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Author Topic: Back in the dark - returned pain around a year post ACI surgery  (Read 241 times)

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Offline Celina1989

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I have had ACI surgery in March 2020. It seemed to be succesful and I must say recovery went better than expected. I was able to go for long walks, full ROM, no pain. Then at 10 months I started having some pressure after a 1 hour walk. In the next month it turned to irritation. I went back to my OS for an MRI, the MRI did not show anything. I was thinking about overgrowth since all went so well but I don't have enough clicking I guess (the doctor can't provoke it). Around a year post surgery my knee pain was as before the surgery. In the next month I had a hyaluronic acid injection without result and a Cortison injection that only helped a little bit for sleeping at night. It looks like even my doctors are a bit clueless. He is now thinking about scoping because that is the only way to see the quality of the cartilage. I also asked him about nerve damage and we will look into that as well.

Over a few months my pain became so bad that I am now only able to do a 40 minute walk once every 2 days (ice before and after). In general I ice 4 times a day and elevate as much as possible. I wear my brace (unloader) all the time. I notice that my knee gets warm (even hot) after inactivity.  Activity does decrease the warmth in my knee. The knee gets so warm and then painful that a normal night sleep wouldn't be possible with regular icing (ice machine  / cold therapy machine). ROM isn't affected. The pain is also at the exact same spot of my ACI, the medial femoral condyle although sometimes I feel the heat on the whole inner side around my kneecap. the pain is more burning and constant.

I know it is a long shot since I tried to research what this can be and can't seem to find it. I really hope somebody recognizes this and can explain to me what this is or give just any advice. Thank you.

Offline vickster

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Re: Back in the dark - returned pain around a year post ACI surgery
« Reply #1 on: May 27, 2021, 02:57:14 PM »
Fat pad irritation?
Tendinitis?
Synovitis?
PFS? Overuse?

Have you had an X-ray to assess the joint space? A CT scan to look at the bones in more detail to an MRI?

The issues sound a bit like an arthritis flare, which would tally with the steroid helping for a bit (and ice). Does anti inflammatory help, either oral or topical?
Have you had a blood test to check for inflammatory markers? Any other health or other joint issues?

How is non weight bearing exercise like swimming, cycling, rowing?
Have you had your feet and footwear assessed? Orthotics made to also help?
Are you bow legged at all?
Do you still have all your meniscus? Is it healthy or degenerate?

Maybe a scope is the way to go so the surgeon can look at the defect and the state of the cartilage. Fibro or when hyaline like is never great, and not as good as the original.
In my experience at least, there’s always more wear than is obvious from the scans.
My surgeon gives HA and steroid at the same time, but it’s a temporary band aid rather than any sort of cure for cartilage issues!

Have you considered PRP or stemcells to get on top of the inflammation rather than more surgery?
« Last Edit: May 27, 2021, 03:51:52 PM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Celina1989

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Re: Back in the dark - returned pain around a year post ACI surgery
« Reply #2 on: May 27, 2021, 04:25:40 PM »
Thank you for your fast reply Vickster. I am thinking it is unlikely to be inflammation because the Cortison injection did next to nothing. I didn't have any other diagnostics recently.might be a good thing to ask for an x-ray and maybe a CT. Ibuprofen 600mg does only work a little bit but I have found that ice seems to be the best remedy. My guess is something keeps causing friction which gives inflammation like symptoms. I have no other health problems (my left knee is only hurting a little from overuse from compensating for my bad knee).

I do have insoles for several years now. Walking is better than standing. Cycling (on a stationary bike) most often goes well but I do ice afterwards. My legs have been checked and no X or O legs. Besides an osteochondral lesion in my MFC I don't have any other known issues with my knee than this.

I was prepared that the healing could not be 100% but all went great till the start of the year. Aren't PRP and stemcells not temporary? I thought it was a treatment,
 But I didn't know it might strenghten a previous treatment.

I think it might be best to do a scope, nerve testing and now also an x-ray and based on excluding causes deciding what to do. Trying prp /stem cells might be a good follow-up if all results are negative / inclusive.

Offline Celina1989

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Re: Back in the dark - returned pain around a year post ACI surgery
« Reply #3 on: June 11, 2021, 03:44:35 PM »
I had my appointment yesterday. They think that low muscle strength (due to rest in the hope that my knee would recover) might cause my symptoms now. I am going back to pt. If pt isn't working then I will get a plug (episurf / episealer). Happy with the result and happy I am finally allowed to do something again. Sitting and waiting is really hard. I now got it a bit in my own hands and that feels much better. I haven't discussed any other treatment yet since that might cover the results from pt. If all goes well a new MRI in 4 months. If not I will call earlier that it is time to continue. 

Offline vickster

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Re: Back in the dark - returned pain around a year post ACI surgery
« Reply #4 on: June 11, 2021, 04:21:04 PM »
Can you get into a swimming pool and work on your strength with the support of the water? Can you do hydrotherapy with a physio in a pool as well? I find it really helpful (plus swimming for fitness)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone