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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282683 times)

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Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
24/08/14 Day 37 Post Op

Still remaining the same and can pinpoint where the main pain is coming from after removing the taping this morning from my right knee.

The pain is around the medial portal when flexing the knee and can hear and feel clicking with pain around the medial portal the lateral portal seems to be ok with slight hardness around the upper portal.

I always seem to get medial knee pain problems and hope it settles down again.

Pre op could walk longer distances now I can only walk shorter distances and usually patient! Now getting annoying as I enjoy walking locally rather then using the car for shorter journey as it helps me unwind and relax.

Swimming is the only way I can burn off my energy levels as it does not put any impact on my right knee as it does with PT & gym work that has led to my medial portal pain!

[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
25/08/14 Day 38 Post Op

I have had a brief chat with my sister who is an orthopaedic nurse and say it important to keep on top of the PT to get the quads firing again.

I do think my new Physio made me do too much in one session. I know he was overworked as he was overbooked seeing other patients while I was at the gym and doing 5 sets of 30 squats and leg raises 5 times was too much! Ending the session lying on my front and lifting my right leg right up to my buttock!

I can take pain well with a higher pain tolerance and forcing my leg by bending it through uncomfortable pain was a bit drastic and less then 5 weeks post op! I know he was under pressure as he was going away on holiday on Friday as it the Bank Holiday weekend in the UK and does not like to turn away patients.

It a great shame that my usual Physio is away overseas as he was less aggressive when I had problems with scope #1 doing friction massage therapy and massaging quads with oil and using a ultra sound machine with gel and not a full gym workout.

I think many Physios out there do not know much about Arthrofibrosis and not to overwork the knee if the patient is prone to scarring! I think forcing my knee through the pain has not helped, I hope it has not caused scar tissue to return!

Pain is more intense around the medial portal and my mum thinks I should see Mr Snow, I am happy to wait as I am visiting my sister on Wednesday. She is working next day at the hospital and could maybe could ask her OS during a break my type of surgery and brief history and my symptoms and if I should get it checked or will it go away with rest?

nickwclarke2014BhamUK 
« Last Edit: August 25, 2014, 10:18:46 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 Snowy

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I think you should see your own surgeon rather than asking your sister to get advice from a surgeon who isn't as familiar with your case and hasn't actually performed surgery on your knee. It's good to have access to an expert through your sister, but given your history and the recurrence of the scar tissue I think it's quite important to keep following up with your own surgeon. Don't worry about having to schedule another appointment to see him, that's very reasonable when you need clarification on post-surgical symptoms that are worrying you.
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
26/08/14 Day 39 Post Op

Thanks Snowy for your reply and do agree that it makes more sense to go back to Mr Snow again that I will do next week Monday 1st September if right knee remains the same! It might just be an overuse problem that I hope will settle down again.

I have been around Droitwich today and popped into Droitwich Knee Clinic and to have an assessment by a Physio costs £40 if you pay on the day. I briefly told them I had AIR surgery that's nearly been 6 weeks ago already been to a private Physio that has now made my knee symptoms worse again as I am prone to scarring.

They did say have to be fairly intense with PT to stop the scar tissue returning again and agree if the pain level acceptable! I am not sure why my Physio did 'prone knee bend exercise' Lifting my right leg lying on my stomach right up to my buttock was extremely painful and something that should be done when the scar tissue is not an issue. No pain no gain but if you experiencing intense pain then need to take it slowly and gently.

I swam today for 40 minutes and pain is manageable, if I swam daily would it be a good alternative instead of going to the gym. It puts minimal impact on the joints and at the same time gives a good overall workout building up the quads again.

When I saw my regular Physio after scope #1 he was not too intense with the PT he gave me, I remember he gave me a blue elastic band to do leg raises that puts less impact on the knee. 

[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
27/08/14 Day 40 Post Op

I can drive ok with the problems I am having is with my medial portal that still remains the same with pain and noticeable clicking that is painful when extending the knee. I drove over 170 miles in one day to the east coast in Suffolk to visit my sister is a orthopaedic nurse with my mum. I am like a elderly person getting in and out of the car due to the pain and stiffness around the medial portal.

I have very similar symptoms after scope #1 with pain and tightness as soon as I try to squat are kneel but without the knee giving out when walking. My left knee is not perfect with clunking and clicking but it is not at all painful with the odd twinge of pain.

The right knee can clearly hear the clicking around the medial portal that does not feel that pleasant with the pain and can really feel the click underneath as if something trapped in the portal! I hope it is not AF and that a cortisone injection will settle the medial portal so I no longer feel the pain and clicking.

I am not going to get down about it too much as I have got use to lots of sets backs in life just annoying as I may not be able to help out the kids at the school gardening community project when the schools start back in September.

I am already in debts being out of work and gardening was a way I could earn to pay of the debts that I unable to do at the moment with the pain, tightness and clicking of the medial portal. The other two portals are perfect no pain or discomfort just seem to have anterior medial knee pain.

