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Author Topic: Nick's FatPadTrim, Medial plica/Distal patella excision, AIR x2, LMR 3in1 Diary  (Read 282723 times)

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Offline Clarkey

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27/01/16 18 Months Day 560 Post Op

Kristin thanks for the links and advice after reading what Vicky advised me what best to do next. I agree with you that it is always good not to go straight for surgical intervention until all conservative and less drastic options have failed!

I did up to the start of December go swimming 3 times a week, I did less swimming during the festive period and have only been twice this year after catching a bad cold and chest injection. Breaststroke is the closest thing to running with a good cardiovascular workout.

I have been diagnosed officially with Asperger’s, I may also have ADD/ADHD undiagnosed as I cannot keep still for very long without becoming very restless! I also dealing with a personal issue right now that putting a big strain on my anxiety and stress levels. I am told not to walk long distances, not to do too much swimming that helps me to calm down when stressed out. Long walks and swimming is a good relaxation technique for me.

When use to go to the gym regular one lady member could run and use all the machines ok me she has knee pain and will be having surgery to try and reduce or stop the knee pain! I cannot run or walk at a steady pace and told to carry on doing physiotherapy. Other that are more mobile than me are allowed surgical treatment to try and sort out their knee problems. 

Other members on KG after AIR surgery had proper aftercare to stop the excess bleeding inside the knee with icing and CPM machine that was not an option after my last scope on the NHS! It is very rare that you can get away without excessive scarring after AIR surgery if you do not follow the AF guidelines post-op that Dr Noyes has recommended who's a well known and respected OS.

The Arthrofibrosis Foundation only has one AF specialist in the UK who is Mr Glyn Evans at the London Knee Clinic

Particular Expertise: Arthroscopic Surgery, ACL reconstruction, Total knee replacement, Partial knee replacement, Plica  syndrome, Tibial tubercle transfer, Arthrofibrosis

http://arthrofibrosis.com/practitioners/

http://www.kneeguru.co.uk/KNEEnotes/specialists/knee-surgeon/dr-mr-glyn-evans

He specialises in Arthrofibrosis and Plica syndrome as well as fat pad problems that I endured over the year with my right knee problems. Only problem he is not on the NHS, only private treatment, I need my savings for other things right now.

Maybe it is best to stick with Prof Snow, should I be honest with him raising my concerns when I see him on 16/03/16. I do not want to come across as if I know it all as he the expert at the end of the day.

I have seen on The Arthrofibrosis Foundation website a physiotherapist that based where I live in the Worcestershire Spa Town of Droitwich ‘Mrs Lesley Hall, Droitwich, UK'. I could ask if I can see her for advise and PT before I my next consultation  on 16th March.

http://arthrofibrosis.com/practitioners/

http://www.kneeclinics.co.uk/page/Lesley+Hall/51/#.Vqj4Erdya70

I am sure she will do a full analysis and report for Prof Snow that will look better coming from her then myself trying to tell him I want something else done at this stage rather than shots of cortisone that will weaken my articulate cartilage.

Sorry if I came across negative or aggressive in any sort of way, it seems to be dragging out, never coming to a positive outcome.

[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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Is there a counselor that understands Aspergers and ADHD that you can meet with to discuss your stress levels and to help you to find alternate ways to manage stress in your life besides running, walking long distances, swimming breaststroke or other activities that are physically demanding on your knees? Maybe limiting certain harmful activities may help you avoid surgery and enjoy your life with other more knee-friendly activities.

Surgery is not a magical reset button to a pre injury knee. You would need to be able to limit your activities for months after any future surgery (maybe longer, but just going with what surgeon told you last time) to give your knee a chance to recover. Many experienced arthrofibrosis surgeons do not give a CPM or ice machine after surgery for scar tissue, but all of them ask their patients to limit their activities. The patient is as responsible for success as the surgeon. (unfortunately there are times despite best efforts from both that success is not possible.)  If your surgeon was to do a major realignment surgery on your leg, that would mean many weeks not even putting any weight on your leg. That is not easy for anyone to do, I am up to 7 weeks now and am extremely bored and restless. Before any future surgery, you should meet with a counselor and come up with a plan to handle stress and end up with the healthiest knee you can.
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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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1397 on: February 10, 2016, 05:02:08 PM »
10/02/16 18 Months Day 574 Post Op

I have been to see a new private physiotherapist this morning that has been recommended on the Arthrofibrosis Foundation list of physiotherapist. She was very precise and good with my initial assessment giving me some good advice that you guys have already mentioned to me previously.

