Hey everyone. Just joined to see if i can get some answers from anyone with knowledge about my problem.
Last august my right leg was crushed at work between an electric burden carrier and a guard rail. It hit me at an angle twisting my knee and calf and pinning me between the car and rail. The only way to get out was for him to back up which caused my knee and calf to twist back the other direction. This caused a tear in my medial meniscus which i had repaired in december by arthroscopic surgery. I went through a few months of physical therapy and returned to work in mid april. I was put on light duty for 2 months since i had been off work for about 8 months. The popping and swelling of the knee are gone. I still get the occasional locking up. Now before i returned to work on full duty in june i told my ortho that i was getting sharp pain on the inside of my knee and down the inside of my calf which was also very sensitive to the touch. He told me it sounded like i had pes-tendonitis in that area and prescribed me 800mg ibuprofen to take 3 times a day. After doing this for 6 weeks i returned to him and told him i was still in pain but now the pain was behind the knee and in the back of the calf also. But this time the diagnosis was damage to the medial head of my gastroc muscle caused by the impact and crushing. He told me to continue with the ibuprofen and released me as permanent stationary. But he wants an mri in december which would be a year after the meniscus repair. I told him i think i need one now but he didnt think it was necessary. Not satisfied i have made an appointment with a new doctor which i see next week. Today i am still working and still have pain on the inside of the knee down the inside and back of my calf and behind the knee. The inside of the knee is very sensitive and when i bend my knee a certain way a bulge the size of a cut in half baseball appears. My work involves being outside and walking on uneven ground and going up and down stairs all day. I am in pain all night at work especially when the weather is cold. I drive to work 40 minutes each direction and even that is becoming difficult to do. I can not do any of my recreational activities which include softball and riding quads. I now take my norco from post surgery to fall asleep. Any ideas??? Im thinking i need an mri of everything and not just my knee which is what the original mri showed. And sorry for the super long post...if you are still reading this.
thought i would post an update. got my mri results back. they are as follows...
clinical history: the patient is a 29 year old male who has previously undergone arthroscopy for meniscal surgery in december 2009. he has medial knee pain and swelling.
technique: this imaging examination was accomplished using a philips (marconi) medical systems proview open mri system with high-performance gradient magnets, advanced rf coils with enhanced signal reception capabilities and noise filtration technology.
menisci: there is diminished volume of the medial meniscus consistent with prior arthroscopic surgery. no re-tear is shown. the lateral meniscus is intact.
ligaments and tendons: the anterior and posterior cruciate ligaments as well as the medial and lateral collateral ligaments are intact. the quadriceps/patellar tendon extensor mechanism is normal.
joint space, articular surfaces and osseous structures: a small knee joint effusion is shown. moderate grade II-III/IV chondromalacia patella is shown at the midface of the medial patellar facet. no subchondral marrow space signal alteration is shown.
adjacent soft tissues: mild linear fibrotic changes are shown in hoffas fat pad consistent with prior arthroscopic port placement.
1. moderate chondromalacia patella is shown at the midface of the medial patellar facet where there is moderate attrition of articular cartilage. no subchondral marrow space signal alteration is shown.
2. diminished volume of the medial meniscus indicates prior arthroscopic decompression. no re-tear is shown.
3. arthroscopic ports are noted through hoffas fat pad bilaterally on either side of midline.
i got the results in december. ortho said my knee is pretty much perfect and i have many years left of a good knee. he suggested 6 weeks of physical therapy to strengthen and increase my range of motion. ended my p/t 2 weeks ago.
on consultation therapist asked if i have ever dislocated my patella because the tracking is off. i havent and was never told by any ortho that i had. so they taped me each visit to get my patella back on track. she also said that the muscle i intially injured on the inside of my knee was small and weak. so she worked on building that muscle up. it was feeling ok with the couple of hours a week of therapy but after each visit my patella would be real sore. now that therapy is over my injured muscle has improved a little but the muscles below that have built up to be way stronger. the therapist said this could be the major cause of my tracking problem. i have never felt any type of patella pain prior to this even after my accident.
i have just finished my first week of full duties at work. i work at a railroad and my job involves driving the locomotives to and from where they need to go in the yard. so for 8+ hours a day i am going up and down the stairs of the locomotive and walking on ballast and uneven ground. i am having pretty extreme pain in my patella while going up and down the stairs of the locomotive and also while sitting for an extended period of time. driving has also become a pain with the 80 mile round trip to and from work. walking on the uneven surfaces has not really bugged me too much like it had before the p/t but i can notice the weakness of my knee.
i go back to see my ortho next week. any thoughts on my problem before he tells me once again that im fine and my knee is perfect??
All of your latest symptoms still point to kneecap subluxation (the kneecap tracking wrong..probably toward the outside part of your knee). It usually happens because of weak quad muscles on the inner part of the knee. I had that problem in both knees. I did 6 months of pt for the left one. Exercises and taping didn't help. I had lateral release surgery to correct the left knee in 2008, and I had a lateral release to correct my right knee in 2009. My surgeon did arthroscopic surgery to check for problems both times, but my lateral releases were open procedures. The lateral release can be done arthroscopically. My kneecap tracking issues never showed up on any of my mri's. My surgeon just diagnosed it during the physical exams of my knees. I have had knee problems on and off since 2006, so I can sympathize with you. If you have any questions, please ask!
thanks for the reply ozfan! since the accident has happened i have had close to six months of therapy at 3 different places. they all seem to work a little but that muscle just doesnt want to build up like it should which means i have had a bad tracking problem since august 2009. is this long enough period of time to develop the chondromalacia? i have only worked about 7 months total since the accident but it does involve stairs and uneven ground 8+ hours a day. and when the accident happened my son was only 3 months old so i have spent everyday taking care of him.
so if the tracking isnt fixed it will cause the chondromalacia to get worse? im not sure exactly what grade II-III/IV means. is it a little of all three grades or is it more towards III/IV?
