The Knee-Free Zone

[Superbob]

Several of us have been coping with knee maladies lately, so I thought I would start a knee thread where any of we disjointed folks can post.

If I recall correctly, Pamela had knee surgery about a month ago, and had some post-op infection, which, last we heard, was clearing up okay. Hope all's going well for you, Pam.

I think Betty (bvdr) is due for knee surgery soon. I'll let her update us about that, when and if she'd like.

Again, if I recall correctly, Ton's hubby had a "dodgy" knee (crikey, I love the way you Aussies talk! ) and was taking some of that glucosamine supplement. Be interested to hear how that's going.

As for Superbob, the official ortho scheduler has sent him a wonderful schedule of appointments that will keep him from overflying tall buildings for the whole month of September and then some. First, a thorough heart checkup on Sept. 12, followed by pre-op lab work on the 17th, surgery on the 23rd, post-op visit No. 1 on September 26, post-op visit No. 2 on Oct. 6, and then a to-be-determined number of physical therapy visits. (Superbob is very much hoping his PT turns out to be as hot as his personal trainer.

Okay, who has Superbob left out? (Sometimes his superpowers fail him.) If I did leave anyone out, please accept my apology and chime in. Let's get all these beautiful knees out there for everyone to see. (Maybe we need to post tawdry bermuda shorts pictures post-op.

 

[Phyllis]

I put you on the calendar for Sept. 23rd, Bob. It's not heart surgery, but you will still be in our prayers and thoughts.

 

[Marguerite53]

Me! You left out me!

So what type of surgery are you going in for. Sorry, I haven't been around here much this summer and knew you were getting the MRI but never heard what they decided to do. Please tell all.

I'm just hanging on with the syn-visc shots until my knee will no longer respond to those (favorably) and will inevitably need a knee-replacement. I'm trying to lose enough weight so that the knee holds up as long as possible. So far so good.

Marguerite

 

[aussigal]

Good idea to start a "knee's up zone" SB...

Hubby has been hopeless at taking his glucosamine but I am gonna take control and hand it to him personally and see if we can get some results worthy of publishing here!

He is currently using a "Futuro" elastic twist support bandage thingy and he likes the feeling of support it offers. It doesnt do much to stop pain but it makes his knee feel less likely to crash. This is all hubby is willing to do at present. He needs something to whinge and whine about!...LOL...

I hope SB's knee is resting comfortably.

 

[Superbob]

Me! You left out me!

So what type of surgery are you going in for. Sorry, I haven't been around here much this summer and knew you were getting the MRI but never heard what they decided to do. Please tell all.

I'm just hanging on with the syn-visc shots until my knee will no longer respond to those (favorably) and will inevitably need a knee-replacement. I'm trying to lose enough weight so that the knee holds up as long as possible. So far so good.

Marguerite

Marguerite, how could I? I told you Superbob's superpowers sometimes failed him! You have been one of the most helpful folks in telling of your experiences with a dodgy knee and offering some great advice.

The MRI confirmed what had been suspected four months ago -- torn cartilage, torn meniscus -- and the doc offered arthroscopic surgery as an option, to scope out the damage and possibly even alleviate where some mild arthritis has started setting in. I am not as good as some of you in getting all the technical details but that's what I got out of it. He also hinted something more heavy duty might be needed down the road -- I gather he was hinting at knee replacement, but we did not get into that.

Marguerite, I hope your syn-visc shots keep helping, and all goes well for you. Keep us posted.

Ton, I am like your husband in liking to whine. We need babying. Hope you can get him to take his glucosamine. Many seem to get good results from it. For me, it was clearly spiking my blood sugar -- up some 20 to 30 points from where it is now that I have quit taking it.

Occasionally I still have a good day when the knee feels normal, but then I have a horrible day, like yesterday. Makes me think fragments are floating or sliding around in there

 

[bvdr]

Ok, here goes. The last few months I have been having a rough time with my right knee. Pain, at first especially when going up and down stairs or stepping off a curb but it kept getting worse. It has been swelling to the point I couldn't bend it more that 45 degrees. It has been catching and locking on me. Many days I needed a cane to get around. I tried to ignore it (deny?) until one day I couldn't put any weight on it at all.

