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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282749 times)

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Offline lucha86

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hey nick
i do agree with you with the sport aspect as a wrestler myself and having to turn away from it and you turn away from your running its rather hard to accept it as its something you love or enjoyed, sometimes its rather funny when doctors say we must keep active and fit and when we do we end up damaging ourselves lol

we do put our faith in experts but sometimes i think when something is'nt  clear it is always best to question it because at the end of the day its our bodies and our knees and we need to understand what the actions of the surgeon is and the consequences following it, its best to be clear about things than be stuck in the unknown...... so make sure when you see your consultant next time that you walk out of there with everything clear including the question of the osteotomy and re confirm all your mri and scan results............

i think with any lower limb surgery everyone has their ups and downs as it effects their normality day to day life jobs etc....... so dont feel bad about it =) hope you are well =)

Offline Clarkey

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22/08/15 13 Months Day 400 Post Op

As it already day 400 post-op to my AIR surgery it would be a good time to give a further update. It might not even happen having a 'osteotomy' on my right knee! After doing some research into the surgical procedure yes it is a big knee surgery to endure and sounds very daunting and scary! It does say it is done on younger patients to delay having to have a TKR! What it does not say it is also beneficial if your knee is not tracking properly.

The metal screws and plates can be removed at a later date having hardware removal surgery so would not be walking around all my life with screws and plate IF an osteotomy is the next course of treatment.

Our moods vary from day to day and was rather grumpy and fed up in my last post op as I did not think it would take so long to try and sort out my right knee. It’s not a simple and easy fix and diagnoses as you would get with other knee related problems and injuries.

I know that a clicking knee is perfectly normal and ok as long as you are not in pain as many live with a clicking kneecap throughout their life without any major concerns. Mine is more of a clunking sound at the bottom of my kneecap by the tibia. It sounds like a snapping sound that can be very clearly heard when I am doing wall squats to strengthen my quads.

Is this worth a mention at my consultation on September 16th and would it be ok to demonstrating it to Prof Snow, or tell him verbally as It will click loudly if I did a few squats to show him that there something not right with my right knee! This should be enough evidence to at least do an exploratory scope if the osteotomy was wrongly advised by his registrar!

Lucha Thanks for your reply or some much needed moral support, you are right that it is our bodies and need to be cautious and ask questions if surgical procedures are mentioned. It also true we are told to take regular exercise but not to the extreme as I did going at a fast pace for 9 miles without any guidance and supervision from a PT or personal trainer! Maybe could have prolonged or prevented my right knee problems from occurring if I followed a proper fitness training programme.

I will make sure I am fully prepared on 16/09/15 with questions that I would like to know more about and question why an osteotomy was mentioned by his registrar if my MRI and CT looks ok?

In my next post I will finally know what is going to be happening next after my appointment, I can then give an update of how it all went.

[email protected]
« Last Edit: September 10, 2015, 10:11:06 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 Scubagrl4

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1337 on: September 09, 2015, 03:39:30 AM »
Hey Nick,
I just wanted to drop by and wish you luck next week. I really hope there is a reasonable answer for you. Funny, it almost seems that there is a reason for all the waiting. We spend so much time being miserable, surgery becomes more of an acceptable option while we wait.
4/14/14 L ACL rupture, grade 2+ MCL tear
6/6/14 ACLr allograft
9/4/14 MUA
10/6/14 LOA/AIR, synovectomy, lateral/medial retinacular release, partial lateral menisectomy, chondroplasty, deep tissue
biopsies.
11/20/14 insufflation, MUA
10/19/15: LOA/air, PLM, chondro, synovectomy, med/lat releases

Offline Snowy

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1338 on: September 10, 2015, 04:16:39 AM »
Hi Nick - I hope all goes well next week and you're able to get some answers on why this might be an option for you knee. Will keep my fingers crossed for 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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1339 on: September 16, 2015, 11:04:29 AM »
16/09/15 13 Months Day 425 Post Op

Thank you Scubagrl4 & Snowy for wishing me all the best for today’s consultation that has now been postponed! I had 2 missed calls on my iPhone this morning saying ‘No Caller ID’ at 08:40 and then said to my mum I do hope it now from the hospital saying I cannot see Prof Snow this morning.

