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Author Topic: Exostosis fibular head  (Read 936 times)

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Offline Vickster

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Exostosis fibular head
« on: December 30, 2015, 02:08:24 PM »
Bit of an odd one this...

I have an exostosis (like an extra lump of bone which develops when the bones don't grow quite right in teenage years) on the fibula head (I believe in both legs but it's the right causing the trouble). I realise this is not technically part of the knee (proximal tibio-fibular joint to be exact) but it falls into the remit of a knee surgeon :)

I've been having pain laterally in my right shin, a couple of inches I guess below the knee since around September 2014, X Ray showed this exostosis, MRI showed torn lateral meniscus and some wear in the knee.  Had scope in Feb 2015 to tidy the torn meniscus, remove inflamed fat pad and tidy up patella. 

The knee has been broadly ok since (other than some PFS, due to weak glutes and really tight calf muscles), I've carried on with desk job, cycled a couple of thousand miles etc but this pain in my shin persists and is indeed probably worsening (there is some swelling of the muscles), it's mostly very achy when sitting, can be quite a sharp pain (e.g. when pushing up hills on the bike)

I discussed treatment options at length with my knee surgeon in May, who thought that the exostosis was irritating the soft tissues around it and that it may settle with time, and to use NSAIDs for relief as required.

There'd been no improvement so after waiting 7 months, I saw the surgeon again a couple of weeks ago for further discussion.  Physio doesn't help and I've been told not to get any sort of massage to the area, nor stretch it (not helped by those tight calves)

Given the location of this exostosis, neither injections nor surgical removal are a very safe option as the peroneal nerve is wrapped right around the area and there is a very high risk of damage to the nerve as it needs to be moved to excise the exostosis (leading to temporary foot drop, sensory issues or worse  :-\ ).  Thus the surgeon was highly unwilling to do anything - I trust him implicitly (he's been patching up my knees for 6 years now), so if he says the risk is high, then it's high! 

He'd much prefer to operate (open surgery) than try any sort of injection as even with U/S or X-ray guidance, the risk to the nerve is significant (even more so with cortisone).  Basically, it's not a matter of whether the nerve will be damaged at all but to what extent and for how long!

I've had a CT scan (awaiting results) so he can get a better idea of the anatomy and to check that there's no urgency to do anything.  Things are complicated for me due to work and more so I need to have shoulder surgery in March.  The leg is uncomfortable (to painful), nothing much seems to help but it is livable but forever, I don't know!  The shoulder surgery will take me off the bike for quite a few months which may help the leg to settle if cycling is indeed the main aggravation!

I could see another surgeon but I doubt the outcome will be any different and I'd rather stick with someone I know, like and trust (he's extremely experienced, very cautious, does a lot of knee surgeries, definitely knows his stuff)

I'm wondering if anyone has been through anything similar - i.e. had to decide on a treatment or surgery that was high risk and would inevitably lead to complications and damage to hopefully reduce pain and improve quality of life going forwards?

I can't do anything for some while anyhow but this is really troubling me as I don't know what to do!  Surgery per se doesn't bother me, and I know all operations carry risks but normally they are the exception rather than the norm!

Thanks in advance  :)
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