The whole thing is a long story but the MRI shows a complex tear of the posterior horn of the medial meniscus, cystic change in the central tibial plateau at the ACL attachment. Grade 4 chondromalacia involving the patellar apex. Less advanced chrondromalacia (grade 2 & 3) in the remainder of the patellar femoral compartment as well as the lateral medial compartments. There is a joint effusion present.
The cruciate and collateral ligaments are intact. Lateral meniscus is intact and there is no fracture.

Like Superbob, I'm scheduled for arthroscopic knee surgery.
The date is Sept. 16th. The surgeon thinks it will help but that a total knee is in the future. It seemed a little unreal. It seems like I have a growing list of orthopedic surgeries that will need to be done at some point. I just want to get it done and over with so I can put it out of my mind. I expect to do just fine and I know that whatever grace I need will be there at just the right time. I'm OK.

 

[Superbob]

I certainly be saying my prayers for you on the 16th, Betty. Have heard from a lot of people who have had good results with the "scoping." Wow, you sure got a lot of details -- did you get a copy of the doctor's report, or did you just remember all that? I guess I should have asked more questions and probably asked for a report (which I guess I can still do)...

Our knee problems seem similar. My right knee also is the one the surgery will be done on, even though my left knee is the one that had zero cartilage left. Who knows what may be down the road -- but one step at a time. Certainly wishing you well.....Thanks for posting ....

 

[Phyllis]

Ok, here goes. The last few months I have been having a rough time with my right knee. Pain, at first especially when going up and down stairs or stepping off a curb but it kept getting worse. It has been swelling to the point I couldn't bend it more that 45 degrees. It has been catching and locking on me. Many days I needed a cane to get around. I tried to ignore it (deny?) until one day I couldn't put any weight on it at all.

The whole thing is a long story but the MRI shows a complex tear of the posterior horn of the medial meniscus, cystic change in the central tibial plateau at the ACL attachment. Grade 4 chondromalacia involving the patellar apex. Less advanced chrondromalacia (grade 2 & 3) in the remainder of the patellar femoral compartment as well as the lateral medial compartments. There is a joint effusion present.
The cruciate and collateral ligaments are intact. Lateral meniscus is intact and there is no fracture.

Like Superbob, I'm scheduled for arthroscopic knee surgery.
The date is Sept. 16th. The surgeon thinks it will help but that a total knee is in the future. It seemed a little unreal. It seems like I have a growing list of orthopedic surgeries that will need to be done at some point. I just want to get it done and over with so I can put it out of my mind. I expect to do just fine and I know that whatever grace I need will be there at just the right time. I'm OK.

Betty you will be in our prayers on the 16th and I added you to the calendar.

 

[bvdr]

...... Wow, you sure got a lot of details -- did you get a copy of the doctor's report, or did you just remember all that? I guess I should have asked more questions and probably asked for a report (which I guess I can still do)...

Our knee problems seem similar. My right knee also is the one the surgery will be done on, even though my left knee is the one that had zero cartilage left. Who knows what may be down the road -- but one step at a time. Certainly wishing you well.....Thanks for posting ....

I got a copy of the MRI report. I always do now. You need your's too so you can be a well informed member of your medical team. No one can remember everything....even Superbob can't remember everything he's told. I only had an MRI on the right but had xrays of both. Did you get an MRI on both knees? If so, get them both and read them and file them away. I make a copy for my PCP to put in my office file as well.

Our knee problems sure do sound similar. I've had a couple of good days in a row but know that is not unusual. It still is swollen though. I'm real sorry that you are going through this too ...but since you are, I'm glad for the company.

Marguerite, I hope those shots continue to help for a long long time!

Phylis, thanks so much. You are very much in my prayers. I know this is such a minor thing compared to what you are going through and you are so sweet to be still watching over us.

 

[Marguerite53]

I think I may have already recounted my story, but here goes.....

