Saturday, January 26, 2013

Knee Surgery Update - medical wonders of the modern world

It's pretty amazing that 8 days after my knee surgery, I no longer need to use crutches to walk (except if I'm going for very far walks, or know I will be walking a lot throughout a day)  
Surgery went well last Thursday, Jan 17 at 6am.  
As I mentioned in a prior post, the doctor had planned to go in and remove excess cartilage from the trochlear groove (base) of my femur, which seemed to be causing my knee cap to rub, causing my problems.  Option 2 was to scrape even more if he found the cartilage to not be in great shape, in order to promote new, healthy, stronger cartilage growth.  Option 1 having a 90% success rate, and option 2 having an 80% success rate. 

(click on photos to see larger versions)

(allergies on wristband.  grass, pollens and dust don't count as allergies)

(post surgery view)

(post surgery snack #2 - apple juice and crackers. 
snack #1 was cranberry juice and crackers)

(my vitals post surgery)

Once in there, Dr John McDonald, (a fellow of the Steadman Clinic) found that although there was excess cartilage that he removed, the cartilage he left was in great condition and no regrown cartilage could have been better than what I already had.  This meant we didn't need to go to option #2.  He also found excess Plica* in the knee, which he went ahead and removed.  John and I spoke the next day, to discuss the surgery and he mentioned that overall, my knee was in great shape and had no other issues at all.  The surgery lasted less than 45 mins, which was half of the total allocated time for the surgery.
*Plica - in plain English, plica** is a fibrous tissue that is left over from when a fetus is growing in the mother's womb. The Latin term essentially translates "mucus-y ligament".  It is so thin that it cannot be detected by an MRI.  Sometimes it can cause great irritation within the knee.

(apparently, Jupiter lives in my knee - bottom right of the above 4 photos) 

After surgery, I was driven home by a friend, and spent the next 5 days (Thu-Mon) doing nothing but lay in my bed with my iced knee elevated by pillows, drugging myself with the pain medication  prescribed, aspirin, anti-nausea, and laxative pills.  While I joked about doping myself, I didn't enjoy the feeling of popping pills at all, and I'm confused as to how someone could get addicted to it as all I looked forward to was not having to take any more.  (I do take Ibuprofen to reduce swelling and inflammation, but the absolute minimum).  I hate pills.  I kept having visions of those movies where someone is kidnapped, and tied to a bed in a room, and drugged so they remain in a vegetated state.  

(rare time spent on couch compared to time spent in bed and  
compression tights on to reduce chance of blood clots due to extreme slothness.)

Monday was my first Physical Therapy session with Amber.  She said my knee was looking great, she measured the bendability of both my legs, and had me do all sorts of exercises.  Based on how great everything looked, she reduced me down from 2 crutches to 1, with the ability to do some light walking around the house without crutches, and sent me home with instructions and daily exercises   
(Knee on Sunday when i was finally allowed to remove bandages and take a shower.  Two incision points.  "YES" written by nurse after I confirmed which knee.  Doctor signed his name above it after additional confirmation by me)

Yesterday, Friday (8 days after surgery) I went in to see Amber again.  In summary, my left leg bendability is 137 degrees, and my right knee went from 101 on Monday to 135, yesterday!  She sent me home with old and new exercises, and instructions to no longer use crutches at all (except for long walks to not over-stress the knee)

**Here's some more about Plica for those that are interested.
This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. The most common location of plica tissue is along the medial (inside) side of the knee. The plica can tether the patella to the femur, be located between the femur and patella, or be located along the femoral condyle.  
The plica themselves are remnants of the fetal stage of development where the knee is divided into three compartments. The plica normally diminish in size during the second trimester of fetal development, as the three compartments develop into the synovial capsule. In adults, they normally exist as sleeves of tissue called synovial folds. The plica are usually harmless and unobtrusive; Plica Syndrome only occurs when the synovial capsule becomes irritated, which thickens the plica themselves (making them prone to irritation/inflammation, or being caught on the femur).
Finding the presence of a plica is impossible to nearly impossible through any external tests, including an MRI. Plica can be detected arthroscopically, and their existence can only be confirmed during surgery. (Source)
Stay tuned for an update once all adhesive tape comes off and you can see how small the cuts were!


Madalyn Oconnell said...

Wow, your recovery was quick! I was sidelined for quite a while after my knee surgery, though mine was to deal with a ligament tear. I'm still going through physical therapy now. The progress is quite slow, but as long as I'm not suffering any setbacks, I'll take it. How's your knee doing now?

MW said...

My last Physical Therapy session was yesterday. ran 2.5 miles on the treadmill. Seeing my surgeon tomorrow for final check up. Looks like i'll be free to start ramping up my running, slowly and carefully, but that's fine with me!
No issues whatsoever.

Thanks for asking!

Mayer H said...

Now THAT'S what I call recovery. Just recently got out of a knee surgery and my doctor said this - livestrong 8.0 treadmill will be a good for recovery. Do you remember what treadmill you were using?

How is your running progress?

ekorinek87 said...

HI, I am a competitive cyclist in the austin area and after this entire year of dealing with knee pain and seeing multiple orthos, I think it is plica syndrome. I have had normal MRIs, and after doing lots of PT, etc., I am pretty confident that surgery will be the next step as I don't know if I can take this much longer. I was wondering, did you originally go in for just plica removal or for something else? I went to Dr. McDonald first off and he thought it was something different to begin with (but that was before all of the info I now have, and continued pain, etc.). I am trying to figure out the best knee orthos in austin, so any advice about your experience would be much appreciated. Also, could you share how long your recover took ? for instance how many weeks back to cycling/running? I have heard that if plica is the only issue, one can be back to biking in 2-3 weeks and running in 4...?

MW said...

Ekorine87 - I really like Dr McDonald. I saw others docs and he was the one I was most comfortable with>
I was back off crutches and doing Physical Therapy within a couple of weeks, and within a month i was running about 20 mins on treadmill at PT office and a couple times a week on my own, built from there and was all good within 2-2.5 months. i forget exactly but I took it easy and was overly patient. Cycling may be faster since there's no impact.
but as you know, results may vary.