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Author Topic: Help - 2 Surgeries in the last year and a puzzled surgeon  (Read 1298 times)

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Offline jester6435

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Help - 2 Surgeries in the last year and a puzzled surgeon
« on: September 18, 2010, 08:12:24 PM »
Okay Pre-story:    It was at least 4 years ago I was playing soccer, was on a full sprint and tried to stop.  It felt like my knee kept going and I heard a loud pop with a few seconds of slight pain.  I managed to stay on my feet, bent my knee a few times and continued to play.  After knee pain bothering me for a few days after I saw my doctor being concerned about a possible ACL tear.  The old guy told me off that it was nothing and my knee felt fine, and told me I should consider just giving up sports soon because I was getting too old... At the age of 21 at the time.  Two years passed with constant pain, then a few times squatting I heard pops and pain in the same knee which led to me not being able to do squats anymore.  After getting a job on my feet for 40 hours a week that I was lifting, twisting, squatting all day, my knee just came to the point where I could barely walk after work.  I saw a new surgeon in town who did an MRI, X-ray and told me I was fine.  The pain continued.  A year later I finally move down to New York, and I decide to go to a Knee Center and get it looked at by a knee specialist.  He grabbed my knee, and for the first time actually compared it to my other leg.  He told me within 20 seconds of meeting me that he was nearly 100% sure I tore my ACL and if I wanted surgery we could do it. 

More possible relevant information: About 3 weeks after the first surgery while I was back in Vermont visiting I broke out into hives over my entire body and had a fever.  I've never had a single hive before, yet my body was completely covered in rash, and itchy.  I spent two days of hell with that before going to the hospital and getting steroids which cleared it up.  This was my first surgery I had ever had, and I'm not allergic to any foods/detergents/ or anything that we know of really.  Sometimes I think this has something to do with my problems.

Which led me to last February having ACL reconstructive surgery using a patellar graft.  My first month went great at physical therapy and my range of motion was great.  Then the place swapped me between three of the trainers because one intern left, one went on vacation, and the girl they gave to was so over worked she didn't even know my file.  She told me to drop the crutches even though it was painful.  Ever since then it has been an uphill battle.  The following months in physical therapy I was at a stand still.  Anytime that I tried to bend my knee while bearing weight I felt extreme pain.  I also felt terrible locking/clicking during an exercise where you sit in a rolling chair/seat and you extend your feet out, and put your heels on the ground to pull yourself to where your legs where.  They decided to throw me in the pool for a month and do rehab in there.  It worked a little bit but anytime I was out of the pool I was still in pain.  It was then they told me I had tendinitis most likely and I began taking it easy and doing only things that didn't hurt my knee which was barely anything.  My knee was so swollen they decided to drain it and give me a shot of cortisone. 

The instant he drained the fluids from my knee I felt my knee cap shift in a weird way and almost pop.  Trying to walk away was more painful then when I had gone in.  My knee now a locking or slipping when my knee was bent in a certain position.    I would have to bend my knee the opposite direction or let it sit for a second otherwise the pop would be extremely painful if I were to keep moving it forward.  This locking/slipping continued, and is still with me today.  The surgeon ordered another MRI and told me straight up that he was absolutely puzzled on what was happening.  He said he had no idea what is wrong with it.  After the MRI and X-ray came out clean he decided to do a surgery to remove the screw and staple on the lower end of the knee.  This surgery was three weeks ago.  His goal is to wait three months from now before considering going in the knee with a scope to look around.  He doesn't think it is a mensiscus tear because when he did the first surgery he looked specifically to see if there was a tear.  Because my symptoms were more directed towards that then an ACL injury. 

Three weeks out of surgery the locking/slipping has already came back.  Any weight bearing with my knee is still unbearable.  I can't even bike with zero resistance without feeling pain. I'm 23 years old, and am missing my active lifestyle more than anything.  This knee is tearing me up inside and it doesn't help to have a surgeon that has no clue what is wrong.  My knee felt a hundred times better before the surgery.  The pain was on an off sometimes so I could run anround and kick a soccer ball, skateboard, and everything.  I did those activities everyday, but now I can barely walk without pain.

Has anybody heard of anything that might be related to this?  Should I ditch this doctor even though all the therapist continue to tell me that he is the best surgeon in town?  Should I try to find somebody else to look at it, and should I let my current surgeon know that I'll be doing so?  Will I be able to get my files sent over from one office to the next?    This knee is holding me back from working, (I'm lucky I just landed a desk job for a bit), i"m not rich and I can't keep affording to go to physical therapy if it's not doing anything. 