About 6 years ago my knee had been hurting for a long time. Same thing as Betty, couldn't bend it all the way, having trouble kneeling down to get anything...just a lot of swelling and pain. I stayed in the grin and bear it mode for a long time. Then one day I was walking across a gymnasium to watch my daughter practice volleyball. Out of nowhere I just fell, my knee just buckled under me and I made the loudest ker-splatt on the floor. VERY embarassing. So much so that I got up the next day and made an appointment with the orthopedist. He thought it was just some water on the knee and put me on the then okay, Vioxx. Much relief. But after the regimine, the pain came back. So after another 6 months, I told him I wanted an MRI. It came back with a deeply torn meniscus. He apologized to me because he then realized how much discomfort I'd been in, and that he'd been wrong! We also MRI'd the other knee and found the same problem. We attributed mine to what can occur with women as their hips pull on the knee somehow. So as well as going in there and repairing the torn meniscus (which actually means just shaving it down like a fingernail with a fingernail file because it's not like it gets sewn back together or anything...just smoothed so that the rubbing and friction is alleviated. An amazing little chomping machine... I got a video afterwards!!) I also had what is called a "lateral release" of the knee cap. His theory is that by letting the kneecap float over the area, the rubbing in one place will diminish and there won't be any more need to repeat the surgery. Years later, as my knee top seems to have worn down its cushion, I wonder about the logic of the lateral release, but for sure, the repair of the torn meniscus was fabulous. NO PAIN anymore for the longest time!! It's like heart surgery....why do we wait???

So please listen carefully, you two, to what the surgeon says to do afterwards in terms of bending the knee and not walking on it until such and such a time. I had both knees done, 6 weeks apart. I should have waitied longer in between. But the first knee I babied way too much and didn't do what he said I should do to stretch things. So the second knee I did the recovery right and it no longer bothers me at all. So listen carefully! And definitely do the physical therapy afterwards. I still use some of the exercises for strengthening.

Then, once the torn meniscus is repaired, and you start to have arthritic pain....then you get those syn-visc shots and you get relief from that pain for 6 months; then another round of shots. There really are helping scenarios that can take you way far down the road before you need knee replacement.

So go into this orthoscopic surgery smiling!! You will be amazed.....you will be walking again!!! And happy!!!

Best wishes to you both for successful and easy orthoscopic surgeries!

Marguerite

 

[Superbob]

I think I may have already recounted my story, but here goes.....

About 6 years ago my knee had been hurting for a long time. Same thing as Betty, couldn't bend it all the way, having trouble kneeling down to get anything...just a lot of swelling and pain. I stayed in the grin and bear it mode for a long time. Then one day I was walking across a gymnasium to watch my daughter practice volleyball. Out of nowhere I just fell, my knee just buckled under me and I made the loudest ker-splatt on the floor. VERY embarassing. So much so that I got up the next day and made an appointment with the orthopedist. He thought it was just some water on the knee and put me on the then okay, Vioxx. Much relief. But after the regimine, the pain came back. So after another 6 months, I told him I wanted an MRI. It came back with a deeply torn meniscus. He apologized to me because he then realized how much discomfort I'd been in, and that he'd been wrong! We also MRI'd the other knee and found the same problem. We attributed mine to what can occur with women as their hips pull on the knee somehow. So as well as going in there and repairing the torn meniscus (which actually means just shaving it down like a fingernail with a fingernail file because it's not like it gets sewn back together or anything...just smoothed so that the rubbing and friction is alleviated. An amazing little chomping machine... I got a video afterwards!!) I also had what is called a "lateral release" of the knee cap. His theory is that by letting the kneecap float over the area, the rubbing in one place will diminish and there won't be any more need to repeat the surgery. Years later, as my knee top seems to have worn down its cushion, I wonder about the logic of the lateral release, but for sure, the repair of the torn meniscus was fabulous. NO PAIN anymore for the longest time!! It's like heart surgery....why do we wait???

So please listen carefully, you two, to what the surgeon says to do afterwards in terms of bending the knee and not walking on it until such and such a time. I had both knees done, 6 weeks apart. I should have waitied longer in between. But the first knee I babied way too much and didn't do what he said I should do to stretch things. So the second knee I did the recovery right and it no longer bothers me at all. So listen carefully! And definitely do the physical therapy afterwards. I still use some of the exercises for strengthening.

Then, once the torn meniscus is repaired, and you start to have arthritic pain....then you get those syn-visc shots and you get relief from that pain for 6 months; then another round of shots. There really are helping scenarios that can take you way far down the road before you need knee replacement.

So go into this orthoscopic surgery smiling!! You will be amazed.....you will be walking again!!! And happy!!!

Best wishes to you both for successful and easy orthoscopic surgeries!

Marguerite

This is really useful information for those facing this situation, Marguerite. I am sure I will refer to it many times between now and October and beyond. Thanks very much!

 

[bvdr]

Yes, thanks a lot Marguerite. That is very helpful. I'm starting to question if I am wise planning on attending our Southern Mini reunion with some of our VR members the first week in October with my surgery being just two weeks beforehand. I'll have to think about this a while.

 

[pamela]

Hi everyone, I've had a complicated 32 year history with knee injuries. The first happened when I stepped on a second base bag and rolled my bent RIGHT knee inwards and forwards completely tearing the medial meniscus radially around the femoral chondyl. The central portion of the torn piece curled away from the bone making a simple partial medial menisectomy impossible.

I went skiing in Austria and another skier hit me on an oblique angle from behind sending me over laterally and twisting off my right knee down the slope. My lateral meniscus was torn and my LCL over-stressed along with my ACL and MCL both recieving minute tears. There wasn't an MRI or CAT scan completed since the facilities in the Canadian Forces Hospital in Germany didn't support these diagnostics.

Since I had been undiagnosed and ignored by the doc in the base hospital for around 5 months, he felt guilty and sent me to the German hospital. They were supposed to repair my knee arthoscopically and send the tape to the Canadian Ortho surgeon for his review and my records. Their camera was broken and I had an open partial lateral menisectomy. I think the drain in my knee adhered to my already weakened ACL and when they pulled it, they tore it completely.

I waited to see the Canadian Ortho for 3 months and by the time I had, my torn ligament had frayed the remaining bits of cartilege and arthritis had begun ... I was 32 years old. He had me continue physio (I was continuous pt from the day I was treated at my home base hospital... every 2 to 3 days for an hour each time) and recheck in 3 months. When I returned my arthritis had proceeded far too quickly for his liking and he decided to perform ACL reconstruction using my patellar ligament.

Coincidentally, this was the surgeon who was unhappy with my heart murmur and took me for an echo, unfortunately, the technician was untrained and my doc was an orthopedic surgeon, not a cardiologist, so my valve was missed.

On my return to Canada, I had 2 scoped debridements over the course of 5 years. On my release from the armed forces, I was granted a medical pension.

Soooo, in December 2006 I fell and tore my LEFT medial meniscus, tore a small (3mm) rip in my MCL and my ACL was torn completely through. I drove to Edmonton in January 2007 for an MRI and on my return home, discovered a clot in my RIGHT leg. With heparin and coumadin therapy ongoing for 6 months, I couldn't do anything until June. I saw the anesthetist and he refused to manage a general and was unqualified in epidural anesthesia. Fortunately, an anesthesiologist booked a preop consult in early July and my surgeon decided to wait for that visit and until after he returned from holidays to reconstruct my ACL. He returned in August and his office called to arrange imminent surgery. Unfortunately, my son had his right arm amputated on August 12th so I refused until several issues were resolved.

Eventually, and at long last I had surgery on my LEFT knee in November 2007. Nearly one year to the date I had discovered the thrombosis in my RIGHT knee, I was using the physio recumbent cycle and felt something let go in my RIGHT knee. I went through the process of referral, surgeon consult and anesthesiolgy pre-op again and finally had a bone chip removed, the tiny bits of remnant meniscus debrided, my frayed ACL cleaned up a little bit and a thourough exam of the rest of my knee completed along with the removal of the screws used to secure my ACL graft 16 years previous.

I'll absolutely need knee replacement in the future, but first, my surgeon prescribed a knee brace to help preserve my native knee as long as possible and to alleviate discomfort felt on weight bearing so that I can exercise and drop some weight. Diet only does so much, activity burns calories... I can hardly wait for the thing to be built and delivered so I can get back to living a fuller life.

Take Heart, no one's ever died because their knee hurt.

 

[Superbob]

Take Heart, no one's ever died because their knee hurt.

Pamela, ouch, ouch, ouch, and ouch. I feel like a wimp now for whining about my knee problem after reading your saga.

