Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary

[Snowy]

If you're getting pain that severe, I would talk to the physio about the exercises - that doesn't sound like something you should be pushing through. Two weeks out of surgery seems quite early to be doing one-legged squats, which put a lot of pressure through the joint. If this is too much right now, they should be able to suggest some gentler ways to work on your quad strength.

[Clarkey]

04/08/14 Day 17 Post Op

keano100, I agree not to be concerned about the portals as it early days post op, however doing squats on 1 leg so in the early stages of rehab is asking for future knee problems again! I hope you can make a speedy recovery and will find each individual recovery period varies from the next. The type of knee surgery that been done will also have an impact on the rehab.

I totally agree with you Snowy that doing one-leg squats after just over 2 weeks post op is too soon that is putting me back rather then pushing forward with my post op recovery. The squatting is aggravating the portals as I can straight away feel pain and tightness during each squat. The last thing I need is to make the AF return again! I am putting too much strain onto my right knee so early into my post op recuperation schedule.

I stayed at home all day Sunday writing my book about my Aspergers as well as giving autism awareness advice in my book that I am knowledgably about. Having high functioning autism and a level 2 in Autism Awareness for Educators that is an online course I passed and completed with ease in June 2014.

I did go out for a short walk around the block and knee only gave out once as I needed some fresh air if you have been stuck indoors for over 24hrs. I cannot yet walk further as the knee still feels unstable that will improve as the weeks pass by.

I have made some progress and driven for the 1st time today post op only driving locally to visit the manager of the autism charity shop I am a volunteer at and even helped out for just over 1 hour as the shop is low on volunteers with the school summer holidays.

I can only drive for around 20 minutes before my right knee and hip start to ache. My friends that live down in Droitwich and Worcester would like me to drive down again to visit them, I will have to put on hold for now. It takes time to recover fully and have to do it slowly by gradually increasing my driving.

The blood clot in the vein is still visible and my mum seems more concerned and paranoid about if it does not go down by the weekend said to go back again to my GP. Phlebitis seems to be a minor health issue that rarely needs a more drastic form of treatment that should hopefully resolve naturally.

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[Clarkey]

05/08/14 Day 18 Post Op

I am now 18 days post op since surgery on the 18th July, recovery is going ok apart from the squatting on one leg that I been told to do by my physio. I know you going to experience some pain and discomfort while going through physio. Straight away I know it is not right to be squatting so soon after surgery. When I squat the pain around the portals is intense and not the normal pain you would associate when going through the physio exercises. 

I know other members that have had AIR surgery saying you have to take be careful post op by not overdoing it as AF could return again. I would not like to ruin Mr Snow’s hard work of getting rid of the excessive scar tissue as squatting on one leg could cause so early on post op.

I have a quote from my previous surgery back in November 2009 after having my medial plica excision and my fat pad trimmed on the 18th day post op, one can clearly see I was not fit enough to return to work despite having a sick note from my GP.

 

DAY 18:

I was stupid enough to go into work again and had to check the course and change the markers over and empty bins while another greenkeeper trimmed the hole cups which I would have done but thankfully did not have to do it which involves squating.

After breakfast my boss could not think of a job for me to do so asked him if I can take a day off as a holiday as I have 8 days left till the end of march but said no so ended up cleaning the concrete yard with a petrol leaf blower on my back which caused pain and discomfort in the right knee. It hurts the other greenstaff knees if they use it for too long so is crazy to be using it 18 days after surgery and knee swelled up more as I could feel knee becoming tighter around the tubigrip.

Now knee more painful and swollen and took 2 200mg of ibuprofen tablets and 2 200mg paracetamol but had no time to ice my knee as I had to do some food shopping and used up the bag of frozen sweetcorn so had nothing in the freezer to ice the knee. I am now on the internet in the library till 6pm and then have to go to the golf club at 7pm for a Christmas party and will have a meal but have to spend a few hours with my boss and cant really say I wont come as the other Greens Staff are going with their wife and partners so will have to go so wont being able to ice my knee again.

My knee now hurts to bend which did not happen before and really annoyed and upset about it and hope I have not ruined my knee that Mr Green fixed up for me. I think he would be disgusted if he knew what I was doing at work along with my GP who advised me to take this week off and rest my knee even the nurse who took the stitches out said need to rest the knee but ignored them all and paid the price with a even more painful knee.

Nick {2009}

One can now see why I walked out of my job in May 2012. I am now training to hopefully become a residential care support worker for children with autism and other special needs once I have sorted out some legal issue.

I also do not want to ruin my right knee if the squatting is causing me pain and discomfort!

