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Author Topic: patellar tendon after scope  (Read 3228 times)

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Offline kathleenj

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patellar tendon after scope
« on: January 14, 2004, 08:12:03 PM »
Hi,

I was just wondering if anybody had problems with their patellar tendon after an arthroscope.  In order to avoid an open incision my OS went right thru the middle of mine.  I was just wondering if anybody has experienced the same thing and how long it takes to get function back.  The tendon is really painful and as hard as I try,  it just doesn't seem to want to contract.  
Any info would be appreciated.    Thanks  
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Heather M.

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Re: patellar tendon after scope
« Reply #1 on: January 16, 2004, 07:36:39 AM »
Hi there.

I have had serious problems with my patellar tendon after a scope, but most of mine were related to my body overproducing scar tissue.  The patellar tendon became surrounded by scar tissue and it started constant irritation.  So the tendon started producing its own scar tissue to help heal; this caused my tendo to contract and shrink down, as scar tissue becomes harder and more fibrous as it gets older.  This has subsequently put a lot of traction on my kneecap from below, and caused a condition known as patella baja.

You should follow up with your doctor and physical therapist, as you may very well just have a serious case of patellar tendinitis.  With this tendon, I have discovered, it is best to act quickly and prevent any serious damage from occuring.  It's much easier to do that than to fix the damage....

Heather

PS do a google search on patellar tenditis, scar tissue, infrapatellar contracture syndrome, patella baja, and so forth to see what you come up with.
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kathleenj

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Re: patellar tendon after scope
« Reply #2 on: January 16, 2004, 08:26:24 PM »
Thanks for the information.  I did do a search and now I'm even more confused than ever :-/  I've been at PT every other day and I do know that there is some scar tissue on and around the tendon that she is trying to break up with massage. OUCH!!!   Right now, she doesnt seem too concerned about it but did mention that we need to get it broken up.  She also mentioned that I have a significant tilt on the patella and from what I have read this could have something to do with scar tissue developing under it or something to do with the fat pad. ?  This is so confusing.  I was hoping that I would be well on my way to healing by now but I still cant move without these 2 crutches as nothing seems to be working as it should.  Muscles dead, ligaments sore......yikes... when will it end?   Any more info you can share would be extremely helpful.
Thanks.......
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Kimby

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Re: patellar tendon after scope
« Reply #3 on: January 19, 2004, 05:14:34 PM »
As Heather said, scar tissue can be a real big problem and can cause constricture of the surrounding support structures.  In addition, the scar tissue can cause the knee to misalign causing other problems like cartilidge erosion leading to other surgeries.

You probably need this all readdressed by an OS.  I never heard of needling through a structure to get a look at another structure, but I'm sure it must happen as they did it in your case.  

I have used Vitamin E capsules (break them open) and massaged the oil into the knee - you really do need to get the scar tissue broken up like your therapist said.  

Definitely get back into the OS pronto, though - this will only get worse before it gets better if someone isn't watching it closely.  Good luck!

Kim
1982 - R patella tendon transversal
1983 - L patella tendon transversal
2003 - R TTT and patella medial ligament   reconstruction
2004 - L TTT and PMLR

Offline kathleenj

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Re: patellar tendon after scope
« Reply #4 on: January 19, 2004, 08:56:56 PM »
Thanks for your input...I just got back from PT and my therapist is a little concerned.  My swelling has increased dramatically and I have lost ROM.  She said that there seems to be quite a bit of scar tissue around the tendon which is causing it to tighten up.  To top it off, I have a stitch coming out of a closed incision so we may be dealing with an infection as well. I will be seeing my OS tomorrow so hopefully I can get all of this under control.  When it rains, it pours!
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline missmyknee

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Re: patellar tendon after scope
« Reply #5 on: January 19, 2004, 09:37:39 PM »
Hi Kathleenj

Please be diligent in your concern from scar tissue buildup on your tendon. My tendon was split by an OS using an outdated technique to place an intrameduliary rod down my tibia to repair several fractures. I had a healthy, functioning knee prior to this. I now have life long damage to the knee from scar tissue so bad it caused infrapatellar contractures and patella baja. I have had TTT osteotomy.,chondoplastys, fat pad removal and scar tissue removals and permant damage from it. My futre holds a PFJR and TKR. Do everything you can to prevent it.

