Advertisement - Hide this advert





Author Topic: Very Complicated Please Read  (Read 1760 times)

0 Members and 1 Guest are viewing this topic.

Offline Allscarredup

  • MINIgeek (20-50 posts)
  • **
  • Posts: 26
  • Liked: 0
Very Complicated Please Read
« on: February 10, 2010, 09:53:38 PM »
Hey everybody, I'll try to keep this concise.

I've had pain in my knee for a long time that was always sharp and caused inhibition syndromes whereby the pain would cause my quad to "shut off" neurologically and the leg would give way. Last summer the pain got worse, and during a rugby match the inhibition happened, the quad gave up control, and my ACL snapped as a result. The ACL is fixed now and the graft is very well done. However, the pain persisted.

New surgeon did a diagnostic arthroscopy, and found synovitis, a cyclops lesion, grade 3 chondromalacia, a fissure in the patella cartilage, heavy scar tissue surrounding the worst of the chondromalacia, and what he described as fractures in the kneecap and the femur. MRIs were negative. X-rays were negative.

After the ACL reconstruction, my quadriceps was significantly atrophied. I've lost over an inch in all areas of the muscle. This apparently exacerbated the pain from the cartilage defects et al, as pain was much worse after surgery, but not related to the ACL.

I am two weeks out from my debridement and chondroplasty procedure to take care of the kneecap and femoral surfaces. I am having significant pain in my therapy exercises whenever the knee is bent, even slighty, under my bodyweight. However, I was 100% weightbearing after the first day out from surgery. I can walk, though stairs are a challenge, and bending at the knee to pick things up is out of the question.

My questions are:

1) What is the standard recovery time for fixing defects of this nature? Is it possible that I, a 23yo active male, could never recover from this?

2) If quad strength is so important to recovery, how do you get it without aggravating these extreme pains?

3) Am I just freaking out too early? Is it normal for the areas chondroplastied that were having sharp pain to keep having sharp pain for some length of time while they heal?

I'm sorry for the long post. I have been having issues for so long that even my enhanced learned patience is kind of out the window at this point. I was playing sport at a very high level and getting better and loving it more every day, and I've been unable to stand up out of a chair for the last half a year.

Thank you very much for any responses.
Nick

Offline Cosmicsnuffle

  • Forum Faithful
  • ****
  • *
  • Posts: 292
  • Liked: 0
  • Life's short - eat pudding first!
Re: Very Complicated Please Read
« Reply #1 on: February 11, 2010, 01:01:16 AM »
Hi Nick,

I'm afraid I can't give you a specific response as I'm not familiar with your procedure and I'm sure there are others on the forum far more qualified to answer your questions, but I just wanted to say how I related to your comment on "enhanced learned patience" completely - a phrase I may borrow if that's OK.

Good luck with the search for information and with the healing......
Oct 04 - torn meniscus
Dec 05 meniscal trim and debridement
Sep 09 torn ACL, kissing contusions, knee locked 30-60o
Jan 10 ACL stump debrided, lateral parrot beak meniscal tear trimmed
May 10 ACLr (Hamstring)
Aug 11 mfx (focal lesion lateral femoral condyle)
Jun 14 100k walk London-Brighton 28hrs

Offline Allscarredup

  • MINIgeek (20-50 posts)
  • **
  • Posts: 26
  • Liked: 0
Re: Very Complicated Please Read
« Reply #2 on: February 11, 2010, 01:11:09 AM »
Thanks a lot. My doctor has been rated top clinician by his peers like 8 years running, is a sports medicine doctor, specializes in knee surgeries. I'm 23 years old and have been active my whole life. Just don't get it. :(
Thanks again.

Offline kscope09

  • SuperKNEEgeek
  • *****
  • Posts: 691
  • Liked: 0
Re: Very Complicated Please Read
« Reply #3 on: February 11, 2010, 12:28:18 PM »
I had chrondoplasty n August, for a couple of months the knee kept getting hot and even when it wasn't it felt like someone wwas pouring hot water on it.  The pt told me to assume it had failed, but an mri in November (typical NHS waiting times and then a couple of weeks for the results) showedthat it had worked.  It had felt like my knee had no improvement for weeks on end and then by the 12 week mark it di start to get better and went from strength to strength every week.  My pt say's that at 12 weeks the chrondoplasty has formed fibrocartliage but it could still be a couple more months before it settles in fully.  i was told not to walk too much on hard surfaces until after xmas because of this.

I've still got the odd pain in the region of the chrondoplasty and often wonder if it has failed.  There is really no set time for how long they can last.  My OS has had good results with patients who've had them last for as long as 10 years, but it seems to be very individualistic.

As for the quads, perhaps you could have e-stim to get them going.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Very Complicated Please Read
« Reply #4 on: February 11, 2010, 12:54:27 PM »
Hi Nick and welcome,

It certainly sounds like you've been through the mill with your knee traumas. I think your enhanced learned patience phrase just about sums up the whole knee scenario. Like you, I have multiple "issues" in my knee, mainly to do with the patella cartilage. Like you, my quads will simply shut down if the kneecap is asked to do a certain action - I've compensated for this for a long while before realising just what was happening and why. The quad in my bad leg has significantly shrunk and it is frustrating that all of the things I used to do in my training for my legs and quads now hurt or could cause further damage e.g. lunges are impossible, squats hurt so I don't do them apart from wall slides and wide leg sumo type squats with no addiotional weight. I used to love kettlebell training but I've tried it since and whilst there is no pain during it, both knees pay for it later as it involves a squat and swing upwards - driven by the glutes and hamstrings but obviously also loading the knee too much for me. I have found that trying to do single leg presses on the leg press machine helps a bit, very light weights and high reps. I have also found that a power plate allows me to do some wide leg squats and supposedly enhances the muscle contractions. I use a Neurotrac e-stim machine to help the quads wake up, this can be useful if they've forgotten how to fire effectively but shouldn't replace proper training or PT.

