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Author Topic: Bone Contusion? Could it be from failed lateral release?  (Read 1648 times)

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Offline annie5970

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Bone Contusion? Could it be from failed lateral release?
« on: August 17, 2010, 08:40:31 PM »
Hello knee friends,

A few weeks ago, I posted about continued knee problems. Let me give a quick overview of my knee nightmare:

August 2008: Started having left knee pain (no accident or apparent injury). Pain increased significantly over next few weeks. MRI found to have small tear in meniscus. Surgery performed January 2009 to remove small piece of torn meniscus, and a buckle of synovial overgrowth.

Pain and swelling continued for several months, so ortho sent me to a rheumatologist, who did an enormous work-up, but all was found to be ok on that front. Was recommended to have arthroscopy to determine cause of pain and swelling. I asked to see a different surgeon, since first surgeon dismissed continued problems, saying I was "just getting old" (I was 39 years old). I was referred to a surgeon about 45 minutes away, who runs a knee institute.

Arthroscopy November 2009-Plica excision, severe wide-spread synovitis excision.

Pain and swelling continued to increase. Continued to develop knee effusions. Knee has been drained 15 times to date since last November. All fluid analysis ok, no reason to think RA, gout, infection as cause.

After the November surgery, everything went haywire. The swelling has been so bad at times, my PT is a bit horrified; you can almost watch it swell. Another MRI was performed at the end of December, showed Baker Cyst had gotten larger from previous MRI, degenerative change of the posterior horn of medial meniscus, increased signal in cartilage of lateral facet of patella, widespread edema.

Surgeon performed a lateral release and extensive scar tissue excision on April 9, 2010. Eight days after the surgery, had to take me back into surgery, due to severe bleeding into the joint. Hematoma was shaved out of joint, and I was in the hospital for a few days with a drain in my knee. I lost ROM terribly after the hematoma surgery, and my ortho performed a manipulation under anesthesia a month ago. I have better ability to bend my knee now, but the swelling/pain continue same as before, and I still cannot bend my knee as well as I had hoped. As the swelling increases, the ability to bend my knee lessens. I keep trying to make my surgeon understand that EVERYTHING I try to do causes swelling and increased pain in my knee. Just standing for a few minutes causes the swelling to increase; forget about walking or enjoying life.

The problems continue: Since the April surgeries, fluid has been removed from my knee 3 more times, and the swelling/pain is severe. I have been off work on disability since November, and I am losing hope. We have tried so many things since November: Months of PT, e-stim, ultrasound therapy, light therapy, cold therapy, heat therapy, bracing, taping, water therapy, synivisc injections, CPM, anti-inflammatories, pain meds, RICE. My surgeon wanted me again try synivisc, but frankly it did nothing when we tried it earlier this year, and I am sick of doing the same things over and over again in vain. I had an MRI last week, but my surgeon thinks it is likely more scar tissue, which will not show up on MRI or x-rays. My MRI report states that everything is still the same as the December MRI, but now I also have a bone contusion (anterior lateral femoral condyle), and that is may be due to trauma. I have not hit my knee, been in an accident, or fallen. When I walk, my knee does this thing: stick, pop, clunk, stick, pop, clunk (best way to describe it). I have been trying to tell them for months that my bone hurts, and it feels like a broken bone in the area where the contusion is noted. I am beginning to think the lateral release has failed to improve my knee issues, and is causing continued kneecap tracking problems, hence the contusion. I have had a hard, long, painful lump in the area of the lateral release for months, and I cannot hardly bear to have it touched.

Does anyone know how to determine if a lateral release has failed, and why I might have a bone contusion in this area with no trauma? I find it hard to believe that the surgery over four months ago has caused a bone bruise to still be seen on MRI. Is a surgery possible to correct or modify a lateral release? Any information is greatly appreciated. I want this fixed so I can get back to work and my life. This has been financially devastating for me and my husband. I have gone to school for years, accomplishing three degrees. I did not do all of that to ruin my career, and sit home on disability.

Any and all opinions are very much appreciated.

I see my surgeon again in two weeks, and want to have as much information in hand as possible, so I can have a productive appt with him.

« Last Edit: August 18, 2010, 02:38:40 PM by annie5970 »
Jan 09-Surgery for torn mensicus/synovitis
Nov 09-Scope-Extensive Synovitis/Plica Removal
Apr 10-LR-Scar Tissue Removal
Apr 10-Hematoma Evacuated
July 10-MUA
Oct 10-Scope/Synovitis/Extensive Scar Tissue/Chondromalacia/Maltracking
Nov 10-TTO/Scar Tissue Removal
Knee Aspirated 20 Times
July 11-LK TKR

Offline Lottiefox

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Re: Bone Contusion? Could it be from failed lateral release?
« Reply #1 on: August 17, 2010, 09:35:58 PM »
Hi Annie

I remember your original post - I am so sorry that the knee has not improved yet.

I cannot offer much in the way of advice but I do have a patella with significant lateral defects and a high degree of lateral tilt. Can I ask why the lateral release was done; did scans/X rays indicate a tilt that required release or was it more of a decision by the OS to assist with the general state of the knee? I do know that an isolated lateral release is rarely that useful unless ONLY tilt is indicated and even then the decision is a bit moot amongst PF specialists. Most times it is combined with a transfer of the tibial tubercle to shift the tracking of the knecap. Again, these are decisions made on extensive scans and X rays and a history of instability or maltracking - its a massively complex field and part of the reason I'm not under the knife yet. I'm guessing perhaps that yopurs was done to try and unload the lateral patella cartilage and slow down the wear and tear. However, if you didn't have the specific need for this then the patella may still not be quite right.

In answer to can it be reversed - I am not sure how easy this is, or how it is done. I have heard of people having it reattached on the lateral side but I can't point to any specifics. The bone bruise is certainly weird but I gues it might have been caused either during surgery or because you now have a bad maltracking and something is hitting that part of the bone. A bone bruise can take up to 12 months to heal so it may show on MRI still, even 4 months post surgery if it was caused then. The long hard lump sounds like scar tissue - do you have mobility of the patella, can you move it at all with your fingers or is it too painful?

It sounds like you are going through a combination of severe reaction to the surgeries, along with possible scar tissue issues. Are you able to hunt down an OS who specialises in dealing with this kind of situation? Ideally someone with a focus on patella femoral issues and scar tissue so they can see if you do need surgery again or if there is a need for a different approach. I would certainly be pushing for another opinion even if you have faith in your current one.

I really hope you find some relief. I am sure there will be others along soon with more first hand experience of lateral release issues.

Good luck

Lottie x
« Last Edit: August 17, 2010, 09:42:21 PM by Lottiefox »
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....