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Author Topic: How long should I wait?  (Read 1459 times)

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Offline Maverick

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How long should I wait?
« on: May 22, 2012, 04:28:10 PM »
I had microfracture surgery last September and I am still have enough pain to affect my quality of life.  At least 3-4 times a week I have to regularly take Advil, Extra Strength Tylenol and even pain meds to make it through the day.  I am at 8 and 1/2 months.  Is it too early to go back to the doc and talk about options or am I being impatient?

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Vickster

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Re: How long should I wait?
« Reply #1 on: May 22, 2012, 07:23:48 PM »
Certainly, if you are concerned and QoL is affected go back to the doctor.  There are many posters on here who say that it can take a year or more for a knee to feel halfway normal after a microfracture and indeed any surgery. 

Muscle strength is very important for helping poorly knees.  It may be worth talking to a sports physio too if you think there may be any muscle weakness or imbalance around the knee.  Is the pain sharp and localised or more a general, achy arthritis type of pain?

Advil, Tylenol are pain meds (well Advil is an NSAID for inflammation and pain), so not sure what pain meds you mean.  If you are regularly needing
to take heavy duty narcotics then things wouldn't appear to be right for sure.

I am not far off 3 years post injury and I am now having to consider my options too  :(
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 Maverick

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Re: How long should I wait?
« Reply #2 on: May 22, 2012, 07:47:34 PM »
Thanks for the resonse.  I am going to the gym 3 to 4 times a week working on strengtheing and feel good about my program.  Progress is so slow though.

The pain meds that I am referring to is, Vicadin.  I usally take 3-4 a week and sometimes they help others time not. 

There are really two types of pain.  The first encompasses the whole knee and is more of bee stings and I think it is related to strenghening as I did have a good amount of atrophy.  The second is localized like an ice pick or a needle being in my knee in the spot of the microfracture.  The pain can be intense but more like a feeling of pressure but not a sharp pain.  If you have ever had an injection in your knee, this is how it feels.  Hopefully this makes sense.
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Vickster

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Re: How long should I wait?
« Reply #3 on: May 22, 2012, 07:54:43 PM »
Have you had a physio check your gym program, form etc?  What type of things do you do?  Remind where the mfx was and what else if anything is up with your knee?  There are some gym based exercises that are good for knees, others are less so (squats, leg extensions, running)

I'd see the doctor (if insured etc), after all, they are here for our health not theirs ultimately.  What's the worst the doctor can say?  :)
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 Maverick

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Re: How long should I wait?
« Reply #4 on: May 22, 2012, 08:57:07 PM »
My PT approved my gym program.

Last September I had a Lateral femoral condyle (LFC) microfracture in my left knee along with a lateral meniscectomy.  Surgery included 7-8 microfractures.  I spent 2.5 months non-weight bearing and did not get off crutched completely until 5 months.  Waiting this long ended up with significant atrophy in my leg.   I have an unloading brace that I just recently set to no-loading (0 setting) but still wear when my knee starts getting painful.  I work out at the gym 3-4 days a week with 30 minutes cycling (90 cadence) and using weight machines for leg press, leg extension, leg curls and abductor exercises using a cable and ankle cuff. I still have significant knee pain in the microfracture area 2-4 days a week, mostly at night.  My surgeon did a bone scan and MRI at 5 months to determine if there were any issues with the knee.  Nothing showed up other than thinning cartilage in the original injury area.

I also had a lateral release of the patella in 2005.

I do have insurance but I don't want to come accross as a wimp :(  Since I have not been through this before I don't know what to expect.

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Vickster

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Re: How long should I wait?
« Reply #5 on: May 22, 2012, 09:04:06 PM »
There is nothing wimpish about speaking to a doctor about pain, but I know what you mean.  I'd see the surgeon, explain your concerns.  What does your physio think - they are often more attuned to this stuff than surgeons who can think that you are fixed once they have stitched you up and you are on the mend :)  Ask what you can do to avoid further surgery at least in the short to medium term

Are patella loading exercises like leg extensions advised when you have had a lateral release? I had grade III on my patella tidied up and was advised by my physio not to use the leg extension machines.  How much resistance if any do you have on the bike - maybe a little more resistance but less speed, or mixing it up, would help the muscles?

Good luck  :)
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 cheeseheadproud

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Re: How long should I wait?
« Reply #6 on: May 22, 2012, 09:11:49 PM »
I feel your pain - literally!

I am 7+ months post microfracture (medial & lateral femoral condyle).  I was given a cortisone shot at 4 months because of pain and that pretty much eliminated all pain I was having at the time.  I was giving the ok to return to activities 2 months ago (right around 5 months).  I gradually worked my way back into running and some higher impact activities.  About a month ago I started experiencing pretty significant pain.  I immediately contacted my OS.  I was told to wait a week to see if my pain/swelling went away and if it didn't they wanted to see me.  I saw my OS's PA who said I definitely needed to have an MRI done.