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[kcknee]

Nick-  if you haven't called already, call your surgeon's office and verify what surgery he performed on your leg. The rehab could be very different depending on what Mr. Snow did. If the squats hurt, hold off on them and do quad sets to make sure your quads are firing correctly. I always started with quad sets then moved to two legged squats pressing my back up against an exercise ball that was leaning on the wall. Once I could do both of those I then progressed to one legged squats. Make sure you ice and elevate and keep knee calm.

I hope your leg continues to get stronger and any scarring stays away this time. Keep posting, it's good to read your updates. I deleted my diary when everything started to seem hopeless for my leg. I recently started another one because there might be finally an end in sight for me - not necessarily a great end, but at least my knee/leg/ankle journey might finally end.

Kristin

[Clarkey]

06/08/14 Day 19 Post Op

Glad to see things are improving for you Kristin and that you are posting again as I know your post op diary will be useful information for other KG Members with similar problems you had to endure. Thanks for pointing out that I should carry on updating my post op.

I have not yet contacted Mr Snow Secretary yet as I only have to wait 7 more days before I see Mr Snow for my follow post op appointment. I can fully understand your reasons why you decided to delete your original post op diary. I will take a look at the new one you started when I am in a more upbeat mood!

I have been up since 4:40am worrying about my right knee that has started to make clunking sounds when I bend my knee sitting up and lying down and less obvious and noticeable when I am standing up. The sensation does not feel at all nice and hurts behind the kneecap when I am bending and feel I am to blame for causing my knee to get to such a state.

Can even hear and feel a clunking crunching sensation every time I bend my right knee compared to left knee that is also not perfect that does tend to click a lot, Mr Snow said is maltracking and if it gets worse a LR might be required, he did not tell me this directly a few physio’s have pointed it out.

The annoying thing is my ROM is almost back fully and was doing really well with my post op recovery and fear the squatting has maybe damaged something internally inside my right knee. Can see bruising coming through around the shin and is dark red around my tibia.

It might be nothing to worry about after all that might improve doing RICE regular. Who knows may have misunderstood the PT’s instructions he gave me as I do know he mentioned squatting on both legs with a ball between my legs and to sit on the bed and do leg raises. The 3rd I was not too clear about said squat holding onto a worktop or table so then assumed must have said one legged squats.

My mum says you are not to blame as the PT should have given me a PT exercise info sheet or written what PT to be doing at home, he was too vague and laid back as he is new to the job, he looked very young with not much experience yet. I am now worried to tell Mr Snow what I did as he might not be impressed with me if I ruined his good surgical work he done inside my right knee.

Tried to book an appointment with any GP who available as I am still not having much luck getting the vein to go down on top of my left wrist as he did say to come back if it stays the same. The new system in the UK GP Practice is poor as you have to wait for the GP to call you 1st before seeing him or her rather then the receptionist booking on the PC for the next available appointment available.

My mum is now stuck at home waiting for the phone call from the GP while I am posting on my post op diary at my local library for one hour, no mobile phone call from my mum yet, looks as if there been no call yet from the GP on duty.

Sorry I am being so down and negative, I am just concerned at the moment that clunking of the kneecap is not normal as I never had this problem after scope #1!

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[Lottiefox]

Hi Nick

I'd find it very unlikely you've caused anything serious to happen inside your knee, but I would avoid anything in the way of squats at the moment and would really recommend you find out the correct protocol for exercises. No point worrying for another week - you're perfectly entitled to check understanding and clarify what you should be doing. I suspect the clunking is because the muscles aren't as strong at the moment and the kneecap and joint are simply moving about a bit more than they should. The pain is also likely to be because it is inflamed and healing. You're not even 3 weeks post a scope where they did a fair amount of work to your knee so it is not surprising you have some pain. Just make sure you're not doing too much. It may well be that prior to your first scope the muscles were working a little more effectively and the knee didn't clunk about. Both of my knees clunk, and it gets much worse when I haven't been able to exercise them as much. When my foot was operated on my right knee clunked loads more because I couldn't use my leg muscles! The muscles will come back but don't be a rush to force things - let your knee heal and please find out the correct protocol for YOUR surgery so you don't get in a worry again?!

Lottie

[Clarkey]

07/08/14 Day 20 Post Op

Thanks for putting my mind at ease Lottie, I slept a lot better last night knowing that it perfectly normal to get clunking inside the knee 3 weeks post op.

The upper portal is now starting to heal up nicely with the scab falling of yesterday as well as the two lower portals. My walking is improving and just had a walk with my nephew to the park and driving longer distance now with right knee that is not giving out so often.