Pam
4Fx Clsd red
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derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
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3 Fusions

Offline Heather M.

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Re: patellar tendon after scope
« Reply #6 on: January 19, 2004, 09:52:45 PM »
Kathleen,

I have to second what Pam and Kim have said.  If the patellar tendon tightens up and scars down, you are going to be in a world of hurt.

The good news, however, is that you have some time to deal with it--usually the most progress is made within the first three months after surgery.  If you're not doing better by then, seriously consider an MRI, full-on exam for patella baja with an EXPERIENCED surgeon who specializes in knees, and x-rays.  I can't stess enough how important it is to see a doctor who REALLY understands and works with arthrofibrosis (scar tissue in excessive amounts).  It's a very rare condition, and an OS who doesn't know what he/she is doing can make problems much, much worse.  I had a great surgeon, one of the top ones in the state (works on the Arizona Diamondbacks and other pro athletes).  But he wasn't experienced dealing with scar tissue, and admitted he'd never seen a case like mine.  We went through 4 scopes in 15 months and I was left with serious nerve damage, scar tissue, septic arthritis (two infections due to cortisone which was supposed to address the scar tissue!) and a knee that is basically a train wreck.

Patella baja (also known as patella infera) and infrapatellar contracture syndrome are nothing to be fooled around with, and both are a result of scarring of the patellar tendon.  They are believed to be two of the more difficult complications from knee surgery, and *no one* has any good idea of how to deal with it.

I don't want to scare you, because you are still well within the timeframe to positively affect your outcome!  You're so lucky to be in this position, because once you've had patella baja and/or serious scar tissue problems for about 6-12 months, many of the changes can become permanent.  There is one person on this board who has been able to beat the scar tissue demon (Laurie) and I truly believe it is because she immediately sought out an expert and did a very specialized protocol with a lot of hard work at home.  I had the same doctor and the same protocol, but my knee had been a mess for almost 2 years by that point...I've not had results that are satisfactory.  Right now I have bone on bone pain and a kneecap that is constantly snapping out of the joint because it sits too low down on my shinbone.  It's very, very painful.  I wish I'd known about scar tissue and patella baja when all this started out, but I didn't until I had been out of commission for 18 months and sat down to do some serious research online.  I wish I'd known then what I know now, so if you can benefit from our experience I'd be really happy!

Take care and let us know what your doctor says.  Go down to the soft tissue healing problems section and read up on patella baja, arthrofibrosis, tendinosis (as opposed to tendinitis), infrapatellar contracture syndrome, and so forth.  It will be a big help--there are even articles you can print to take to your doctor.  If he/she doesn't know what they are doing with scar tissue, then run for a big names expert who specializes in this condition.  

Heather

PS Where do you live?

PPS I wouldn't worry about the stitches coming out of the incision--the same happened to me from my last surgery.  About 3 weeks postop it started sticking out, and it took another five weeks for my body to 'spit it out.'  It happens sometimes, no biggy as long as you don't have other signs of infection.
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kathleenj

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Re: patellar tendon after scope
« Reply #7 on: January 19, 2004, 10:13:31 PM »
You guys have been extremely helpful.  I have done alot of research and I feel like I am totally prepared to see my OS tomorrow.  So many questions..he wont know what hit him.  I will definately not sit back and let this become a problem.  I live outside of Boston so I'm fairly confident that I'll be able to find a great doctor if it comes to that.  Right now, I feel very comfortable with my OS, he has been very honest and frank with me and for now I trust him.  I'll let you know what happens tomorrow.......thanks again everyone.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline kathleenj

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Re: patellar tendon after scope
« Reply #8 on: January 22, 2004, 08:31:21 PM »
Well I saw my OS.  He said the scar tissue is something that we need to keep under control.  He has ordered some sort of massage to loosen it up and keep it from causing any serious complications.  He was more concerned about the swelling that I have been having.  My PT stopped our session after 10 minutes the other day because I swelled up pretty bad.  I had started more weight bearing over the past week and was actually able to get around with one crutch.  He  thinks it may be too much too soon and said I need to go back to 2 crutches.  I dont really understand all this but he says that the more it swells the more scar tissue is formed.  Has anybody heard of this?  I need to go really slow with my PT because it swells up so fast.  Exercise for 5 minutes then wait to see if it swells, if not, proceed, if it does, stop and ice.  Does this seems normal to anybody?  
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Heather M.