Yesterday I went in for my MRI and to have my OS review the results.  Turns out I have a significant flare up on my medial microfracture site (where my pain/swelling is).  It's basically a stress fracture from doing too much, too soon.  I am now back on 8/10 weeks limited activity and have another MRI set for the middle of July.

To me it sounds a lot like your pain is similar to what I was experiencing.  If you were on crutches for 5 months, it's going to take a while for everything to get back to working right.  Unfortunately I'm learning the hard way that with microfracture surgery - you have to be patient.

I definitely think at any point in your rehab, if you are having pain, you need to have it looked at.

Offline Maverick

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Re: How long should I wait?
« Reply #7 on: May 22, 2012, 09:34:09 PM »
Thank you all for your feedback. 

I am still on low impact and my PT and surgeon says "no" running now or ever.  Probably a quick jog across the street won't kill me but both my PT and surgeon said that I can no longer run.  I am not a big running fan but I used to do MMA which is out as well.  A low impact life is ahead of me which is quite the challenge.

My assumption is that because I have thinning cartilage around the microfracture area that the area is very subseptable to further damage fairly easily. 

I see my PT on May 31st for likely my last visit.  He says that my strengthening program is working and there is "nothing else" he can do.  I have a two week business trip the first two weeks of June and my thought was to see how my knee felt after the trip.  If I still have the same pain issues I would setup an appointment with my surgeon then to discuss my progress.

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Maverick

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Re: How long should I wait?
« Reply #8 on: May 24, 2012, 11:45:50 PM »
Well I made the OS appointment but it is not until June 20th due to his schedule and mine.  I will update my post then.

Any other thoughts are appreciated.  Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline minor_discrepancy

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Re: How long should I wait?
« Reply #9 on: May 25, 2012, 12:52:10 AM »
I had the same surgery three months ago.  I went into my surgeon after the pain resurfaced and just wouldn't go away.  What he said to me was that it's better to try and do something about it sooner rather than later and not burn bridges.  If your pain is effecting your quality of life, then something might be up with your surgery.  I definitely wouldn't ignore it like your PT is seeming to want you to do.  Last time I ignored pain for two years, when I finally gave in and went back I was told my bone had irreparably rotted away. :/  I'm sure your case is not as severe, but it's never a good idea to straight up ignore it when you are in pain.
02/21 (scheduled) OATS
4/09 Dislocated patella
6/09 LR + Chondroplasty, LB removal
2/12 Microfracture + Chondroplasty
7/13 Chondroplasty + Cleanup

Offline dm

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Re: How long should I wait?
« Reply #10 on: May 25, 2012, 01:48:10 PM »
My mfx took nearly 18 months to fill itself in, but the damage on that side is so bad, according to the second OS I just saw, that it's now the best looking part of that side of my knee.  I've got grade 3/4 damage in 2 compartments, I discussed things with the OS I just saw this week, who's never seen this mess of a knee before - fresh eyes on the subject - and he looked at 2 mri's, my last scope pics, standing xrays including skyline view, and said the 2 options I've got left are try Hyalgan and see if it gives me some relief, and if it doesn't - I need a new knee - the left side is shot. At least he was honest about it, and didn't give me some garbage about how he couldn't do a TKR because I'm only 40.... he even knows my other OS, says the guy's a good doc, but is by the book, and says sometimes you gotta put the book aside....
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Maverick

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Re: How long should I wait?
« Reply #11 on: May 25, 2012, 03:12:21 PM »
Thank you for the support! 

As many of you know, living with cronic pain is a nightmare.  When I last saw my OS in February he said that if things did not be better then he wanted to scope it to see it for himself.  I likely have waited too long to go back but wanted to give me knee adequate time to strengthen before doing this again.  We will see what he says when I see him on June 20th, which will be 9 1/2 months post microfracture. 
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Maverick

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Re: How long should I wait?
« Reply #12 on: June 01, 2012, 03:24:48 PM »
I had a good visit with my PT yesterday and we went through all my pain symptoms, questions and challenges.  He was great and very responsive.  Going through all the movements that cause pain, he believes that I have Patella Femoral syndrome.  We have been working on my patella for a while now as it does not track straight.  When I tighten my quad, my knee cap tracks to the outside of my knee.  We are trying a bit different method of taping and he gave my one new exercise to strengthen my inside quad.

Based on my research on Patella Femoral syndrome, this is a catch 22.  What it really needs is rest to minimize the pain but to get it better through PT, I need to continue to strengthen my quads and hamstrings.  I will continue my workout as described earlier, continue to ice and see the PT again 2 days before my OS visit on June 20th.  Hopefully with working hard on my new exercise I will see improvement and less pain.  As this makes so much sense to me, at least I have renewed hope that I have not turned into a wimp :)

Has only else had experience with Patella Femoral syndrome?  I am interested in your exercises and experiences.

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick















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