I was right as I received a 3rd call No Caller ID and was able to take the call, it was the hospital calling saying that Prof Snow has scheduled me for surgery and unfortunately he will not be in clinic today. On my notes I need to be seeing him rather than his Registrar again.

I have been booked in thankfully next week Wednesday 23rd September at 11:15. It is frustrating as I was psyched up and ready for today only to find out 2 hours before consultation it been postponed. What now looks guaranteed and certain is surgery as the person who I spoke to on my iPhone said I am scheduled for surgery and Prof Snow needs to confirm it with me so I can give my consent to go ahead with it.

At least I did not waste my time and the Registrar could fit me in again the following week, I did not have to wait another 4 weeks! It just shows they do have free spaces when it necessary!

I suppose 1 week is not going to make much of a difference, it just frustrating being told at such short notice, It is better being told this way then turning up at the clinic and being told that Prof Snow is not in clinic today! This would have upset me as it would have been a wasted journey for me.

I even called the to double check last week Friday with Prof Snow Secretary and she said as far as she can see he has not go anything on his diary and should be in clinic on 16/09/15.

[email protected]
« Last Edit: September 23, 2015, 04:58:50 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 lucha86

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1340 on: September 17, 2015, 05:43:02 PM »
 a good thing is nick at least they called you beforehand to say he wasnt there and you didnt waste time =) fingers crossed for next week i hope you get all the answers you need =)

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1341 on: September 18, 2015, 04:16:39 PM »
18/09/15 14 Months Day 427 Post Op

14 months post-op after AIR surgery and hope I am 3rd time lucky in 5 days when I finally get to see Prof Snow. Lucha, you are right that it a good that the hospital are making sure I am seeing the best! My right knee problems has not been a straight forward fix as originally planned.

It will be a big stress and release finally knowing what going to be happening next and no longer trying to guess? I am not going to let a bigger surgery than the previous two get me down after googling 'rotational osteotomy' kids under the age of 9 have had this procedure done think mainly because they have ’rotational deformity!

I will type out the report and as far as I can see and from what the Registrar told me that my CT scan came back looking ok but he was under time pressure!

Dear Dr ****

I have reviewed this gentleman in clinic today, with the results of the CT scan. His TT-TG on both sides is 13mm and there is approximately 37 degrees of external rotation of the distal tibia with respect to the proximal tibia on the right, and 42 degrees on the left.

I discussed possible treatments with rotational osteotomy, I explained all the pros and cons of the surgery, however I would like Professor Snow to consult the patient before listing him for further surgeries. I asked him to come back in four weeks’ time and we can decide about his further treatment.

Yours sincerely

Mr *** ****
 

I do know that 13mm is within normal range and nothing to worry about. What I am not so sure about is the 37 degrees of external rotation of the distal tibia with respect to the proximal tibia on the right, and 42 degrees on the left is something to look at as it matches with the term ‘rotational osteotomy’

Could the wrong angles cause excessive maltracking problems to such an extent that the a knee realignment surgery of rotational osteotomy is required! PT has not helped my PFS is at a chronic level that it now having a daily impact in my daily activities.

I am not a expert as I am only guessing what could be wrong! I would think an exploratory scope or a lateral release surgery would be a less drastic form of surgery that often not a successful surgery! I will not say anything or suggest to something else. I will leave it to the capable hands of experts to decide what happens next. Why did he say surgeries in his report that could well be a grammar error! It could be for hardware removal if the procedure in the report was to go ahead.

[email protected]
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 Scubagrl4

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1342 on: September 19, 2015, 02:43:21 AM »
It sounds like you have a lot on your mind and a lot of questions. I think you should take those into your appointment with you. But, I'm sure you know that already.  ;)
4/14/14 L ACL rupture, grade 2+ MCL tear
6/6/14 ACLr allograft
9/4/14 MUA
10/6/14 LOA/AIR, synovectomy, lateral/medial retinacular release, partial lateral menisectomy, chondroplasty, deep tissue
biopsies.
11/20/14 insufflation, MUA
10/19/15: LOA/air, PLM, chondro, synovectomy, med/lat releases

Offline kcknee

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1343 on: September 19, 2015, 03:00:33 AM »
 Hi Nick- sorry for not writing sooner, I needed a break from focusing on my own medical problems, so haven't been on KG in awhile.

