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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282893 times)

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Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
13/08/14 Day 26 Post Op

13 up until now has been an unlucky number for me with my knee problems! January 2013 re-injured my right knee and had to pull out of the Droitwich 2013 Half Marathon. I was number 13 competitor for the running club.

The good news is that Mr Snow has told me that I will gradually be able to build myself up again running long distance. He found no damage to my cartilage as he originally thought as it looked like I would require a microfracture procedure. If there was cartilage damage Mr Snow would have told me not to run anymore long distance.

The MRI Scan showed medial femoral condyle bone oedema which I think probably represents cartilage degeneration?

The 1st question I asked him was that their was confusion when I saw the PT saying I had LR on my notes, he told me the nurse must have misunderstood like I did when leaving after my scope. I have had AIR that can easily be confusing as AIR is less commonly known then LR.

There was a lot a scarring around the fat pad and medial femoral condyle and removed a large amount of scar tissue that was causing me the pain, discomfort and restriction. I asked him would scar tissue return and could not say yes or no. It could still happen I overdid it too soon and need to slowly build up to prevent any scar tissue from building up again. If it was to occur again would happen around now the early stages post op.

The clicking/clunking of the kneecap is normal that could always be there, the pain around the portals should hopefully ease over time. I have been told to move my right kneecap side to side, this helps to reduce scar tissue from building back up again forgot what the technical term he used.

I can cancel seeing the PT as Mr Snow said I know what exercises to do already from past experiences.

[email protected]



« Last Edit: August 14, 2014, 11:47:11 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 Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
14/08/14 Day 27 Post Op

I had limited time yesterday and left things out that are helpful and useful to mention on my post op diary.

I showed Mr Snow the sticking out hard vein on the top of my left wrist and told me it can take several months for the vein to settle down again that can happen after the canella is inserted into the vein to some patients and it is nothing to worry about.

I want to do all I can to prevent AF coming back again and read that you need to move the kneecap regular to prevent scar tissue coming back again! CPM machines are often mentioned and not sure if it would be beneficial for me as I am fairly flexible 4 weeks post op and doing the PT exercises I have been told to do.

Here is a good article that relates well to the type of problems I have been having with my right knee.

http://www.hughston.com/hha/a.extmech.htm

My mum 1st impressions of Mr Snow was that he came across serious when he saw me before going into theatre, I told her he has to concentrate 100% before each surgery he performs so is going to come across serious.

Every time I seen him during consultations he is easy to talk to and answers my question showing respect to his patients and is not serious and reserved.

Mr Snow happy with my progress and will see him again in 5 months time that will be sometime next year in January 2015, by then hope I am able to run once again.

Any extra tips and advice to prevent AF from returning would be greatly appreciated!

[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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A CPM machine is a bit different to patellar mobilization, which is specific movement of the kneecap. CPM machines are more typically used immediately after surgery to preserve range of motion, or to try and increase it if you're having difficulty recovering flex later on in rehab. It doesn't sound as though this is a problem for you, so I suspect patellar mobilization would be of greater benefit than a CPM.
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
15/08/14 Day 28 Post Op

4 weeks post op today and making good progress and only realise that I had knee surgery when I try to walk too quickly and squatting and kneeling around the portals. I have cancelled my NHS physio as I know what exercises I can and cannot do as I know my limitations best.

I helped out for the whole morning at the local autistic charity shop for children with autism and went back home at lunch time. I gradually want to build myself back up and not overdo it too much to keep AF from returning.

Snowy thanks for confirming as I thought that the CPM is not required and patellar mobilization is a better option to for. I am glad you are doing well with you knee problems that are now in the past.

[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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That sounds like really good overall progress for 4 weeks post-op. It's very good that you're not rushing things - that's very important when you're trying to prevent AF recurring. I hope all keeps going well!
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
16/08/14 Day 29 Post Op

Thanks Snowy, I mowed the back and front lawn for the 1st time in 4 weeks, it was last mowed a day before my exploratory scope. Been fairly dry in the UK for the last 4 weeks, so the grass was not as long I as one would expect it to have been.

I am still struggling to squat and kneel, I did not trim around the edges as I began to feel pain in around the portals. Once I mowed both lawns I elevated and iced my right knee. I then had a nice warm shower and relaxed, I wrote more into my book that I been working on since January 2006.

I am going to re join my local gym on Monday by doing some gentle exercises, hopefully the same personal trainer is still working at the gym. I will tell him what knee surgery I had done and what I should be doing to build up my quads again.

