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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282456 times)

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Offline Clarkey

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21/10/15 15 Months Day 462 Post Op

Less than 24hrs until my US to see how my patella tendon is doing and hope it does not require a cortisone shot as I am just concerned and weary that it might weaken my patella so much that it is more at risk of rupturing! This is not something I want to experience.

The letter from the hospital says not to drive to and from the hospital and to get a lift there and back which I never had to do on my previous cortisone injections. I googled ‘can you driver straight after a cortisone shot’? You can drive after the injection as long as you can do an emergency stop safely.

My mum and sister are flying out to Germany tomorrow for a funeral of my Cousin son who committed suicide recently at the age of just 31, his funeral is on Saturday. The flight is in the late afternoon and it would be a lot of hassle to take me to the hospital and then take me back home again.

Maybe they are being too cautious and overprotective to cover themselves fully! I can understand that I will need to take it easy for the rest of the day by not doing anything too strenuous that would agitate my knee. I cannot see it being a problem if I drive to and from the hospital, I might not even have the cortisone injection.   

The link below has the following information that confirms my fears towards having a cortisone injection around the patella tendon!

http://www.mayoclinic.org/diseases-conditions/patellar-tendinitis/basics/treatment/con-20024441

Corticosteroid injection.

An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain. But these types of drugs can also weaken tendons and make them more likely to rupture

Lucha, thanks for the link about having an MRI scan done standing up that does make sense. I was asked by Prof Snow does my knee hurt at night when lying down and said it fine pain wise until I put weight and pressure onto my knee when standing, walking and trying to kneel and squat is very painful so avoid it if possible. 

It is the cost that the hindrance as I can travel to London ok as my brother and his family live in Staines Upon Thames so easy to reach London from there by train and tube.

I can see Prof Snow more cautious approach before scoping my knee as it would be more reassuring knowing pre-op what I am dealing with and what to expect after the surgery. It would be fantastic if my next MRI scan came back positive that can take a while on the NHS.

Another option saving time is paying for an MRI scan private? I then have to decide if I should go for the traditional MRI scan of lying down or the latest MRI scanning technology of standing upright so you are fully weight bearing . For anterior front knee pain and PFS a weigh bearing knee injury than the link you gave me of the MRI scan standing up sounds more logical that's likely to come back positive.

Scubagrl4, I hope your post-op recovery period goes smoothly this time round as it is not a nice feeling not knowing if more surgery might be required in the future again! My knee is not too overly swollen just can see that the bottom of the knee not at all happy with swelling concentrated in that specific area only.

I think fluid in the knee is a natural way of protecting the knee from getting more extensive damage, I might know after ultra sound therapy tomorrow the reason for having fluid inside the knee.

[email protected]
« Last Edit: October 22, 2015, 12:13:01 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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Considering you have had laying down mris which haven't shown things and the pain is more weight bearing maybe the standing up ct would show the pressure points more so what about speaking to the Secretary to see if you can get that scan on nhs if not when I looked into it it was 600 pound...
Your doctor maybe just wants to check everything before he looks St the knee so he knows what he is dealing with..

Offline Clarkey

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22/10/15 15 Months Day 463 Post Op

Went to the hospital this morning for my ultra sound guided cortisone injection that was done in the injection suite that was not very clearly signposted. Ended up on the other side of the hospital! At least I still managed to make it in good time for my 10am appointment.

There were two Doctors looking at my ultrasound around the patella tendon, it did not take them long to spot the fluid that came up black near to the patella tendon. It confirmed that I have patella tendonitis and hopefully the cortisone injection will improve my chronic knee pain?

It was not a pleasant experience to go through as it was painful when he injected around the fluid with local anaesthetic twice before finally giving the important cortisone shot through the syringe. I could see the needle stick out on the lateral side of my right knee at the bottom between each shot!

The Doctor asked me do I have someone with me and said no as my mum is going to a funeral so have no transport so have no option but to drive. He said rest for 45 minutes to 1 hour before driving again.

