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Author Topic: Edema in knee hasn't subsided after 5 months?  (Read 3622 times)

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Offline kneegurubro

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Edema in knee hasn't subsided after 5 months?
« on: March 23, 2015, 10:05:13 AM »
Compared to my MRI of 5 months ago the edema hasn't seemed to have reduced, what could you do to help remove it? Can anyone recommend drugs, supplements, other treatments or would it require surgery?

EDIT this page seems to think subchondroplasty is a good option would anyone recommend? http://www.howardluksmd.com/orthopedic-social-media/bone-marrow-edema-knee/
« Last Edit: March 23, 2015, 10:08:26 AM by kneegurubro »

Offline Vickster

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #1 on: March 23, 2015, 10:09:52 AM »
Bone marrow edema?  A bone bruise, can take 6-12 months to heal.  There's no surgery unless there's a specific cause other than trauma to the bone

You could try PRP possibly to remove any other inflammation in the joint, possibly need multiple injections, can get expensive

What does your orthopaedic specialist suggest?  If you've not seen him since the injury, you should go back to discuss what treatment might be appropriate.  With bone bruising however, it's mostly time and avoiding anything that makes it worse.  Which bone is affected?  Are there cartilage defects as well?

Ref the subchondroplasty, you'd need to find a surgeon who does it, check whether it's covered by insurance or how much it costs.  Looks like it's an arthroscopic op

http://www.subchondroplasty.com/about_subchondroplasty/subchondroplasty_faq

http://www.subchondroplasty.com/about_subchondroplasty/what_is_subchondroplasty
« Last Edit: March 23, 2015, 10:31:02 AM by Vickster »
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 kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #2 on: March 23, 2015, 11:36:06 AM »
You're right it's  focal bone marrow edema, it's been 12 months now ( i got the first MRI about 5 months after the incident)
Does HGH injections have a similar effect to PRP? I'm currently in USA so you can  get it pretty easily
They are saying to exercise and let it heal on it's own, but i've been waiting a long time now so i'm looking for other options.
The MRI says the damage is a focal bone bruise in the media femoral condyle
There may be cartilage damage, the knee sometimes crunches whenever i fully extend it while walking, while sitting it always crunches when i fully extend it. That may be patella tracking or being roughed up like you said.


Offline Vickster

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #3 on: March 23, 2015, 11:53:50 AM »
The bone bruise in the condyle won't cause patella crunching, that'll be maltracking or damage to the patella.  If the cartilage is damaged, it's very hard to repair effectively.  If on a weight bearing surface, it will cause pain potentially when moving around

 PRP is anti-inflammatory, help with reducing pain as a result and can promote healing (of soft tissue, not so much proof in controlled trials that it helps bones)

You should go find a knee specialist who offers these treatments and discuss your case.
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 dal_knee

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #4 on: March 23, 2015, 04:31:22 PM »
kneegurubro,

I just had the subchondroplasty procedure for the same issue 3 months ago for chronic bone marrow edema (~ 4 years), associated with a chondral defect.  In the months prior to the procedure, I "tried" 3 PRP's which did nothing for the femoral bone pain.

If you look at my recent posts, I have more info on my issue and surgery, results etc.     The surgery has helped but I'm not yet out of the woods.  I had a recent stem cell injection, and that really set me back and am having more bone pain now.  I'm practicing patience......   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #5 on: March 28, 2015, 10:21:58 AM »
I checked it out and your symptoms seem to be more severe than mine, as for me it feels tender to touch and there is a lot of popping (that may not be due to the edema) and a dull ache (more so at night)
Am i correct that, for you the subchondroplasty was painful for a couple of weeks but then improved, do you think it made any improvements over how it was before you did the surgery?
I was going to do subchondroplasty surgery to reduce the edema,  and then take HGH to see if it would heal the cartilage damage, which may be causing the crunching of the knee (likely also due to patella tracking)
« Last Edit: March 28, 2015, 01:03:32 PM by kneegurubro »

Offline dal_knee

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #6 on: March 29, 2015, 12:38:26 AM »

HI,
I would say I was "uncomfortable" for about 4 weeks post-surgery before real improvements started.   I was told to attribute it to walking on the weight-bearing area of the condyle while simultaneously allowing the bone paste to help heal the bone marrow inflammation.  It's the whole "it's going to get worse before it gets better" perspective.     