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Re: patellar tendon after scope
« Reply #9 on: January 22, 2004, 10:17:54 PM »
Kathleen,

Kiss your doctor!  He's given you the absolute best advice possible, and it shows that he really knows what he's doing with scar tissue.  I'm thrilled for you.

The standard knee protocol is to push, push, push.  When you have scar tissue, that is the worst thing to do.  I know it's tough, but I'm so relieved to hear that you are back on two crutches and bearing less weight--I was really worried reading about your posts.

Your doctor is at the cutting edge, he's ahead of 99% of surgeons out there when it comes to dealing with scar tissue.  You are going to be fine if you follow the rules of no swelling and going slow, slow, slow.  Go to the soft-tissue healing problems section and read about various post-surgery posts (mine, Janet's, soccermom's, Laurie, and so forth).  You will have to go back a year or more to get all the posts.  You will see that the common thread was NO SWELLING, PAIN, HEAT, or REDNESS in the knee.

I was doing a great deal in PT, but NONE of it was weight-bearing until we had the swelling under control.  Talk to your doctor about patellar mobilizations (you should be doing these at home daily), wall slides (if your tendon repair permits--ask the OS!), quad sets with a towel rolled under your knee, scar tissue massage, anti-inflammatory treatments (Jobst cuff was the best), and the tens unit on interferential setting.  You've got to keep the knee moving without increasing swelling or heat.  Do you have a CPM?  I was in one for 5 weeks post-op, 16+ hours a day/night.  It was instrumental in my recovery.

You've got a lot of research and learning to do, but it really sounds like your doctor is on the right track.  Please check out the routines we have all done, take some info in to your PT/OS, and ask what you can do and should avoid.  Everyone's situation is different, but the common key is to keep the swelling and heat out of the knee while still keeping it moving.  Swelling is the mother of scar tissue--your doctor is right.

Sounds like you're in good hands.  Take care and keep posting.  Let us know how PT goes.

Heather
« Last Edit: January 22, 2004, 10:22:48 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kathleenj

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Re: patellar tendon after scope
« Reply #10 on: January 23, 2004, 10:57:17 PM »
Things are beginning to seem so much clearer to me now.  I really do feel like I am in good hands with my OS.  He called my PT right after we met the other day and discussed exactly what he wanted done.  My PT said doctors rarely call them personally, but he did.  
As far as therapy goes, today went great.  I was there for much longer than normal but came out with minimal swelling and so far its doing pretty good.  She did do the massaging but went very slowly with it and then put on a topical steroid with electrical stimulation  to prevent swelling and break up scar tissue.  I dont know if anybody else has heard of it or has had it but it works wonders.  It was quite uncomfortable for about 25 minutes but, wow, what a difference afterwards.   We will continue this for the next few weeks to see how it handles the scar tissue.  I am actually looking forward to more PT on Monday.  My knee is feeling better today than it has the past few weeks. Still stiff, but much better.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Janet

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Re: patellar tendon after scope
« Reply #11 on: January 24, 2004, 03:22:58 AM »
You are incredibly lucky to have a doctor who recognized the problem right away and took steps to minimize the swelling. My problem was ignored for so long (I was told to "be patient, it takes a long time"), I ended up with infrapatella contracture, patella baja, a tracking problem, and a totally messed up knee. And to think this could have been avoided if the scar tissue had been dealt with sooner. It took me four doctors to find one who really knew what he was talking about, but by then the damage was too severe to do much about it. I had a fourth surgery last June, and I think we've got the scar tissue issue controlled, but I will always have pain and limited function, and will eventually need more surgery. Consider yourself blessed and good luck!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.