Sorry you have had that series of serious injuries. Closest I came, I guess, was waaaaaay back in high school football when a couple of big lunks fell on my outstretched left leg and bent the knee the wrong way. That's the knee that now has no cartilege left; the meniscus tear is in the other one.

I sure hope you are heading to whatever you need -- even the total replacement -- to being freely mobile.

I will take heart indeed from your concluding sentence.

 

[Superbob]

Thoughts?

Thoughts?

On the basis of this study that just came out today (!), plus some other research I have been doing, I am leaning toward canceling my arthroscopic surgery on the 23rd, and trying more physical therapy and non-surgical options.

http://www.latimes.com/news/nationworld/nation/wire/ats-ap-med-knee-surgerysep10,0,3766965.story

My knee has lately been feeling gradually better (not 100 percent of course, because there is osteoarthritis at work). I am not sure any possible benefits outweigh the risks (clots, infection, etc.) at this point.

Another well-known doctor (Dr. Gabe Mirkin) who has treated many knee injuries writes, "Surgery to remove cartilage just hastens knee replacement." He recommends not doing knee surgery "unless you have a torn ligament that needs to be repaired or you have sudden locking of the knee during walking or you cannot fully straighten or bend your knee. (Which I am not having now.) Otherwise, surgery is likely to hasten your need for another surgery -- knee replacement."

Thoughts? Am I just chickening out or was it providential that this New England Journal of Medicine study just came to public attention?

 

[PairoDocs]

I agree that surgery to remove a torn cartilage hastens the need for replacement. Think about it. The cartilage is meant to protect the bone, and without it, there is bone on bone and increased inflammation. If your knee locks, though, the floating pieces need to be removed, and that can be done arthroscopically. I had arthroscopy on my right knee 8 years ago, and I have still not needed replacement. He removed the piece of the meniscus that was flapping around and the pieces of cartilage on the articular surfaces that were flaking off. I know exactly what he did because I had it done with spinal anesthesia, and could see it all on the screen. I also didn't get any Versed or anything, so I have total recall of it all. I also have a large Baker's cyst, but it is intertwined in the tissues and muscles of my thigh and calf, so cannot be drained easily. I have done the Synvisc and steroid injections as well as weight loss. I am still using my original joint. I have a permanent handicapped placard, but only use it on bad days (once a week, maybe).

Basically, most (not all) of the time, it's best to get the most use out of native tissues. A joint can be like a mechanical valve-it may need to be replaced after 15 or 20 years, in many cases.

Having a good evening in Idaho,
-Laura

 

[PairoDocs]

Forgot to mention-my husband, who actually had the OHS, had arthroscopic surgery when he was in college or graduate school, I forget which. ANyway, he has never had a lick of trouble since.

Still a nice evening in Idaho,
-Laura

 

[PairoDocs]

To confirm Laura's comment, I did go into detail about my arthroscopic surgery in one of your first posts right after you injured your knee (I haven't looked, but I think it was steps into your basement). I said I suspected a bucket-handle torn mensicus like I got from stepping on an angled flat rock with my full weight when I assumed it was actually flat--it was as dark as a cave in Waynes Cave where I did it--well sort of. We all had our headlamps on, but the passage was large and white LEDs hadn't been invented, so the lighting was very yellow and not at all adequate for near-sighted me to notice the rock. Step--crunch--Oww! Then 1200 foot crawlway back after 8 further hours in the back passage--ran out of water, too! I don't do well dehydrated with an injured knee. My group leader thought I'd cracked, and never wanted to go into a cave again with me--well at least for the final two months at Indiana University before my doctoral examination and departure for the West Coast. At least I managed to exit the cave, including the final 16 foot vertical climb at the end, under my own power.

It was my left knee. It swelled up for several weeks, and after the swelling went down my knee would jamb and feel 'wrong' as if something was in the way when it otherwise didn't hurt. In November 1993, between the end of my Post-Doc at WSU, and start of teaching at CSI, Idaho, I had arthroscopic surgery by Dr. Goldstein, and the results were so good that 15 years later I have no sign of any trouble using my left knee. My right one is still good, too (Thank You God!), so I often end up walking so briskly at times I even tire the kids out, and have to turn around and go back for Laura or at least take a break (which I appreciate--gives me a chance to stop and smell the roses--as it were.)