My PT I am doing so far is working well, when I squat my kneecaps no longer go inwards as they did previously, she’s also happy with my muscle balance. What she did manage to spot straight away was problems with my fat pad that sore and tender to touch that she clearly pointed out to me. She did 5 minutes of ultrasound therapy and has tapped my kneecap. Less pressure is exerted onto the fat pad. She told me to see how it goes the next couple of days and to cover the tapping with cellophane when showering.

Kristin you are spot on with your advice and guidance not to overdo things too much! Less walking longer distances slowly increasing the distance as long as the knee does not become too painful. Breaststrokes should be reduced, I could see how it goes cycling at the gym. The only concern I have is that cycling is also bad for the knee if you are going up a steep gradient.

My Aspie friend depressed with his left knee injury saying even cycling is too much for his knee. With the way my knee is I would not risk it! I suggested he see my OS for a 2nd opinion. I know he will do all he can none invasively 1st to try and sort out his knee pain and discomfort.

Paragraph of my latest MRI scan that was done in December 2015.

The MRI showed change of signal of the fat pad underneath the patella. Otherwise there were no pathological findings on it. On further evaluation of the MRI one may appreciate a slightly bigger distal pole of the patella with a bone spur which may be affecting the fat pad, however the signal of the tendon is normal. In addition Professor Snow was a little concerned about developing of patella Baja after surgery.

'Slightly bigger distal pole of the patella with a bone spur'!
Has anyone else had this come up on their MRI scan, that could explain the clunking sensation, anterior knee pain and maltracking problems?

She also mentioned the bone spur might be catching along the fat pad! It might well be scar tissue causing it that cannot be ruled out yet. Five weeks till I see Prof Snow again, I will mention to him that I no longer want any more cortisone injections and very much hindered daily as my walking pace has slowed right down.

MRI scan shows fat pad and patella tendon inflammation and spurs!

I have been doing PT and stretching exercises for a while now without seeing any benefits, the 3 cortisone injections have not made much difference that could potentially cause articulate cartilage deterioration!

PRP injections has been suggested! If you goggle it will see plenty of web links that highlight that PRP injections are beneficial for patients with patella tendonitis. However there are other links that say to stay away from it altogether!

Mr Charles Willis-Owen a UK based OS located south of London has done extensive research on PRP injections for inflammation of the patella tendon saying the following quote.

PRP (platelet-rich-plasma) injections have been shown in large metastudies to be of no benefit for patellar tendinitis.

http://www.kneeguru.co.uk/KNEEnotes/specialists/knee-surgeon/dr-mr-charles-willis-owen

There are other way to try and resolve patella tendonitis by trying out all the conservative methods of treatment.

1.   Physiotherapy
2.   Cortisone injections
3.   PRP Injection (does not work)
4.   Extracorporeal shock wave therapy (ESWT)
5.   Surgery

Link below is NHS based that mentions ESWT so assuming it is available that I could possibly try out before resorting to surgical intervention.

http://www.nhs.uk/Conditions/Tendonitis/Pages/Treatment.aspx

Surgery

Surgery may be an option for some tendon injuries, but this is often only considered as a last resort because it's not always effective and carries a risk of complications such as wound infections, scarring and rupturing of the affected tendon.

Surgery can be used to:

•remove the damaged section of tendon

•remove lumps or deposits that have formed on the tendon

•encourage the tendon to heal

•repair ruptured tendons

Has anyone been through Extracorporeal shock wave therapy (ESWT). Was it a success or failure, that can be done on the NHS, that's a cheaper and safer option to be going for before considering surgery.