I think I will contact my Sport PT who always given me sound and helpful advice, who gave me friction massage therapy to break down the scar tissue after my 1st op around the portals. I know it will be worth seeing him again, been seeing before I had my 1st exploratory scope in November 2009, so  knows my knee history well.

I also plan to go swimming next week again as well as helping out for a couple of hours at Droitwich Library. I know Snowy use to or still works at a library. It sounds easy sorting and stacking books, just not sure if it is too soon as I am more prone to scar tissue formation and AF!

[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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Nick - arthrofibrosis is an overly broad term that covers a one time scarring event in the joint and also the condition where scar tissue keep returning very soon after every attempt to remove it. I hope, and do in fact believe, that you had the first kind, but unfortunately there is no test to know except seeing if it comes back.

I think it is great that you can do so much, but do pay attention to your knee. The fat pad area is prone to scarring, even without the 2nd kind of AF. You have to respect the fact that you just had surgery a few weeks ago. If you look through the AF diaries, between weeks 4-6 is a major time that scar tissue returns to the anterior interval with an early sign often being clunking at going to extension.  Clunking can also be from muscle imbalance, so I am not trying to say you have AF or panic you, but be aware. Don't push your knee too quickly. That's easier said then done for all of us, I don't follow my own advice enough either.

Look through this tutorial: http://www.kneeguru.co.uk/KNEEnotes/courses/arthrofibrosis-rehab-tutorials-dirk-kokmeyer-pt-scs-comt

Once you have your patella moving freely, your quads firing and your knee has become stable, non inflamed or sore, then progress to major strengthening.

I really want to see you successful and not ever needing another surgery on this knee.

Kristin
« Last Edit: August 16, 2014, 04:59:37 PM by kcknee »
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 Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
17/08/14 Day 30 Post Op

Kristin thanks the link and helpful and sound advice about AF and how to stop it from reoccurring!

Maybe I need to take one step back as I admit that I did too much yesterday in one day, mowing the lawn and walking and shopping. Toward the evening I knew I might have overdone as my right knee gave out a few times again.

This has not happened for around a week, so presumed it was just quad weakness that now building up in strength again. Know Kristin mentioned it also a sign that the knee is being overworked!

I did elevate and ice my knee and felt most of the pain when knee is agitated around the medial portal area in particular. It does not seem settle down as well as the lateral portal!

I doubt I would be 3rd time unlucky with AF returning! I will contact my Sports PT 1st thing tomorrow morning as he can access and advise me. He may do some friction massage around the portals as he did after my 1st scope.

[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
18/08/14 1 Month Day 31 Post Op

Exactly a month ago I had my AIR surgery on my right knee and already know my next post op appointment check up with Mr Snow next year on Wednesday January 14th 2015 @10:10. It will soon be there before I know it.

I took it more easy yesterday not to overdo it too much as I do not want the AF to return and hope it's the last I see of excessive scaring problems! I am my local church part time gardener and was one way I was getting some payment while out of work.

I think digging and lifting into the 5th week post op when scar tissue is at it highest risk of returning is unwise and may have to tell the church to let someone else take over until the spring of next year. I hope by then back to full fitness and running long distance again.

[email protected]
« Last Edit: August 19, 2014, 04:22:06 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 Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
19/08/14 Day 32 Post Op

I have been in contact with my regular Sport Physio who is away in China for a while, he will think over my AF issues and is not back in the UK for another 9 weeks and knows another Physio that can help me out. I know I just cancelled a few days ago seeing a NHS Physio as they are not a contentious as a private Sport Physio.

I rather pay to see a private PT as I more prone to scar tissue formation and do not want scarring to reoccur ending up with a 3rd scope on my right knee! The next 2 to 4 weeks is when I am most at risk post op of getting new scar tissue build up.

I visit the Worcestershire region twice a week and make use of Droitwich Leisure Centre that has a highly qualified physiotherapist that does not charge a high fee of only £36 this includes 1st initial treatment and assessment, this is not a bad price as other private physiotherapists can charge £50+.

My Sports physiotherapist is often away overseas so makes sense to find a replacement.

If I was not prone to scar tissue I would not bother seeing a physiotherapist and best to be cautious and get a proper assessment and advice.

 http://www.russellwillis.co.uk/about/

[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
20/08/14 Day 33 Post Op

I am seeing my new Physio tomorrow morning at 10:40 for an initial assessment and see how it goes from there. Getting pain and tightness around the portals as I am only into my 5th week post op and will not panic yet thinking it is AF returning! It is normal to get pain around the portals.

I swam yesterday for half an hour and will be doing the same again tomorrow after I have seen my new Physio at the leisure centre. I know that Droitwich Athletics Club recommended him as he must be doing ok as he was fully booked this week and kindly managed to slot me in.