There is a write-up here on KG, written by Dr. Mark Sanders, that may help you understand more of what your surgeon is recommending and why.

http://www.kneeguru.co.uk/KNEEnotes/articles/general/2014/rotational-deformity-miserable-malalignment

Good luck with your meeting with your surgeon next week. Make sure you understand why he thinks this surgery will help.

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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1344 on: September 19, 2015, 03:59:48 AM »
Hi Nick - completely understand the frustration at the additional delay, but it's actually very good that they're making sure you can see the specialist rather than a registrar or other doctor. I'll keep my fingers crossed that next week's appointment goes 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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1345 on: September 22, 2015, 05:26:51 PM »
22/09/15 14 Months Day 433 Post Op

Thank you all for the good luck messages and advice it really does help having KG helping and supporting each other with our on-going knee problems. I double checked this morning calling the hospital to make sure Prof Snow in tomorrow morning in clinic. He is in clinic and will finally happen and go ahead as previously scheduled.

I was swimming last week Tuesday evening thinking I was going to have my consultation the following day. I was doing breast stroke and felt a slight twinge and thought overstretched my neck muscles and thought nothing of it. It is not my neck it is my left shoulder that is now causing me pain and discomfort and even with high pain meds I still know the pain is there!

I have noticed lately that my joints do click more than usual as I do get clicking in both my shoulder, knees, elbows and ankle. I just feel reluctant to ask to get Prof Snow to take a look at my left shoulder that he also specialized in. I do not want to come across as some hypochondriac as I usually can take pain well.

My left shoulder feels stiff and sore without any pain killers and thought of seeing my private physiotherapist! As I have the chance to see a shoulder specialist as good as Prof Snow he can give me some advice and guidance how to get it right again. I now cannot swim which is annoying as it was the closest I got to running. 

Bad luck comes in three, I bruised my ribs a few weeks ago dismantling a wooden shed and then walked into closed double glazed patio door with a bloody nose and mouth that have both healed up nicely. Now it's my left shoulder! One can only laugh about it, how accident prone I am lately.

A good description of the pain and discomfort is that I feel like The Hunchback of Notre-Dame the stiffness and pain! Of course do not walk like him just feels that way lol.

I will not go through each individual members good luck message. I would like to thank you all for taking up your time to reply to my post-op diary.

Less than 24hrs before I finally know where I am standing.

[email protected]
« Last Edit: September 22, 2015, 05:46:31 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 Vickster

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1346 on: September 22, 2015, 05:49:14 PM »
Good luck for tomorrow Nick

Regarding the shoulder, if it doesn't improve with a week or two's  more rest and gentle stretching, go see the physio. It's likely just a little twinge from the swimming motion. Presuming you can reach up and backwards, forwards and to the side ok even if it is a little sore. :)
A heat pack, a hot shower or lying in a warm-hot bath can be really helpful for neck and shoulder twinges too

Professor Snow won't have shoulder expertise, so best to concentrate on your knee in the appointment, understanding what surgery he is considering, especially the benefits and risks, the post op period such as length of time on crutches etc, and the rehabilitation from the surgery
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline lucha86

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1347 on: September 22, 2015, 09:46:47 PM »
hey nick good luck for tomorrow, remember the most important thing is for you to concentrate on what he tells you what he wants to do, and dont walk out of the consult room untill every question =)
even if surgeons use the hmmm technique ask for an answers, dont accept nothing else =)

it certainly happens in 3's but remember things can only get better now since the three things have happened...

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1348 on: September 23, 2015, 04:58:05 PM »
23/09/15 14 Months Day 434 Post Op

My on-going right knee saga continues on and now I am totally confused and getting stressed out as this morning consultation went pear shaped! I arrived in good time for my consultation and tried  to electronically book myself and said on the screen that I am not booked in today for a consultation. I then reported it to the receptionist and looked on the list patients for the day and told me I was am not booked into clinic this morning.

I am not daft or stupid as the person I spoke to last week Wednesday that postponed my appointment said 23rd September @11:15. I was booked in in the end after the lady at the desk made a few phone calls and was then booked into see Prof Snow. I then find out his clinic is 50 minutes behind schedule that added to an already stressful scenario.

Then a nurse comes to the reception waiting area admitting they have double booked patients at the same time which is why there a long delay! Overbooking is what she was basically saying. I should not have been there theoretically.