I had a cappuccino at the hospital café for an hour and surfed the internet on my iPhone to pass the time. It still feels tender and sore which is not at all surprising if a needle is stuck directly into the fluid.

I had a cappuccino at the hospital café for an hour and surfed the internet on my iPhone to pass the time. It still feels tender and sore which is not at all surprising if a needle is stuck directly into the fluid. I have been told to take it easy for the rest of the day at home. I will catch up on some course work.

Shall I take painkillers this evening and ibuprofen before going to bed! Where the needle was inserted it has become more swollen around the lateral side of my knee!  This should help reduce the swelling maybe RICE technique might be wise as well?

[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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I would say at least yes to ibuprofen and ice. That should help reduce the irritation from the trauma of the injection. Cortisone shots can be quite helpful for tendinitis. Sometimes it just needs to reset after being irritated for so long. If you still have pain, I think it would be acceptable to take a pain med.
It would be really great if this took care of your issues. The key is to rest....if you piss it off again too quickly, it will just start the inflammatory process over again. So, be lazy this weekend! Lay around, read, ice, elevate...it should pay off.
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 Clarkey

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23/10/15 15 Months Day 464 Post Op

I know it's still very early to say if the cortisone injection has helped or not? 24hrs after the cortisone shot I feel I am worse off than I was before the injection. I am now walking with an even bigger limp that I have become more self-conscious about.

It is good to know that Prof Snow was right about the patella tendinitis that I do not feel is the main pain factor and discomfort. I am still feeling the same sort off pain and discomfort around the tibia and bottom of my kneecap, that's now becoming extremely frustrating. Every procedure that has been done so far on my right knee ends up making my chronic knee condition even worse!

I have elevated and iced my knee a few time by rested it most of the time, I have taken 1 Naprosyn tablet last night before going to bed. I slept ok until 4am waking up in pain around where the injection spot, I tried not to take any painkillers until 4:40am as it would have kept me awake. I took one codamol tablets that thankfully stopped the pain and was able to sleep again at 5:30am. I know this is normal after the trauma my right knee had to endure 24hrs ago. Hopefully it will settle down over the weekend with the pain not keeping me awake again.

I cannot see PT having any positive impact, it is going to be a long wait until Wednesday 30th December to see if the injection has helped or not when I am booked in next to see Prof Snow. I know my knee best of all, I have never experienced the crippling pain I am now facing on a daily bases making it a challenge and an ordeal to walk now! Running again is no longer a realistic target to achieve.

Lucha. I fully agree with you that it does sound like a wise decision to go for the standing up MRI scan as PFS and anterior knee pain is closely linked to weight bearing of the knee and the pressure points. I am going to wait until Monday morning before contacting Prof Snow Secretary about having an upright MRI scan, as long as it ok with Prof Snow authorisation. I know it a lot of money that will be worth it if it comes back with positive MRI scan result.

My only reservations if I spend only £225 on a standard lying down MRI scan at The Worcestershire Imaging Centre that in the same town I live in. I am not saying your idea is not a good idea it just the cost at £600 plus. I very much doubt that the NHS will give the funding as they have to save money.

http://www.wicmri.com/

However there is one upright MRI Centre close to where I live not far from my mum's previous house when we both lived in Birmingham until June 2015. I know the road and area where the centre is based.

http://www.uprightmri.co.uk/centres/birmingham/

The above link makes more common sense that costs a lot more money that is worth every single penny if it comes back with a positive MRI scan result this time round.

Scubagrl4, I wish I could be more positive about the cortisone shot that I know is not the main cause of the knee pain right now! I think it just one out of a few problems as the fluid was not present before I was booked in for my US guided cortisone injection yesterday morning.

I do not like taking meds and injections to mask the knee pain, this is not going to solve and fix my knee problem. At this stage I cannot see why a diagnostic arthroscopy has not yet been considered, it would save a lot of time and money for the NHS. Prof Snow looked surprised and concerned seeing how much I limp now during Tuesday's consultation.