So, get the surgery done, Bob, as the benefits far outweigh the risks and discomfort of a prosthetic knee. I can kneel with both feet against my bottom, can get on and off the floor without my arms (impressed my physical therapist that I could do that 4 days post OHS), and do deep knee bends. If you wait too long, arthritis my set in and make the need for the artificial knee much more urgent, plus you'll have to endure that feeling of something getting stuck sometimes in your knee joint for the duration between now and when the whole knee starts to go. My injury was in April 1992 and the surgery was in November 1993, so my knee had time to settle down from the swelling and trauma of its initial injury to a non-inflamed knee prone to getting 'jammed' and me having to hit the bulge to get the cartilage back into place so I could straighten my leg. Usually it happened when I would bend my knee extremely like described above. After surgery, all freedom of movement returned and still remains to this day. Laura, in my opinion, waited far too long for her first surgery. The first injury took place before I even knew her (perhaps even the same year I injured my knee) and was aggravated by a bad fall on black ice by the Doctor's Lounge (sort of like my rock with its invisible slant). Even then she waited several years before proceeding with the surgery described.

In my opinion, get the cartilage snipped and smoothed before the irritation of the torn bits cause other deleterious changes in the knee. Mine was caught in time; Laura's wasn't. One robin doesn't mean Spring, and one study doesn't mean you should cancel your appointment.

Final point is this, if you do get a total knee replacement, you will never fully crouch again or feel the heel of that leg touch your bottom, as you're forbidden to bend it beyond a 90° angle (a few modern ones permit slightly more acute bending, but nothing like a natural knee). My mother had a hurt knee from being hit by a car in the early 1970s and now has an artificial knee despite having virtually no arthritis elsewhere at age 75. My father, 75, injured by a tree limb falling on his left knee did have open knee surgery in the 1970s (my mother didn't). Despite him having arthritis in most of his joints including his right knee, his left knee, which had about half of its mensicus cartilage removed in 1976, is now his most functional knee--all parts original.

Like me, my father got the torn cartilage out in time, and 30 years later still reaps the benefits. Pray about it, too. There are studies (maybe it applies to more severely injured knees with ACL and other ligament damage, too.), and there is my family's experience. It's up to you. I'll pray that God's wisdom guides you as well.

Been there, felt that,

Chris

 

[Bonzo Dog]

Bonzo is wondering if Superbob has a sporting past? Why? Knee problems are often rooted in either a professional or serious amateur sporting youth.

 

[ALCapshaw2]

Ok, here goes. The last few months I have been having a rough time with my right knee. Pain, at first especially when going up and down stairs or stepping off a curb but it kept getting worse. It has been swelling to the point I couldn't bend it more that 45 degrees. It has been catching and locking on me. Many days I needed a cane to get around. I tried to ignore it (deny?) until one day I couldn't put any weight on it at all.

The whole thing is a long story but the MRI shows a complex tear of the posterior horn of the medial meniscus, cystic change in the central tibial plateau at the ACL attachment. Grade 4 chondromalacia involving the patellar apex. Less advanced chrondromalacia (grade 2 & 3) in the remainder of the patellar femoral compartment as well as the lateral medial compartments. There is a joint effusion present.
The cruciate and collateral ligaments are intact. Lateral meniscus is intact and there is no fracture.

Like Superbob, I'm scheduled for arthroscopic knee surgery.
The date is Sept. 16th. The surgeon thinks it will help but that a total knee is in the future. It seemed a little unreal. It seems like I have a growing list of orthopedic surgeries that will need to be done at some point. I just want to get it done and over with so I can put it out of my mind. I expect to do just fine and I know that whatever grace I need will be there at just the right time. I'm OK.

SO, Betty, will you be getting Lovenox or Heparin BRIDGING Before (and After) your Knee Surgery?

Have you discussed this with your Cardiologist and/or AntiCoagulation Manager? Have your Cardiologist and Knee Surgeon had a discussion (and agreement) on the subject?

If so, I'd be Very Interested in the Bridging Schedule.

My "curious mind" wants to know :=))) !

'AL Capshaw'

BTW, have you tried walking DOWN Stair Backwards?
That sometimes seems to be 'less stressfull' on the knees.