1 hour and 15 minutes later @12:30 I am finally called in to see Prof Snow and his Registrar. After he went through my MRI and CT scans he told me he cannot really find any specific problems with my right knee? Now he wants to do an ultrasound around the patella tendon region and then a cortisone injection might be considered if they feel it will be beneficial.

It could be just a bad case of patella tendonitis or runner knee! I am not that convinced as I have already been given a cortisone injection at the bottom of my right knee close to the patella tendon region over 3 months ago. The injection has eased some of the pain slightly but can still feel something is not right at the bottom of my kneecap.

I am not making the knee pain up in my head it is real or why am I limping around and feeling intense pain at the bottom or my kneecap as soon as I try to walk a quicker pace and kneel and squat. There is some slight swelling at the bottom of my right kneecap compared to my left that inflames even more after gardening and walking long distances.

I felt Prof Snow was under time pressure which was not his fault if his clinic was double booked with patients so only saw him for 5 minutes. It was the registrar that did that mainly dealt with me. What both of them never mentioned was the possible ‘rotational osteotomy’ just the last surgery to remove the bone oedema.


Why even mention doing a ‘rotational osteotomy’ to me if my knee alignment looks ok? The registrar when he was filling out the forms for CT Ultra sound said it a borderline case that my knee alignment is ok or not!

I have been pre-booked to come back to clinic in 3 month time for CT Ultrasound and to see if the cortisone injection has worked or not. I Googled 'runners knee', I have already had a cortisone injection and done PT and stretching exercises that is not making much difference just less tightness with the knee pain remaining at the same level.

I am going to be honest I am not at all happy with the conservative approach at this stage as I have had on-going knee problems for 12 years and know my right knee best. Before my 1st scope in November 2009. Back then my OS at the time was also reluctant to go ahead and do an exploratory arthroscopy and pre warned me if I am happy for him to go ahead with the surgery. Once he was inside found spotted an inflamed medial plica and fat pad!

I am limping around and feeling more knee pain now then I was prior to post-op #1 & #2 and was unsure about having a ‘rotational osteotomy’ done but did think at this stage Prof Snow would see that the next option left is to do an exploratory arthroscopy. I do know soft tissue injuries and AF is hard to pick up on an MRI scan clearly. Also when I had my last MRI scan a week later I felt my right knee give out going down a steep undulation! Sine then the bottom of my right knee has been more painful.

I arrive back home after my consultation and find a letter from the hospital that comes around midday where I live. I was booked for Wednesday 14th October @11:45 to see Prof Snow! What should I do now cancel the appointment or still go and see him and tell him my concerns and if he would be willing to go ahead and do an 'exploratory arthroscopy' that I am happy to risk and give my consent! Or do as he advised me to do and if my right knee still not improved in 3 months then I can insist that I want something done to sort out my on-going right knee problems.

I apologise in advance for having such a negative post I am frustrated right now over the whole right knee saga, that is never seems to come to a conclusion! I am not imaging the knee pain, it is real and just grumpy after a stressful morning.

[email protected]chSpaUK
« Last Edit: September 24, 2015, 04:44:42 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 Scubagrl4

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1349 on: September 24, 2015, 02:01:48 AM »
I am really sorry that you had such a crappy appointment. I don't think the doctors understand what it's like to sit around and wait without being able to even walk like a normal person. Ugh.
As far as your "extra" appointment, maybe hang on to it for now and make a decision when you get closer to the date. You could always go into that appointment and explain that you didn't feel you had time for him to address all of your questions and concerns.
I'm just thinking that 3 months is a long time from now. Maybe you can at least speed up the ordering of the ultrasound so you can jump through all of the hoops he wants you to a little faster. Doing nothing but waiting longer just doesn't make much sense.
Thanks for replying to my last post by the way. It's always good to know we aren't alone in this.
Stay strong Nick!
4/14/14 L ACL rupture, grade 2+ MCL tear
6/6/14 ACLr allograft
9/4/14 MUA
10/6/14 LOA/AIR, synovectomy, lateral/medial retinacular release, partial lateral menisectomy, chondroplasty, deep tissue
biopsies.
11/20/14 insufflation, MUA
10/19/15: LOA/air, PLM, chondro, synovectomy, med/lat releases















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