What I feared has happened I was not taken too seriously thanks to April's negative MRI result! Since then my right knee deteriorated to a point that I can no longer really walk and feel it is more than just runners knee that I am dealing with. It impacting my left knee now causing daily pain as it is trying to compensate for my bad right knee. 

Sorry to always come across in a negative tone it is hard not to if you have a never ending knee problem that many KG members fully know too well from you’re never ending knee sagas!

[email protected]
« Last Edit: October 26, 2015, 04:04:32 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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29/10/15 15 Months Day 470 Post Op

One week since my cortisone injection, I have found it has not to be beneficial in any way with my right knee remaining the same. I did have a long chat with my sister who is a nurse in orthopaedics, she advised me not to get in contact straight way to Prof Snow secretary as I need to have shown him that I given the injection time to work.

My long term plan for now is to contact Prof Snow secretary on Monday morning 2nd November asking for at least an MRI scan of my right knee before the end of the year. I mentioned to my sister about the upright MRI scan? She said save your money and have a standard MRI done on the NHS if it is possible before I next see Prof Snow on the NHS on Wednesday 30th December. 

I realised that I have had 4 cortisone injections into my right knee and not 3! I have been told the more injections you have there is a higher chance you might trigger off osteoporosis of the knee. It not looking too good as I am still limping around and have had to cut down on walking longer distances I pay the price. My right knee bruised up yesterday as I did too much walking in Worcester Town Centre yesterday.

Another option to speed things up as I know that Prof Snow married so is likely to have kids so it is certain he will not be not in clinic over the festive season. I am happy to pay for a private MRI scan at the cost of £225 as £600 is a lot of money if you living on your life savings! I know a follow up appointment costs around £110 privately, I would still be spending less than £600.

Lucha, Thanks for the information, if I was working I would be happy to pay £600 for a standing up MRI scan, I am confident this time round that a standard MRI scan will come back positive. The last time I had fluid in my knee I had bone oedema coming up on my MRI scan pre-op to scope #2 in July 2014 of AIR surgery.

If it comes back negative again I will insist that I would like to give my consent and permission to have a diagnostic arthroscopy in the early part of 2016. It would be nice to finally know what I am dealing with! My sister thinks my right knee is now a chronic rather than acute, maybe running long distances is history.

[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 lucha86

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Hey nick
Hope your doing ok like I said before keep taking photos when your knee is bad and show him those when you see him next.........
Also regarding the mri that's a good way to go see what the standard one come back with and go from there but remember I suppose what my physio says less is more and it's rather true..... :))
I hope you get everything sorted :)))))

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1372 on: November 16, 2015, 03:36:35 PM »
16/11/15 15 Months Day 488 Post Op

Today marks my 6th anniversary of my scope#1 on my right knee when I had my medial plica removed and fat pad trimmed. In two days on Wednesday 18th November 2015 will mark 16 months post op after scope#2 when I had AIR surgery.

I am finally making some progress and been booked in for my 2nd MRI scan this year on Tuesday 1st December @18:05 at a mobile MRI scanner at the same hospital I had my two previous right knee surgeries. Prof Snow has been very understanding. He did not want to see me out of pocket which is why he has booked me in for another MRI scan on the NHS.

The cortisone injection has only numbed the pain slightly but has not stopped the sudden sharp spurts of pain when I more physically active when gardening or walking for longer time periods.

I also have emailed the hospital as I was unsure if they had booked me in or not for Wednesday 30th December as I saw Prof Snow privately after cancelling my earlier NHS appointment with him as well as not booking me into clinic on my last visit on the NHS.

I received an email back confirming I am booked at 08:30 on Wednesday 30th December in clinic with Prof Snow or a member of his team. I might sound odd and crazy, I am hoping for a positive MRI scan this time round so I finally know what is causing all the pain and discomfort.

The best way to deal with it is to think to myself the worst case scenario that once again the MRI scan is negative. I do however have a gut feeling that this time round something will show up on the MRI! The pain is real, it is not easing in anyway, I want something done about it. It has gone on for too long.

