communication is lacking as I am 95% certain that Mr Snow mentioned AIR and not LR and even asked him did he do a LR and said no he didn’t he had to remove scar tissue and did say anterior something release to me. Maybe I had both procedures done at the same time and not sure why a LR needed to be done as I have only read on KG that LR just made members knee problems even worse! It is very much a gamble type of surgery.

I could call or email Mr Snow Secretary that I am reluctant to do as the hospital will start to call me Victor Meldrew from ‘One Foot in The Grave’ from my previous queries, changes and complaints. 

I have been told by my PT to do 10 x 3 sets of squats a couple of times a day as my quads are weak. I am not sure if this is wise as he thinks I have had LR when I may well have had along with AIR and might need to change the PT exercises slightly! It does hurt around the portals squatting and concerned that it might make the scar tissue around the portals increase, even my PT said it could be scar tissue around the portals causing the pain.

I went to my local GP Practice yesterday about the vein sticking out on the top of my left wrist and he said will see me after he has seen his last patient of the day just before 6pm. What he did find odd and also I found bizarre was that the vein started to change in size on Thursday Evening 13 days after my surgery.

I have thrombophlebitis or phlebitis that Kristin kindly found out for me by sending me a link on KG personal message. It is a blood clot that at 1st sounds serious that should calm down again as I would know if it was DVT. I have been prescribed an antibiotic cream and have to apply 15mg of fusidic acid cream 4 times a day onto the infected vein.

Another question that keeps slipping my mind is it ok to sleep with pressure against my right knee as I tend to sleep on my stomach on my right side with my right knee pressed onto the mattress. Would it increase scar tissue formation or not make any difference.   
 
I will not go swimming until I seen Mr Snow in Clinic on Wednesday 13th August @14:00, my next PT appointment is the next day 14/08/14 @19:00.

[email protected]

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline kcknee

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Hi Nick -

I'm glad you had your had your wrist looked at to confirm what your problem is. Hopefully it clears up quickly.

Can your PT call Mr. Snow's office to confirm the instructions that he was given? He's part of same system and I am sure you are not first patient coming to him with confusion over what was done in surgery.

I was never told not to sleep with pressure on knee. Pain always dictated if I slept on knee.

Kristin
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline Snowy

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I think it would be a good idea to call them for clarification.  The most important thing is that you do the right rehab for whatever procedure you had - they will understand this and I'm sure they'll find it reasonable to ask for confirmation when you've been told two different things.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
03/08/14 Day 16 Post Op

I agree with you both that it would be a good idea to clarify what has been done. It would put my mind more at ease knowing what exactly Mr Snow found and what surgical procedures were carried out inside my right knee.

The small blood clot on top of my left wrist is still there and applying the antibiotic cream 4 times daily that contains 2% fusidic acid in a 15g tube. It should hopefully disperse the clot and break it down. I am finding applying the cream till it has been absorbed agitates the vein more and pills might have been a better option to go for.

Also finding that the squatting exercises the PT has given me is increasing my pain level. One leg squats is too much for the knee to cope with as I feeling pain and discomfort around the portals that is hopefully just a small amount of scar tissue that will break down.

I was elevating my knee last night and suddenly got sharp shooting pains and had to stand up to help reduce the pain. Bruising is now green with redness around the tibia with darker bruising on top of the knee on lateral side.

Portals seem to be healing up nicely apart from the upper portal that still has a large scab protecting the incision. Swelling is mainly at the top of the knee and at the bottom by the two portals.

[email protected]
« Last Edit: August 03, 2014, 09:54:10 AM by Clarkey »
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline keano100

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Hi Nick,

I wouldn't be too worried about the portals. Mine took a good 4-5 weeks before healing up properly. From my experience the physio is just running through the standard treatment of quad strengthening exercises post surgery. Unfortunately i don't rate any of them very highly. I'm still having problems doing 1 legged squats 4 months post surgery. It just feels like there is something compressing inside my knee each time i do them. I still get occasional episodes of the knee giving away now. I think its something that improves with time. This scar tissue is a pain in the backside. I cant work out if it is this which is causing my problems still. Anyway sometime patience is key.