I did mention to my PT if I should try ESWT? She said to mention it to Prof Snow that might not be beneficial for my on-going right knee problems.

It has now reached the crucial stage of making a decision if surgery is worth risking at this stage of PT, cortisone injections have failed! It is good to play it safe by taking a conservative approach before going under the knife again. All other options have been exhausted! Sound like there is bone rubbing against the fat pad and scarring that's causing all the problems!

I am glad that I saw a PT today she has been very helpful just like Kristin who was right all along not to overdo it too much! Easier said than done.

[email protected]
« Last Edit: March 07, 2016, 11:36:10 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 #1398 on: February 12, 2016, 02:53:11 AM »
I'm so glad you have found a PT that you seem to be connecting with. It sounds like she is open to try anything to help you get your knee back. I think that is a great step in the right direction. I know this has been frustrating, but am so impressed with your ability to keep trying for options.
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 #1399 on: February 18, 2016, 11:50:06 AM »
18/02/16 19 Months Day 582 Post Op

Already 19 months post-op and no better off than I as pre-op to scope#2, I would say my right knee feels worse with pain, discomfort and instability then any of the two previous scopes. The report was done by the Registrar on 23/12/15, seen him each time I attend the clinic.

Mr Clarke returns to clinic with flare up of his right knee. I reviewed him today in the presence of Professor Snow. He was doing very well after the previous surgery until a couple of weeks ago when he started to experience more anterior knee pain during physiotherapy. He could not return to running.

Had to re-correct the red highlighted lettering as I have never really seen improvements since the surgery and have never done really well! I will point this mistake out when I next attend clinic.
 
On examination he has full range of motion, no knee effusion. He points out pain in the patella region.

The MRI showed change of signal of the fat pad underneath the patella. Otherwise there were no pathological findings on it. On further evaluation of the MRI one may appreciate a slightly bigger distal pole of the patella with a bone spur which may be affecting the fat pad; however the signal of the tendon is normal. In addition Professor Snow was a little concerned about developing of patella Baja after surgery.

Professor Snow explained all the problems and symptoms to Mr Clarke. There is not much we can address surgically at this point as Mr Clarke’s rotational CT showed normal alignment and the MRI scan did not show an obvious pathology. Therefore Professor Snow injected Mr Clarke’s right knee with Kenolog and Marcaine and hopefully this will give him pain relief. We will see Mr Clarke back in clinic in 3 months’ time.

Yours sincerely, 

Mr  *** ****

Senior Clinical Fellow to Professor M Snow


Have already explained in my last post what I think should happen next when I am next in clinic on Wednesday morning March 16th. It is now hindering me on my daily lifestyle, being restricted in what I can and cannot do! With spring around the corner with longer warmer days will become agitated if I cannot go for regular long distance walks etc.

I will decline a 4th cortisone injection that I doubt will be offered to me again! It is obvious now that it’s not really working and of great benefit in resolving the knee pain and discomfort. Extracorporeal shock wave therapy (ESWT) is another none invasive treatment, it’s a cheaper/safer option to go for? It might not work, the last option would be surgery! I doubt rest will solve the patella tendonitis that now looks more chronic rather than an acute condition. 

Scuba, I am glad to find an understanding PT that knows how to go about getting my knee right again unlike the one I saw shortly after pre-op. He made me do too much PT; this made my right knee even worse! I am now paying the price for it!

[email protected]
« Last Edit: March 01, 2016, 04:54:04 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 MyKnee2010

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1400 on: February 19, 2016, 12:13:00 PM »
Did they mention anything about the bone spur, that maybe that should be removed? Just thinking, it seems that could be aggravating things inside there causing your pain.