I will post my lastest consultation report on Wednesday with further information on how my right knee is right now.

Lucha,
I fully agree with you that showing any photos and videos when my right knee is at it's worst to Prof Snow and any other OS's is good concrete proof that the knee is not right that requires further investigation.

[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 #1373 on: November 17, 2015, 03:24:06 AM »
December isn't too far away from now. I really hope that MRI will show the source of your pain. I hope that if it is negative, professor Snow's diagnostic skills will be enough to get an idea of what is wrong.
Wishing you the best of luck!
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 Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1374 on: November 18, 2015, 10:40:13 AM »
18/11/15 16 Months Day 490 Post Op

Here is my latest report after my last consultation on October 20th. At least this time something new has been spotted with grade 1 effusion that was not present previously!

Dear Dr ***

Diagnoses: Anterior knee pain ? patella tendonitis.

Nicholas returned to clinic today earlier than planned because he has an increase in his symptoms. He has anterior knee pain which is in the area of the patella tendon of insidious onset with no history of trauma. This has present over the last 6 weeks and is worse going up and down hill. He is struggling to kneel, but the pain does not wake him up in bed at night. He has significant pain walking around during the day and particularly on long distances. He has had no locking or instability.

Clinically today Nicholas walked with a stiff knee gait and there was a grade 1 effusion.
There was tenderness over the patella tendon proximally at its insertion into the patella. There was no joint line tenderness. Otherwise knee examination was unremarkable. He still has slight hamstring tightness with evidence of a fixed flexion contracture at the hip.

Nicholas has an ultrasound scan booked at the Royal Orthopaedic Hospital in 2 days’ time with a potential injection if it is a positive for patella tendonitis. I will check the scan result on Friday. If it is positive then we will need to re-organise him physiotherapy alternatively if it is negative I think we will repeat his MRI scan given the presence of an effusion today. He has an appointment booked at the ROH and I will see him then.

Yours sincerely

Prof Martyn Snow.


Scubagrl4, You are right that December is not too far away now, by the end of 2015 I will hopefully finally know what is causing the pain and discomfort in my right knee. If the MRI is once again negative I will stand my ground asking for a diagnostic arthroscopy. This might well be the next option that Prof Snow has in mind as no change after PT, injections 16 months post op.

Pain is more manageable for now that's only being numbed by the cortisone. I can still feel the same type of pain as it was before my cortisone shot. Still not walking very well, limping around, I now want something to happen. 2016 will not be the greatest start if surgery is scheduled? I have been preparing for it for some time now so will not be a shock or surprise for me to endure.

[email protected]
« Last Edit: November 23, 2015, 04:24:58 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 #1375 on: November 19, 2015, 10:52:22 PM »
hey nick =)
its good to see your doctor has mentioned the effusion, but not long now till the 30th of october like i said the more pictures you have and take and give to him when your knee is at its worst it cannot be argued and it is their in plain for them to see.....

goo to see the pain is more manageable nick keep us posted i hope all is well =)

Offline Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1376 on: November 28, 2015, 03:30:05 PM »
28/11/15 16 Months Day 500 Post Op

Time has flown reaching 500 days since my AIR surgery on July 18th 2014. As I mentioned in my last post as expected that the cortisone injection on October 22nd has helped to reduce some of the chronic knee pain making it more manageable when walking at a slower pace.

Only 3 more days until I have my 2nd MRI scan of 2015, I hope this time round it comes back positive rather than negative as the previous MRI scan was back in May 2015. The pain is still around the bottom of the knee near to the tibia that came up clearly on the last ultrasound I had that showed that there is some fluid in my right knee.

This is what Prof Snow spotted on my last consultation grade one effusion! Something not right or would not be limping around in pain and discomfort. I hope something can be done about it as it been going on for some time now and have not made any progress yet.

My private PT I used for many year who is now living abroad pointed out that I would benefit from custom made orthotics. He pointed out there wear on my trainers around the back of the heal, I can see what his point of view. I have worn out the back tread of my three trainers this year and do not do too much walking. 