It sounds like you've had fairly extensive chondro to the patealla and femur - being weightbearing probably was fine as they hadn't needed to microfracture anything, more a case of smoothing and tidying. However this is still a big trauma for the knee cartilage especially with Grade 3 damage (I have that too) and a fissure. It is going to take time and because of the work on the patella I am not surprised that stairs and bending under load are painful. I think 2 weeks is very early - I was told up to 12 weeks for significant improvement and then it will keep getting better - if it is going to. (I'm still debating, as my damage is quite big - a cartilage transplant may actually serve me better in the long run...) Unfortunately cartilage surgery is such a long process and there are no guarantees or timescales - everyone is different. Its a vicious circle with the patella as it relies on the quads, which in turn are weak, etc etc - round you go. Can you swim? Or do some exercises under water - this helps me a lot as I can do actions that hurt without the support of the water. No breastroke though, the knees don't like it. Also try some of the proprioception exercises - even standing on one leg with good alignment and balancing works the muscles around the knee - progress to doing it with your eyes shut....

Are you having any specific PT? This would be good to set you a proper program of exercises and monitor your progress.

I'd also try and do as much as you can in a holistic way to rehab your knee. I take glucosamine and chondroitin religiously each day and have just introduced rosehip capsules after speaking with ex rugby player at the gym who has knees with huge lumps of missing cartilage and who swears by rose hip and balance training. :P I figure they won't hurt and might help regeneration. I have also started acupuncture - again, it won't hurt but it can improve range of movement and pain control for some people. My friend had a scope and 12 months later she still felt like her leg was "dead" weight - 4 acupuncture sessions and her knee kind of went "pffffffffffffff" and felt like her own again! I'm a big fan of foam rollers and proper stretches as well - especially on the calves, IT band, quads. They really help the knee stability and tracking and overall feel. Explore all options and try and find what works for you.

You've had a LOT of issues dealt with and it will take time. You're young and fit and those are BIG plus points in recovery.

Good luck and keep us posted

Lottie  ;D
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 NadiaMac

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Very Complicated Please Read
« Reply #5 on: February 11, 2010, 03:52:40 PM »
hi there- I agree with Lottie that two weeks out of chondroplasty/arthroscopic surgery is pretty early--  you will continue to improve as swelling decreases and flexibility increases for sure.  I also have patellar pain after chondroplasty/arthroscopy and mcconnel taping has helped a lot in mitigating pain while permitting me to do the hard work of rebuilding my withered quads.  something to keep in mind and ask the PT about.
4/09 MTB crash, severe patellar impact. MRI cleanish, but lots of pain
6/09 start PT, cortisone, synvist
10/23/09 scope: medial plica excision, lateral meniscectomy, chondroplasty

Offline kscope09

  • SuperKNEEgeek
  • *****
  • Posts: 691
  • Liked: 0
Re: Very Complicated Please Read
« Reply #6 on: February 11, 2010, 04:08:05 PM »
I ahd taping in the 2nd week after surgery and it really helped.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline mmrocker13

  • Forum Faithful
  • ****
  • Posts: 367
  • Liked: 7
Re: Very Complicated Please Read
« Reply #7 on: February 11, 2010, 04:34:24 PM »
It can vary of course, but still having pain now--esp. if you went in with already extremely weak quads--is not unusual.

I had a c'plasty and debridment at the beginning of October. I went in to it following a long season of triathlons, running, and cycling, as well as prepping my quads with lifting etc. I was still having swelling and some residual pain and weakness when I went in for my DFO in January--and I had been hitting the weights HARD in prep for that.

So, at two weeks out..you're fine. Just keep with the PT regimine, gradually adding weight and exercises, and you'll get there. It won't happen overnighth, and it will probably hurt...but it WILL happen.
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline Allscarredup

  • MINIgeek (20-50 posts)
  • **
  • Posts: 26
  • Liked: 0
Re: Very Complicated Please Read
« Reply #8 on: February 11, 2010, 05:32:08 PM »
Thank yall very much.

I am writing my doctor now to ask if he did any techniques to induce bleeding, or if it was simply a trimming and smoothing.

I believe there were also two fractures at the femur and patella that were supposed sources of sharp pain, since they were associated with the cartilage defects. I don't know why they would have still been present, as I can't remember any serious knee contact with anything in the last 7 months.

Nick

Offline Allscarredup

  • MINIgeek (20-50 posts)
  • **
  • Posts: 26
  • Liked: 0
Re: Very Complicated Please Read
« Reply #9 on: February 13, 2010, 03:14:29 AM »
I've attached a picture of one of the "Fractures." As you can see, it looks like a spiderweb crack with an obvious center, and there is scar tissue growing over it that looks like a cloud. This scar tissue was removed. Though I don't know how that helps it heal.















support