Offline Vickster

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Re: Nick's RK Medial plica excision/fat pad op#1 Anterior interval release op#2
« Reply #1401 on: February 19, 2016, 02:50:21 PM »
That's a very good point. I have a 9mm spur on the back of my fibula which is causing untold irritation to the surrounding tissues. It's a risky procedure to remove due to a big nerve in the area but I will give it serious consideration later in the year

Definitely worth asking Prof Snow especially if you do go down the scope route (I would need open surgery on mine so the nerve can be seen and moved)
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 Clarkey

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07/03/16 19 Months Day 600 Post Op

Thanks for the responses with regards to the bone spur, I think it could be the culprit to the knee pain I am experiencing right now. The pain is around the fat pad region and it the area that is sore and delicate as soon as I try to exert any pressure feel intense pain! 

My PT that I am currently seeing on a weekly basis has got me using an anti-gravity treadimill machine that puts minimum pressure onto the knees. It a bizarre experience to go through as you are lifted slightly of your heels. I did a brisk walking pace for 10 minutes that felt ok apart from at the back of the calf muscles.

She advised me to try and push through the pain and discomfort as there not too much swelling so thinks my knee problem is not an internal knee problem. I did try push my knee to it limits finding each large stride extremely painful at the bottom of my knee.

Afterwards I was in pain and discomfort for a couple of days along the edge of the shinbone where the bone meets the muscles. Painful around the tibia and fat pad that sore and tender to touch and feel it not a good move to make me push past the pain barrier. 

It's very confusing for me, some are telling me listen to your knee pain and if it hurts to stop or slow down. Other are telling me to push through the pain and then end up suffering the consequences of my actions. In a way it frustrates me that my knee is not more swollen. I then wouldn't be pursuaded to push through the pain tollerance level.

I have had knee problems for a while now, each time pre-op my right knee has minimal swelling with signs of fluid in the knee. The pain now is more intense, I am physically unable to walk at a quicker pace, running is out of the question. I do get frustrated when PT's make you do too much that only aggravates the knee even more. At this point in time at almost 20 months post-op, something needs to be done.

I have plenty of questions to ask during my next consultation on Wednesday 16th March in 9 days time. I hope that something is suggested, I refuse to have a 4th cortisone injection! I have read about bone spurs in the knee that could be a piece of loose cartilage or arthritis! My fat pad & patella tendon could be restricted by the bone spur, causing rubbing together as the bone growth could be causing the pain and discomfort that I am clearly feeling.

Might be offered a job position at autism young peoples group I help out at as a playworker in September, ideally I would like to have a more mobile right knee that's less restrictive. I cannot keep on waiting and waiting incase my right knee makes a miraculous recovery!

[email protected]
« Last Edit: March 14, 2016, 04:50:09 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 MyKnee2010

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My PT has said it's ok to have some pain when you start doing the exercises but then the pain should even out or decrease as you keep exercising. If the pain keeps increasing, stop the exercise. He also said you should not be in pain for days afterwards. I was careful to keep track of the pain & report it in detail to him at the start of each session. If your PT isn't listening to you maybe it's time to get a new PT.

Good luck at your next appointment!

Offline Clarkey

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16/03/16 19 Months Day 609 Post Op

I am more stressed out now then I was before my consultation! Prof Snow is still hesitating to go ahead with a diagnostic arthroscopy in the fear of making my right knee problem even worse than it is right now. I can see why he is thinking this way, I am prone to excessive scarring, the MRI looks ok with just a few minor issues picked up. 

He gave me plenty of times to discuss options with him as he he knows that I will not accept the way my right knee is by living with the problem. I did mention electric shock wave therapy to him, he has referred me to see a sport physician at the hospital to see what he suggests what should be done next. I cannot see it working at 20 months post-op, I am already doing plenty of PT. 

I cannot push my knee too far as it too painful and sore, it doesn’t make much common sense that pre-op to scopes 1 and 2 were ok to go ahead with a scope, when I was in far less pain and discomfort. A 3rd diagnostic arthroscopy is always brushed aside when my knee pain now is more intense and restrictive than my previous 2 scopes.

I mentioned the bone spur, he thinks it is not causing too many problems, saying that many people have bone spurs without knowing they have got them. They are not feel any pain and discomfort like I am going through right now.