It is definitely long enough. I initially developed my tracking problem in my left knee in January 2006. By July of 2006, I was diagnosed with chondromalacia. It can develop quickly. When your kneecap tracks wrong, the cartilage under your kneecap is being thinned and frayed constantly. When I finally had surgery on that knee in 2008, the cartilage under my kneecap looked like a stretched out cotton ball because of the damage that was done to it. Yes, the cartilage damage gets worse if it isn't fixed. I'm not totally sure what the grades of severity mean. I was never told how severe mine was. The surgeries that I had to fix my tracking issues were well worth it. 2 and a half years after my first surgery, my left kneecap is still tracking properly. By the way, I had to go to two orthopedic surgeons before I found the one who did my surgery. If you disagree with your orthopedist's diagnosis, a second opinion might be a good idea.
wow i guess it can happen very quickly. well im happy to hear your knee is still doing good and that it can be fixed and is still holding up after two and a half years. im ready for some pain free days, especially since i have my daughter due in may.
i may have to go to another ortho if this guy starts acting like the other ones. the only orthos i have seen have been the ones my employer says i have to go to.
how long did it take you to be up and walking after your lateral releases? now that they are tracking properly do you have any pain? what about if you go up and down stairs or walk on uneven ground? sorry for so many questions.
I was bearing weight on my knee with the aid of a walker (because I can't use crutches) on the day of my surgery. The full recovery for me was 2 to 3 months, but I was back to fairly good shape after 6 weeks. I don't have much pain now, but the pain I do have is not from tracking issues. I have scar tissue built up in my left knee, and I had part of my meniscus removed in my right knee 6 months after that lateral release in 2009. The tracking issue and the meniscal tear in my right knee were totally unrelated. I do walk slower up and down stairs, but that is just because I want to prevent further injury.
well i saw my ortho yesterday. i told him all of my problems and he decided to take me off of work again. he wants me to do another month of p/t and work on my quad muscle.
we went over my mri's and surgeon notes since my injury. first mri, taken a month after accident, showed no chondromalacia. surgery notes from meniscus repair, 4 months after injury, showed removal of part of the meniscus along with loose bodies. surgeon also noted start of chondromalacia but didnt do anything to it while he was in there. fast forward to my latest mri taken 15 months after injury. the chondromalacia has gotten worse. it is now grade II-III/IV.
so my guess is that my nearly six months of p/t hasnt really done much to help and may be actually making my knee worse. i have a follow up appointment at the end of march. not sure what the next step is. guess i will have to wait and see.
newest update...started therapy again at the end of february. on first visit while doing calf stretches my knee completely locked up and i could not put any weight on it. p/t had me lay on my stomach and she twisted my calf and pushed down on my foot and the pain was almost instantly gone. i stopped exercises after this. on my second visit while doing the same calf exercises my knee locked up again. once i got on my stomach the p/t could see a bulge sticking out the lateral side of my knee. she did the same thing where she twisted my calf and pushed down on my foot and the pain and bulge went away. i tried some heel raises after my knee felt better and it happened once again. after putting my knee back in place she advised me to see my ortho and said it could be a lateral meniscus problem.
so i got in yesterday to see him. he did some movement tests on me and i told him what was happening. he said he can clearly see the patella tracking way off and is requesting a lateral release for me. he is also gonna be checking everything else out including the grade II-III/IV chondromalacia. not sure what can be done about the damaged cartilage now. maybe scrape it out or something.
So i guess i should update my post. Its been about 6 months since i had my surgery. I was hoping by now i would be able to post that i am happy and fully recovered. Well im not. Some notes from surgery report:
1. Right knee softening of the lateral patellar facet.
2. Chondromalacia of the lateral patellar facet.
3. Chondromalacia of the lateral tibial plateau with softening.
1. Right knee arthroscopic partial synovectomy.
2. Right knee arthroscopic lateral retinacular release.
The patient had a significant anterior fat pad and synovitis. The patient also had a patellar tilt with a tight patella that could not be made flat or smooth parallel to the femoral trochlea and minimal to no translation medially.
I thought by now, with 3-4 months of physical therapy, i would be good to go but with activity, including too much walking and stairs, i am getting intense pressure behind the knee cap. If i do not relax and let that pressure go away it will turn into an awful pain that puts me on the couch with my leg elevated. And the last few weeks of therapy i was starting to get a lot of pain in my other knee. This knee has no previous injuries or problems. PT said she sees a lot of patients who have an injury to one knee start having problems with the other due to over compensation with the good knee. This has been a consistent problem for over 2 years now.
Ortho decided to do a blood test to see if any other sources were the cause. Everything came back negative except i have an elevated SED RATE. Its a 25 and im supposed to be at a 15 or below. He says it is probably arthritis but ruled it out as my knee pain. He has since released me back to full working duty, which includes 8 hours of stairs and walking on uneven rocky ground. And he pretty much said my knee is perfect and i shouldn't be having any pain. Which is exactly what he told me a month before he performed my surgery. Well guess what...he is wrong again.
Just wondering if anyone is in the same boat as me after having a couple of knee surgeries and having the same type of post surgery diagnosis. Sorry for the long post...if you are still reading this.