To anybody who took the time to read this, thank you for at least caring.  And if you have any ideas whatsoever please let me know.  Thank you all.
« Last Edit: September 18, 2010, 08:15:33 PM by jester6435 »

Offline annie5970

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #1 on: September 18, 2010, 11:27:30 PM »
Hi Jester,

I am so sorry to hear you are experiencing knee issues post-op, and your surgeon is baffled. I wonder if you have issues with scar tissue?l You should check out some  of the information at this site on scar tissue and arthrofibrosis, and see if your symptoms are similar. Scar tissue will not likely show up on xrays or MRI. How is your ROM? If your current surgeon is confused, he/she may be open to you gaining a second opinion, and may even recommend someone for you. You should absolutely be able to get copies of all of your tests and surgery report. I have all of mine, and keep everything in a file in case I need it. My OS always gives me copies of everything; I do not even have to ask. I always recommend keeping copies of your reports for your records. When I have MRI's, CT's, bone scans, etc. I also get my films or a CD with the pics for my records. The diagnostic centers I have been to for MRI's etc. always give me my films at no charge for the first copy. However, if they are lost or damaged, they will charge to replace them.

You may need a second opinion on your knee. A fresh pair of eyes may see something your current OS is missing.

I hope things begin to improve, or a correct diagnosis and subsequent course of action can be undertaken to alleviate the pain and problems you are experiencing.

Best Regards,
Annie
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 crankerchick

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #2 on: September 19, 2010, 04:12:11 AM »
Hi jester, you most certainly can get a second opinion and you don't need thid doctor's blessing to do so either. There may be a charge to get your records, but its a good idea to get them. Like Annie said, getting your op reports and copies of your xrays and MRIs are also helpful.

You have had 2 surgeries with this doctor and your knee is stil jacked and he/she is talking about doing more. You have said yourself that you don't think your current doctor know how to help you now. Seems like its time to move on. You are way too young to be told to give up sports over a simple ACL reconstruction gone bad.

You mention NY, I don't know much about the hospital for special surgery, but it seems people on here tend to like it so maybe that is a place to start?

Scar tissue is a possibility. Another possibility is the graft wasn't placed properly, but in a non-anatomical way.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline soozles

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #3 on: September 19, 2010, 01:04:19 PM »
You should be able to ask for a copy of your MRI from either the surgeon or the place where you had the MRI. Same for the surgical reports, you can ask for a copy of the reports, you don't need to tell them why. You don't need to tell your surgeon that you're seeking a second opinion. Personally, I think it's a good idea, especially if he's talking about more surgery, and you're not entirely comfortable with him. Personally, I went to a couple doctors before deciding to do surgery, and I decided to do the surgery with the second surgeon. A good friend of mine is an ortho resident, and one of his attendings is an excellent knee surgeon as well, and his informal opinion coincided with the other opinions as well (I would have gone to him myself, but he doesn't take my insurance).

I don't know where in NY you are, or if you're still here, but if you are, you might want to consider looking into going to Hospital for Special Surgery or NYU Joint Disease if it's anywhere near you. They're used to being the second opinion and fixing what other surgeons screwed up. Or even telling you if anything was screwed up in the first place.
May 2005: Torn PCL, misdiagnosed as chondromalacia
April 2010: pain worse, lots of instability
Nov. 23, 2010: PCL reconstruction
progress here: http://pclrecovery.blogspot.com/

Offline messie_jessie

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #4 on: September 19, 2010, 05:01:30 PM »
Hi Jester - sounds like you're having a rough time of it!

I think you should be definitely getting a second opinion and a new MRI scan. I had a similar situation of having a surgeon who wasn't sure what was wrong with my knee and even my MRI was inconclusive. It was really frustrating as it made me question whether I did have a real problem in my knee or whether I was just being a bit of a wuss with the pain. In the end, I pushed for a diagnostic arthroscopy and lo and behold, when the opened me up the found a large defect at the bottom of my femur. So don't be put off by the doctors - you know your own body!

Also, I've had hives post-op too. I'm 4 weeks post op now but after 1 week I came out in a really itchy, hot red rash of raised bumps on my arms and legs. The doctor diagnosed it as hives and gave me a high dose of anthisthamine which cleared it up quickly. Apparently it can sometimes happen post-op as a reaction to all the meds.

Hope this helps - stay strong!  :)
Medial meniscus right knee microfracture 2006
Medial femoral condyle right knee microforacture 2010

Offline jester6435

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #5 on: September 19, 2010, 05:08:55 PM »
Thanks for all the responses.  I meet with my regular surgeon sometime this next week for my 1 month post-op where I'll confirm I'm still having issues, and I'm sure he'll tell me he wants to wait until the three month mark to scope the knee.  When he went in last time I wanted him to scope the knee before removing the hardware but he said he didn't have enough proof that it needed to be done.  Or something along those lines.  I'll tell him I plan on getting a second opinion and start looking into finding a doctor.  I was thinking about heading to the athletic trainer from my college and asking for some ideas on who he thinks I should head to because i know he has been around the area for quite some time. 