My patience is wearing thin now, I did not make any progress when I was put on the spot, I now regret not going on my gut instincts! I wish I said to Prof Snow please scope my right knee I am happy to take a risk and gamble rather than carrying on down the conservative route. I may have been a bit cheeky saying to him that I am not being rude, do you think I should get a 2nd opinion or maybe you can discuss my case with another OS at the hospital. 

I never had this much knee pain in all the years I have had problems with my right knee, It is my choice and my knee and body. I am getting agitated and frustrated now, I want something done now, I am feeling ok at this stage to take a risk and gamble. MRI are not always that accurate, it could be missing something out.

Another and last option is seeing an OS down in London that specialised in patella tendon problems for a 2nd opinion. I am now at the stage when I was expecting to have a diagnostic arthroscopy.

I will no longer see my private PT as she just trying to push my knee too far just like the one I saw shortly after scope #2. No one seems to think I have a knee problem so should start to push through the pain! I then end up limping, ending in even more pain and discomfort for a few days afterwards.
 
I am sorry for coming across all grumpy and irritable, I am just getting depressed, I cannot accept the way my right knee keeps playing up. Will get there in the end, it is just a long, slow and stressful process in order to make any progress.

[email protected]
« Last Edit: March 16, 2016, 04:56:05 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 MyKnee2010

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Oh Nick, I am sorry you had such a frustrating visit! I know exactly how that feels! If I were you, I'd definitely get a second opinion. It's not an insult to your doctor. Here in the US, some insurance companies even require you to get a second opinion on some procedures. I regularly tell my doctors that I always research any procedure or new medicine they prescribe, & I've never had one insulted yet. You have the right to find out as much info as you can about your body.

Just my thoughts -- probably not worth more than 2 cents, or is that pence? :). I watch Bargain Hunt (UK show) everyday & I'm starting to get my dollars & pounds mixed up! :)

Offline MyKnee2010

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Oh, one more thought -- is there someone you could bring with you to your appointments? I've found that doctors listen more if both my husband & I go to appointments. Two people can back up each other if it appears the doctor isn't listening or understanding. It also helps to have a couple different brains interpreting what the doctor has to say.

Offline kcknee

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Sorry you didn't have the best appointment today. It wasn't all bad though, you are going to see a sports physician who might be able to determine why your knee hurts and what needs to be done. Mr Snow does not know what to do next for you, so another set of eyes might help. Make sure you stress to the sports doctor that your knee is primarily a problem with your work and daily living activities taking care of yourself and your mother and then that it also keeps you from exercising, running or walking far.

I hope you can schedule with the new doctor quickly. It might turn out to be a good thing either by fixing your knee or letting Mr. Snow know what to operate on.
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 Scubagrl4

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I'm so sorry that you are feeling so frustrated Nick. I'm sure it is incredibly difficult to wait so long for an appointment to feel like some of that time has been wasted. I do know that you have enough fight in you to ultimately find an answer to your knee problems. It will be interesting to hear what the sports guy says and it will be good to get a new set of eyes on your knee.
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 lucha86

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ok Nick you have to do or feel is right for you i would take the advice of that sports doctor first then think about what you want to do next because i know this sounds weird to say this but maybe this person could pick up on things which  doctors cant as remember every doctor and physician has different specialities etc.......

When it comes to second opinions, i suppose its the way you get a second opinion, in my experience an every experience is different, i think it was better for me to go out of my local area to get a second opinion, as all doctors talk in the same area...sorry but they do lol......i had to fight for my second opinion, because a doctor was adamant nothing was wrong when it fact there was.........i suppose its rather down to ones quality of life, and the ability to lead life without problems pain etc..... even with the second opinion, i think the doctor realised with me that something was seriously wrong because you never see a late 20's athlete begging for help crying in tears lol

when it comes to a second opinion, make sure if you do go down that route ring up the site and ask the secretary for that surgeon what is their speciality in.....and research them on line and check what they have published on........ generally on one of my private consults i didnt tell them the name of my surgeon so it wouldnt create and biased opinion.........

but i would suggest try this doctor and see what happens remember its a pair of fresh eyes =)