Continuing to walk around my local block twice a day that a bit of a hazard as some of the pavements have been re-tarmacked while others have got concrete slabs that was the fashion in the 60s and 70s that have sunk and cracked and nearly tripped over twice. The local counsel are going to replace the paving slabs with tarmac throughout the City of Birmingham. This will save the counsel money in the long run having less compensation injury claims against them.

I am still taking ibuprofen and swelling is mainly above the knee and slightly less at the bottom of my right kneecap. I have not had a drop of alcohol post op. I am not much of a drinker and think it might be best to avoid it until the swelling subsides as the alcohol might slow down the healing process.   

My local medical practice never called back and I am sure will be one of hundreds of angry patients that think the new set guidelines to reduce the amount of patient that see the GP for something trivial and minor. The good old days could book over the phone the next available appointment with a GP. Now you have to leave your mobile or landline number for the GP to call you back again, they then decide if you should come into the surgery or not. I cannot see this new system lasting long and hope the original booking system returns.

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[Snowy]

Sounds like things are progressing well. Have you had any luck finding out what procedure was done?

Excellent idea to avoid alcohol until you're further out from the surgery - as with anything that compromises the immune system, it can slow down healing. Eating healthily and sleeping well are both very good things for your body right now.

[Clarkey]

08/08/14 Day 21 Post Op

I am glad you agree with me Snowy about avoiding alcohol post op that is not going to be great for the healing  process as you have clearly pointed out. I think the same rules should apply in the UK as they do with tobacco no adverts on TV and higher taxes on alcohol. No more special offers in supermarkets and off-licenses that just will make children think it ok to under age drink!

My brother-in-law died in June 2012 who drank heavily leaving his mum, and two sons and my sister his wife without a son, dad and husband. I am very surprised that all 3 main political parties cannot see the logic of my way of thinking as the NHS have a lot of added strain with alcohol related health problems and injuries caused through excessive drinking.

Back to my right knee I will wait to see Mr Snow to find out what procedure was done and I am 60% certain he did AIR and maybe also LR. It is now less then a week away my follow op post op appointment so might as well wait.

I have stopped squatting and following the PT exercise sheet the hospital gave to me after leaving ACDU that are your standard post op physio exercises I will ask Mr Snow if I can see the PT I saw pre op as I got on ok with him who wrote down the PT exercises and made sure I was doing them correctly.

I have to slow down more, I was being as you do as an uncle to my two nephews in my sisters back garden standing letting my nephew hit the tennis ball with the cricket bat to hit over to me to catch, who managed to hit the top of my right knee! It hard to just sit back and do nothing as I like to keep physically active having a good time with my nephews and nieces.

Shall I get Mr Snow to examine my left knee as I know have maltracking problems and PFS in my that plays up having good and bad days. I can cope with my left knee as it is for now just want to know if it will be a problem in the future or remain the same.

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[keano100]

Its good to see you are walking a bit better and having less knee giving out incidents. I always find perfectly flat surfaces ok but any inclines or declines are more troublesome.  I find it difficult to describe the exact feeling in my knee but clunky is definitely a word that springs to mind. It just feels like its pressing anything something that shouldn't be there. I could say it is pressure but I'm not sure thats correct. The knee cracks all the time but the surgeon said that's quite normal and doesn't necessarily mean anything. I had trouble with my other knee but this seemed to disappear once my limp improved. Went to my GP the other day to see what he suggested and he has put me on Naproxen for a month due to the swelling. I've actually taken a pic of my knee so I have a comparison once the course is finished.

[Clarkey]

09/08/14 Day 22 Post Op

Glad I now know that it is fairly common and normal to have clunking, I also find that my knee gives out more if the surface is undulated going up and down steep slopes. Cracking of the knee compared to clicking does feel worse and find clicking of the knee does not hurt while cracking of the knee can be painful. I was also taking Naproxen when I was having right knee pain and problems post op surgery #1 that my GP and pain clinic doctor at the hospital prescribed to me in early 2010.

Think you are the 1st KG member to send a photo attachment of both knees on my post op diary. I will try and give it ago myself attaching some photos of my right knee from the last 3 weeks, early ones might look grim if you do not like the site of blood of my 1st week pre op photos taken.

Slowly the bottom portal scabs are lifting away nicely that are not too noticeable apart from the top portal that is slightly larger in size. I still have a lump around the top portal that should go down again, hope it is not scar tissue as the lump is fairly large and hard, feeling pain around the upper portal more than the lower portals.