My sister says to go back to see Mr Snow again as it does not sound healthy noticeable pain and clicking around the medial portal! I just feel like I am a nightmare patient if I see Mr Snow again as he did a good job surgically. It my on stupidity that I am now in pain and discomfort by pushing myself too soon as I put too much trust in the PT's I have seen post op.

Also been told by my sister and PT's have to push hard with PT to stop the scar tissue from returning again as it can build up if you do no PT and then if you do too much it can cause scar tissue formation.  Finding it very confusing as you cannot win and hard to know what you can and cannot do!

[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
28/08/14 Day 41 Post Op

Has anyone had any personal experiences with AF 6 weeks post that have had clicking and pain around the medial portal as recovery would be going ok if the medial portal was calming down. I said before can hear it clicking while bending the knee and a loud pop at times with pressure and intense pain of I try to squat and kneel. This is really hindering my recovery I knew I should have stuck to my gut feelings and not see a new private physio.

I know you have to go through some pain and discomfort to try and break down the scar tissue but forcing the knee through intense deep pain is not sensible option. I will text my physio that I can trust fully who told me if I having problems still he can make alternative arrangements that maybe I should have done to begin with.

At least I was able to kneel and squat and could walk long distance pre op and now can no longer walk far as the knee gives out after walking a certain distance. It is annoying having to go back to see Mr Snow earlier again before January 2015. I may as well save £40 and not see another physio at Droitwich Knee Clinic and best to see Mr Snow again 1st?

[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
DAY 42:

Less then 2 days till I see Mr Green and not really seen any vast improvements as swelling has not really reduced and still feel pain and tightness around bottom of kneecap when bend it 90 plus degrees. I meant to be working from New Years Eve onwards and hope Mr Green allows me back to work again full time as I need full pay again and getting bored being at home all the time.

Kirsty it might just take time for my knee to heal up again but so far seen no improvements, hope your ankle injury does not cause you too many problems.

Milly I should ice my knee more often as I do not do it often enough when I should do.

Not sure if I will be online tomorrow as its a Bank Holiday so Library closed and cannot keep coming to my sisters house so may be back online on Tuesday.

Nick :) {2009} :)

I am now 6 weeks post op and can see from the above quote 6 weeks into scope#1 I was having the same type of problems with pain and tightness at the bottom of the knee with the medial portal being the main hindrance.

It seems that it is never ending once you prone to scarring that it will never go away completely and the more surgery you have even if it AIR to reduce the fibrous scar tissue it comes back again and may come worse off than you were pre op!

[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- please read through the tutorial on AF rehab and Dr. Noyes course on AF if you have not done that already. AF rehab is different than what most physios have been trained in.

Are you doing the patella mobilizations several times a day? Are you doing hundreds of quad set a day ( if knee can tolerate without inflammation)and are your quads firing? Have you tried deep massaging the portal yourself? Without a hands-on therapist, most of the deep tissue work has to be done by you. You are still in the earlier stages, but you have to stop inflaming your knee and have to get your patella moving and break up any scar tissue that has formed by portals.

Yes, it is true that with recurrent AF, you can do everything perfectly and still end up with a knee full of scar tissue. You do not know if you have that yet. Please read through the information on AF rehab and try to slow down and keep your patella moving. I hope you can see your surgeon soon.

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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30/08/14 Day 43 Post Op

Thanks Kristin for your reply and advice and will try and do more quad sets a day and do more regular patella mobilization religiously daily. Think the quads are slowly getting stronger, the knee giving out increases when I have overdone it with the PT or walked too far long distance.

Not done any deep friction massage around the portals as it harder to do it yourself. I will take a look at Dr Noyes research on AF as you are right not many PT’s are trained in AF and what to do after AIR surgery apart from my regular PT that is overseas.

He did a good job when I had scar tissue problems using a thera-band that is a resistance band that still helps to build up the quads without putting too much pressure and force onto the portals like conventional physio excercises can do.

6 weeks post op is still early days, fingers crossed it will resolve by itself. Is it worth seeing Mr Snow earlier with the clicking and pain around the medial portal that is not subsiding yet! Next scheduled appointment is on 14th January 2015, 5 months is a long gap to wait to see him again and should he be ok if I ask to see him earlier.

[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 Lottiefox

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Hi Nick,

Sorry you're having some complications with your rehab. As Kristin has said, read all you can from the tutorials on AF rehab. You must become an expert in your own rehab and also ensure you don't inflame this knee too much. Yes, there is a need to work on your exercises but aggravating it behind what is sensible won't do you any good. In answer to whether you should see Mr Snow sooner...I would say Yes, this is your body and your concerns. Never feel you are being a difficult patient when in fact you have a genuine question and worry. Had I not listened to my gut feeling after foot surgery and had I felt I was bothering my surgeon for no reason I'd not have had the crps diagnosed so rapidly and been so lucky with my remission. You only get one body. It needs to last a long time. If you feel unsure or in pain go see him. Don't think you'll never be able to walk again long distances etc, I thought I'd never do the same after my foot fusion but I got there. Patience is the key sometimes.

Just my thoughts!

Lottie :-)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
31/08/14 Day 44 Post Op

Thanks Lottie for post reply and this setback is just a minor one, I have more important things to sort out right now that is getting there slowly that I know you will be aware of when I was on FaceBook until I deleted my account in March 2014 for personal reasons. 