I appreciate all the information and ideas, and hopefully I can update this with some good information soon.

My surgeon told me to stop physical therapy and not to bother with it for now even though I just had anohter surgery.  Does that sound like something out of the ordinary?  I mean I'm not doing any exercises what soever right now, not even the ROM exercises, but I'm nearly at full range anyways and can easily get it back in a matter of days if I stretch.

Offline crankerchick

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #6 on: September 19, 2010, 05:27:48 PM »
Sounds like a good plan. Glad to read you are going to get a second opinion.

I'm not a doctor, so take it with a grain of salt, but I know if it was me I would be still be doing exercises and stretching. The stationary bike is like the best non-weightbearing exercise for the knee and I would be all over it everyday in addition to other core, quad, hamstring, hip, glute, and calf exercises I could do relatively pain free. Your patello-femoral issues give reason to believe that exercise and stretching are definitely in order. Can you stretch your heel to bum while laying on your stomach?

Since you say you have full ROM, I don't think you have a scar tissue issue like AF. But I do see you say you have pain riding the stationary bike ::sad panda:: but I still say stretching activities and exercises that don't increase your pain too much are worthwhile. A guy needs a strong knee regardless of if more surgery is in the future or not.

Best of luck to you.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline jester6435

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #7 on: October 13, 2010, 09:31:27 PM »
Well thought I would update.  I've been trying to find somewhere to go for a second opinion but I am unable to find anybody that will look at my knee so soon after surgery.  All the places around me are saying that they wait 6 months after my last surgery before I can come in.  My surgeon and I met for our one month post-op and he still claimed to have no idea what is wrong with my knee.  He suggested doing some more muscle strengthening, and three months from that date we will visit again and hopefully some of the symptoms would be gone by then.  Immediately after meeting him I was in the same building so I met with my physical therapist who gave me some exercises I could do at home very lightly to help strengthen.  As soon as I started trying the exercises many of the symptoms of pain and clicking came back, and I am still unable to even bike with zero resistance for more than 5 minutes without pain. 

I guess I'm stuck waiting until January before the surgeon will even look at it again, so it won't be until March when I would have the next surgery to take a look around the knee . Wicked bummed out,  and does anybody know if the six month post surgery is common or should I just keep calling random offices in order to find somebody that will take a look at it sooner.


TLDR

-Full range of motion
-Clean X-ray & MRI
-Removed screw and staple
-1 month 1 week post-2nd op

Pain:

Straightening leg, behind the knee crunching feeling with clicks with or without weight on it
Bending the knees while bearing weight brings pain to under knee cap,  bottom of quad/knee

Also: say I'm standing and have my toe to the ground about 2 feet behind me. If I lift my heel towards my butt/in the air then I feel a shift in my knee and a space.  Huge gap feeling in my knee, and my other knee can't recreate this feeling.
« Last Edit: October 13, 2010, 10:38:02 PM by jester6435 »

Offline emergRN

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #8 on: October 13, 2010, 10:11:48 PM »
It sounds like you have been through it!  I hope you get your answers soon.  Good Luck!
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline jester6435

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Re: Help - 2 Surgeries in the last year and a puzzled surgeon
« Reply #9 on: October 13, 2010, 10:44:05 PM »
Also still a concern I thought I would mention.  Was from the original post:


More possible relevant information: About 3 weeks after the first surgery while I was back in Vermont visiting I broke out into hives over my entire body and had a fever.  I've never had a single hive before, yet my body was completely covered in rash, and itchy.  I spent two days of hell with that before going to the hospital and getting steroids which cleared it up.  This was my first surgery I had ever had, and I'm not allergic to any foods/detergents/ or anything that we know of really.  Sometimes I think this has something to do with my problems.


Had a reaction on smaller terms about 1 month post-2nd op.  Just hives around my waist/groin area that were itchy but not nearly as bad as last time.  Had different medication this time then the first time.


My question is could there have been an infection?  I remember about a week after the first surgery thinking that I had a fever, and felt like garbage.  My knee was swollen and always letting off crazy amounts of heat until after I got treatment for the hives (which was steroids + antibiotics). When I was seeing my doctor post Op they never once took my temperature.  If I had gotten an infection would it be possible for it to go away from the antibiotics?  Could that have any effect on my knee today if it wasn't reopened and washed out?  There was all the symptoms of infection, including drainage from where incision was made, redness/warmth around the knee, possible fever (I know there was a fever when I went to the ER, but I"m pretty sure I had one earlier as well),


Also, thanks for the all the help and encouraging words.  People around me have heard me bitching enough about my leg, so it's nice to talk to people who have felt the same discomfort.
« Last Edit: October 13, 2010, 10:54:27 PM by jester6435 »















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