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[keano100]

To be honest I only thought of the idea myself the other day and wish now I had taken one pre and post op. At first glance they might appear quite normal but if you look closely you will see the right has much more swelling than the left. In my own head I don't think the swelling on my right leg has changed much post op but i have no way of verifying this. I wish my right knee looked more like my left. What surprises even more is that an MRI didn't pick up anything unusual, only what had been completed during the OP and it also differed from the one that was taken a year earlier. This leaves me with a whole bunch of questions:

1) Are they reliable for soft tissue injuries
2) They are only taken when the leg is in a relaxed position but is that really suitable for a condition which only has symptoms when the leg is compressed
3) If its not your surgeon reading the scans then how do I know the person is qualified to read them correctly.

I've only been on the Naproxen a few days and haven't noticed any real change in the knee. Maybe its taken a slight edge of the pain but thats about it. I suppose it takes a few weeks to start working properly.

I only had 2 portals and I remember they were still bleeding a week after the OP. A scab formed shortly after and I recall one healed quicker than the other. Have they offered you any ultrasound at the physios yet?

[Clarkey]

10/08/14 Day 23 Post Op

It good to compare both kneecaps in front of a long mirror, I have always had some swelling at the bottom of my right since surgery #1. Been told I will always have slight swelling around the portals.

Left knee can see swelling at the bottom of the knee on the medial side and do know I have PFS and more maltracking in kneecap compared to right. I remember before my 1st exploratory scope the PT I saw mentioned may need LR surgery. My sports PT mentioned to me it could become more of a problem in the future if I do lots of long distance running.

I will be 36 in December and never had the chance to run in a half marathon as I always seem to be prone to injury. I had to pull out of my 1st ever half marathon 6 weeks before the half marathon when I sustained a new injury to my right knee that led to exploratory scope #2!

Lots of you posting on my diary saying should find out what type of surgery I had so I can do the correct type of PT recovery programme.

I was reading back on my diary when I had scope #1 and back then did not have to see a PT at the hospital. To be honest the NHS PT I saw recently was not necessarily as the hospital could have given me a PT exercise sheet for the specific surgery I had when I left the ACDU. 

Keano I will try to answer your questions through my own personal experience and from what I have read on KG from other members posts tomorrow. Reason why I am using my iPhone with limited data allowance and easier to do it on a desktop tomorrow at the library. I cannot afford internet at home till I find a full time job again.

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[Clarkey]

11/08/14 Day 24 Post Op

All 3 portals are healing up well and more flexible again with good ROM going into week 4 post, I only have to wait 2 days for my post op check up appointment with Mr Snow. I can still feel the clunking inside the right knee that one can hear in a silent room.

If I place my hand over my right kneecap can feel a popping sensation inside the knee towards the bottom of the kneecap with some pain and discomfort that and will point this out to Mr Snow. I am sure he will pick it up when he examines my knee.

Now will answer your questions

1) Are they reliable for soft tissue injuries

Soft tissue injuries are often not picked up on an MRI scan, before my 1st exploratory scope had an MRI scan done on my right knee and came back with just a minor problem with the fat pad with fluid around it that was not a concern at the time. My inflamed medial plica did not show up on my MRI scan.

2) They are only taken when the leg is in a relaxed position but is that really suitable for a condition which only has symptoms when the leg is compressed

They strap and put a light foam block between both sides of your knee that stops your leg from moving. They rarely sedate patients unless they are extremely nervous or are young children or have a condition where they cannot help but move their leg.

Makes no difference if you get symptoms when your leg is compressed as the MRI scanning machine will still pick up any problems.

3) If its not your surgeon reading the scans then how do I know the person is qualified to read them correctly.

A radiologist will see any problems that are well qualified and experienced at reading MRI scans. They then will send a report of their findings back to your OS who will look over the MRI scan images that come up on a computer screen and decide what course of treatment would be required to get the knee right again.

I hope my answers are useful and informative.

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[Clarkey]

12/08/14 Day 25 Post Op

Less than 24hrs until my 1st Post check up appointment with Mr Snow and will finally know what surgical procedure I had done on my right knee. I am sure he will not mind checking my left knee just to reconfirm it is still maltracking and PFS, will it cause problems in the future. Will also find out realistically if I can return to long distance running again or will it just make my knees worse and best to avoid it.

I still have a weird feeling vein just below my left wrist on top of my hand near to where were the canella was inserted into the vein, feels hard and boney and can move it from side to side. I am fully aware Mr Snow does not specialise in vein problems juts be good for him to know what happened to pass onto his surgical team.

Is it worth seeing my private sports physio again as he knows me and my knee problems well and does a give realistic advice and PT program as well as actually do something that benefits my knee. Massaging the muscles with massage oil followed by friction massage to break up the scar tissue. The NHS does not provide this service with their team of physios!

I have increased my walking distance still making sure I do not do too much walking, limping is less obvious so recovery seems to be going well so far.

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