I do remember your foot problems that took a while to get right again and will never be 100% again and can say the same with my right knee. It is better to be safe than sorry and to get something checked out if it is worrying you. Even my sister an orthopaedic nurse said it best to get it checked over again by Mr Snow as the OS's she works under often see outpatients earlier then their scheduled appointment that they have been given.

I did try doing some friction massage therapy around the medial portal and can feel it is more inflamed and agitated compared to the lateral portal that feels fine no pain at all. Patella mobilization and doing quad raises are also beneficial and hope it all helps towards my recovery. Can see swelling at the bottom of the knee again that I always had slightly since scope#1 that could also be fluid that is slightly more swollen then it was before scope#2.

I will call the hospital to re-schedule my original appointment to bring it forward earlier then 14/01/15 as I need an appointment in September, will call them tomorrow morning.

[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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1211 on: September 01, 2014, 04:12:36 PM »
01/09/14 Day 45 Post Op

I received a letter from the hospital Advanced Nurse Practitioner with a report the type of surgery that was done on my right knee. I also rang up Mr Snows Secretary and the next available appointment is not until Wednesday October 15th 2014 @10:40.

Here what has officially been written to my GP!

I reviewed Nicholas in the clinic today, who underwent a right knee anterior interval release four weeks ago. Operative findings showed significant scarring of his anterior fat pad, he had a 5 degree fixed flexion contracture.

On examination today his portals wounds have healed with no signs of any infection, he does have full extension with full knee flexion, he still has some soreness generally around his portals; he can straight leg raise but does have significant quadriceps weakness and wasting.

He needs to focus on building his muscles strength and stability back again and should also concentrate on patella mobilisation. I have shown him how to do this today and although I offered to refer him to physio he was quite happy to do his exercises on his own.

Mr Snow has seen him today and reassured him that he is making good progress at this early stage. Mr Snow has given him advice in terms of returning to his normal sporting activities, however he should hold off any high impact running for some time yet to allow his knee to fully settle.

I have given him a review appointment for four or 5 months’ time (Mr Snow to see please)


The catching was no as bad or noticeable or painful when I saw Mr Snow 13th August and have got some time now to build up the quads again as advised. My sister said that my quads are slowly building up again, this rules out quad wastage and weakness when I next see Mr Snow in October.   

[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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1212 on: September 02, 2014, 05:06:24 PM »
02/09/14 Day 46 Post Op

I am carrying on doing what has been said on the letter I received from the hospital doing patella mobilisation and leg raises of 100 plus a day. I have just purchased an inflatable England football that only cost 99 pence to wedge between my leg so I can do squats.

I hope by the time I see Mr Snow again in mid October my muscle will be a lot stronger and then cannot say it the quads not firing properly causing the pain and clicking on the medial portal.

Still giving out the knee but not as bad as it was after my PT session, I will be going for a swim soon for 45 minutes that is a good workout and enjoyable excercise to be doing.

[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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1213 on: September 03, 2014, 06:52:33 PM »
03/09/14 Day 47 Post Op

Slight improvement since doing more PT with right knee not giving out so much but still feeling clicking and discomfort around the my medial portal. It is becoming a hindrance when I start the gardening project on Tuesday 23rd September as I am unable to kneel and squat.

The next day I am helping out an art therapy session in the evening for children and young adults with autism and again not being able to kneel is not ideal by not being able to get to the child’s eye level and height that important factor for children on the spectrum not to look above them all menacing! Will also be doing one to one support/mentoring for a 6 months once a week for a couple of hours so be nice if the right medial improves.

Hope to start level 2 in childcare and need to work with pre-school age children while doing level 2 and can then work my way up to older children next year doing level 3 in childcare. I can sit on the floor ok with one leg tucked away and my right leg stretched out that could be a health and safety hazard as a potential trip.

If my medial plica was as good as my lateral and upper portal I would be recovery excellent and hope PT and patella mobilisation improves the catching and portal pain when bending, kneeling and squatting. May be to blame partly misunderstanding my NHS PT by doing one leg squats rather than 2 legged squats 2 weeks post op!

[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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1214 on: September 04, 2014, 07:40:20 PM »
04/09/14 Day 48 Post Op

Right knee remains the same and have seen some slight improvements with knee giving out less. However the medial side is still clicking and feeling pain within the medial portal that not reduced in pain yet. Usually into week 7 post op you can start to do light jogging on a soft surface at a short distance and gradually increase it as the knee improves.

I had the exploratory scope for one main reason to get back into competitive running again and until I can start to run again and rejoin the running club will not be content and satisfied. Long distance running happens to be my favorite sporting hobby that's important to someone like myself with high functioning autism commonly known as Asperger syndrome.

It important that I can run again long distance and I am feeling the same pain and discomfort post op as I did pee op. Mr Snow in his report said significant amount if scar tissue not moderate or small amount so must be AF prone that not all OS's diagnose patients with when doing AIR surgery.
 

[email protected]
« Last Edit: September 06, 2014, 11:12:03 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