I will not re-join the running club till spring 2015, hope by then will back to full fitness and running again at a competitive level.

[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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Nick-

I was looking through my SportMed Doc's website today and saw a link to his youtube videos. He does gait analysis as part of practice with a lot of working with runners. I am not a runner and never have been, but thought these videos might be useful for you. I'm not sure if you have a heel strike running pattern, but remembered that your IT band gets overly tight, so thought this could possibly be an issue along with the scar tissue you just had removed. These videos explain how gait impact strike angles and therefore muscles and joints.  Keep listening to your knee and hopefully slowly but surely you will be back to running again.
http://m.youtube.com/user/njsportsmed

Along with the patellar mobilizations, make sure you are doing deep tissue massage around portals to. Break up any scar tissue. Putting vitamin E oil or something similar on skin first makes deep massage easier.

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 Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
21/08/14 Day 34 Post Op

Thanks for the link and advice Kristin, I saw my new PT today he was excellent with over 25 years experience that clearly shows and is very popular and gives a discount for being a member of Droitwich Leisure Centre. In future will only pay £27.50 per session thats not a bad rate to be charging privately. I am only paying an extra £2.50 as my old PT only charged a fee of £25.

You are right about gait being an important factor to improve knee pain and straight away he spotted my right kneecap goes outwards when it should be more inwards and central that can be solved with orthotics that will help reduce knee pain and slow down gradual wear and tear.

I certainly got my monies worth and was very thorough with his assessment checking my gait and comparing the left and right quads, my right quads are 2cm smaller due to 2 scopes that is going to happen. He told me running is out of the equation for a couple of months still and not to rush into running again as my right knee has to be more stable before I attempt my 1st run.

Also not to push too far past the pain boundary and not to overdo it too much, he certainly made me do a good workout at the gym. It was painful when he moved my right kneecap from side to side and even more lying on my front and lifted my right leg right up that was painful even for someone with a high pain tolerance level like myself.

I spent 1 and a half hours in total and tapped my right kneecap at the end so the kneecap is sitting more central that I have to keep on for a few days. I am now limping more again as I did a lot of squats and leg raises in the gym. I think I will take it easy for the rest of the day and ice my knee and take ibuprofen now that it is sore again.

Next time I bring shorts was walking around in my t-shirt and underpants going up and down stairs to the gym! No one seemed to mind or care, I think they can see my right knee had surgery and get people walking in their swimming trunks so there is nothing out of the ordinary in a leisure centre setting to walk in underpants!

[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
22/08/14 Day 35 Post Op

I am still a feeling a little sore after yesterdays PT session “no pain no gain” and know often that PT can be painful, just hope it is not making the scarring worse as the clunking is more noticeable and more painful again with the right knee gives out more!

I would say the PT has knocked me back 2 weeks and know you have to try and break down the scar tissue, my new PT has been in practice since 1987 so has expert post op knowledge towards AIR surgery. He did say not to push through the pain too much knowing what my limits are.

I agree with him last thing is to start to run again that several months away till I reach that stage and told me to do squats using a raised block with my right knee on the block that could be a step or a wooden block that will not move or topple over. Leg raises by holding the leg for 5 seconds then rest for 5 then repeat 5 sets of 30.

Squatting on a low board keeping kneecap straight and central with a weighed ball was another exercise he showed me, can see the quads working that tightens under the pressure with slight trembling of the muscles!

[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
23/08/14 Day 36 Post Op

I am not happy to push myself with physio as I was able to walk around my local neighborhood block for the last 2 weeks without my right knee given out or hardly giving out. 

I was walking around the block yesterday and my right knee gave out in a dramatic way as it jolted/collapsing down that was clear to see with pain and discomfort! My right kneecap is still taped up and will be removing the bandage tomorrow morning.

It hard knowing what is right and what is wrong as one has to be forceful at times to break down the scar tissue as many others that have had PT on their knee or other joints say it a painful process and often come back feeling sorer then at the start of the session.

I know having clunking in the kneecap is normal 5 weeks post up and since doing the squatting 2 weeks post op and now the PT the clunking is more noticeable then before my PT session. Feeling more pain/discomfort, this was not as intense before.

Hopefully it just post an op problem that takes a while to settle down again as I know that AIR surgery can go 50/50 either way that I suppose applies to all knee surgeries that can work or not work for each patient. If the same portal from scope #1 is opened up again then logically there will be even more scar tissue formation!

I need to be fit for September to carry on doing courses and volunteering for good causes and would like to be more flexible rather then limping around still.

[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