And certainly, I'm better off than I was prior to the surgery.   

Do you know if your MRI says there is a chondral defect adjacent to the area of femoral bone edema?  How big is it?  That is more likely to be a causative factor in the development of the bone edema than patellar maltracking.    You may have two different issues.   Patella maltracking can be corrected with PT exercises in most cases, unless you have a congenital defect like patella alta/baja.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #7 on: March 30, 2015, 03:50:18 PM »
I now see that the report says no chondral defect
« Last Edit: March 30, 2015, 04:23:08 PM by kneegurubro »

Offline dal_knee

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #8 on: March 30, 2015, 03:58:06 PM »
That's really good.    I read up on your history and I believe that since it's due to an isolated incident (you fell onto your knee directly right), and there  is no associated chondral defect, that the orthopedist is correctly advising you to wait it out and allow nature to run its course.  Resolution could take as long as a year and  a half.  I know that's probably not what you want to hear.   

I don't have any experience or input with HGH, but I think PRP would be helpful to calm the swelling and inflammation, assuming that's an issue for you. 
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #9 on: March 30, 2015, 04:21:37 PM »
Yes that's exactly what happened
For me, there is some swelling (which may be  another thing causing the aching),  including a semimembranosus bursa
PRP does seem to be highly recommended by everyone, i will check it out, I also read that taking both of these will give even more benefits
If there's no chondral defect, do you know if that means that there is no cartilage damage to the knee?
Would you recommend getting the subchondroplasty to reduce the edema, or would you feel it's not necessary? The reason i would take is if it would speed up the healing , but i'm questioning that since my problem isn't that big
« Last Edit: March 30, 2015, 08:22:24 PM by kneegurubro »

Offline dal_knee

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #10 on: March 30, 2015, 08:31:44 PM »


Hi,
If there is no chondral defect on the femoral condyle then there is no cartilage damage there (on the femur).  But you may still have cartilage softening, fissuring underneath the patella.  The patella has cartilage underneath it too.   

I wouldn't recommend the subchondroplasty surgery if it's something that will heal on its own.  If it becomes chronic and debilitating for you, I would certainly consider it.     You wouldn't be considered chronic until you are about 1.5 years out when it comes to bone bruises.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #11 on: March 31, 2015, 12:26:10 PM »
Is PRP similar to subchondroplasty, as in does it reduce edema?
On the topic of  crunching, since there doesn't seem to be cartilage damage, what do you think the cause of the crunching would be? I see you mentioned patellar maltracking, or could  it be caused by something else?
« Last Edit: March 31, 2015, 12:42:39 PM by kneegurubro »

Offline Vickster

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #12 on: March 31, 2015, 01:42:50 PM »
PRP reduces inflammation and aids healing in soft tissues primarily, not bone

You'd be best off seeking out a specialist who can advise.  With bone bruising, time is the thing, there's no miracle cure
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 kneegurubro

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #13 on: March 31, 2015, 08:27:56 PM »
Will do, so for swelling then, the best to reduce it is subchondroplasty, while PRP is for inflammation
i was looking for something to speed up the healing of the bruise

Offline Vickster

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Re: Edema in knee hasn't subsided after 5 months?
« Reply #14 on: March 31, 2015, 08:42:01 PM »
You'd be best off contacting one of the specialists who do the procedure

http://www.subchondroplasty.com/physician-finder/index.html

But do you want surgery with the potential complications that can occur when all it likely needs is time :)

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















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