It is something to do with gait and being slightly bowed legged as I have maltracking problems in both knees. My last pair of trainers were Adidas of a good quality but has worn out so far that there is a hole on the edge of the back tread/sole by the ankle and heal. I have only worn them for 4 months and have already had to replace them.

I read this is a common problem excessive wear on the treads of trainers if you are flat footed or knee have maltracking problems. Going through 3 pairs of trainers a year is unusual and expensive. It might be something to do with the way my right knee is tracking as I hear clunking/popping at the bottom of my right knee rather than a clicking sound.

I am still doing 20 one legged mini wall squats and leg raises in the morning and can hear a loud clunk/pop when squatting that happens once and then does not clunk/pop for the remainder of the wall squats. I also do 30 sets leg calf raises to loosen the tightness. The PT is helping as the tightness is less now but the pain and discomfort remains the same.   

When I saw the registrar at the hospital he suggested doing an osteotomy, during the examination of my knee he twisted my right knee at a certain angle and could pin point the exact pain where I am feel the clunking inside the bottom of my right knee. This is still an option that could still go ahead but as the last resort as Prof Snow would rather avoid doing an osteotomy if it possible to do another procedure less invasive.

Lucha, I think you got the month mixed up it on December 30th when I have my next consultation and not October 30th! That would be a long wait and it easily done making errors that often happens to me. It is a good thing the effusion showing up as it now confirms why I am limping around with limitation with my right knee. I hope the MRI scan result are positive as I would then would not need to show any proof that I have issues with my right knee. It is true that photos and videos are concrete clear evidence of a knee problem.

[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 #1377 on: December 01, 2015, 03:34:38 AM »
I hope your MRI goes well tomorrow.  :)
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 Clarkey

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1378 on: December 02, 2015, 02:20:34 PM »
02/12/15 16 Months Day 504 Post Op

Today I received a letter in the post from the hospital saying my appointment has been cancelled on 30th December and rescheduled for Wednesday 16th March 2016! It the last thing I needed on my Birthday to have such a long wait for the results of my MRI scan that was done yesterday.

I have got use to delays over the years so I went to over to the receptionist at the BMI Droitwich Spa Hospital that know me too well now with so many setbacks to book me in for another private consultation. In the end things have turned out better than I was expecting after the receptionist spoke to Prof Snow Secretary he will give me personal phone call with my MRI scan results.

It is rather poor if you scheduled appointment has been delayed by nearly 3 months if you been booked in September you should have priority as I am sure there must be some free spaces or cancellations. At least they been on to it straight away and sorted out the problem.

It is not doing my stress and anxiety levels any favours as this is not the 1st fiasco I have to endure as it seems to be a regular occurrence on the NHS that patients are led up the garden path with appointments being extended or even forgotten or double booked or not booked in at all as I experienced during my last NHS consultation.

If my MRI is positive and surgery is required would I have to see Prof Snow to be pre-booked in or require a signature from me to give my consent! Or can he do it over the phone as it been going on for a while now! I would like to come to a conclusion at this point post op to scope #2.

Scubagrl4, Thanks for wishing me good luck for yesterdays MRI scan that was funny as I was going out with my friends for a curry after the MRI scan. Four friends turned up at the MRI unit, when I confirmed my date of birth 02/12/78 told the receptionist they are here with me to celebrate my birthday after my MRI by going out for an Indian meal.

I hope my MRI scan shows up a problem this time round so I finally know what I am dealing with and what will be the next option. It is becoming very stressful when I had a date in mind and then it is cancelled and re-scheduled at a much later date!

[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

Online Vickster

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1379 on: December 02, 2015, 02:38:34 PM »
That's a shame. Unfortunately the doctors strike that never happened yesterday has messed up all the scheduling. My mum had an appointment pushed into the new year too

Make an appointment with the GP to get the MRI results perhaps?

I'm curious from previous posts as to why you are convinced the steroid won't relieve the patella tendinitis, you just need to be careful now it's settled not to overdo it and get another flare up
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