Just What I Kneeded

What happens after a life-altering knee injury?

Cashing in my bad luck

13 Comments

The last three days have been… interesting. I’m not even sure that’s the right word. Maybe overwhelming is more accurate. I was presented with the awful truth that not every problem has an identifiable cause, nor does every problem have a ready solution.

Good news from my surgeon is that the DeNovo NT cartilage graft transplanted behind my patella (knee cap) looks pretty good. One or two thin spots, but filling out nicely. Bad news is that the MRI didn’t show anything that should be causing the pain that continues to plague me. Like the plague.

To recap, I was doing extremely well in the first part of this recovery, then plateaued a bit, and then took a giant leap backwards for no obvious reason. That last leap was eight weeks ago now, so we’ve been working on limited PT and waiting, really, for the last two months to see if things would even out.

I was presented with three options. 1) Continue to wait. 2) Try Synvisc. 3) Undergo arthroscopy.

None of these options appeal to me. I’ve been waiting it out for two months now, and my mobility has decreased while my pain increased. We tried Synvisc before, and it provided only partial relief for about six weeks. The Euflexxa (a similar synthetic hyaluronan injection) lasted only four weeks. Finally, every fiber of my being rebels at the thought of another surgery. Especially when the arthroscopy would be exploratory, and there is no guarantee that my surgeon would find anything or that he could fix it if he did find something. Plus, as he put it, “Surgery hasn’t really been kind to you.”

I nearly had a high-speed come apart in the exam room. I was wholly unprepared to receive news that neither my surgeon nor the radiologist who had prepared the report could see an obvious problem. I need to know what to fix! I need a solid plan of attack.

I went home feeling rather dejected and adrift. We had decided that we’d wait. In the meantime, I’d been told to continue trying to strengthen my VMO and give swimming a shot (hopefully won’t cause too much pain while building strength).

After I got home and had nothing to do but ruminate on the options before me, I started acting like a crazy person. I decided that, if there was nothing wrong on the MRI, there must be nothing wrong with me. And if there’s nothing wrong with me, there’s no reason that I need to take my pain medicine (big mistake number one). And there’s certainly no reason that I couldn’t go to the gym and get my sweat on in maniacal fashion (big mistake number two). And absolutely no reason that I couldn’t kneel on the bed like I don’t have two screws in the front of my knee (ok, this last one was a total accident, and I won’t be doing that again).

I just needed a minute or two days to wallow in self-pity. Then I made up my mind that I’m not going to wait for another eight weeks, hoping that something clicks and the pain subsides. I simply can’t continue to rely on narcotics to get me through a normal day that consists of little more than going to and from work. I called the surgeon’s office yesterday and asked, “On a scale of one to ten, how useful do you think a second opinion would be at this point?”

I posed the question because I have no clue what’s better. Get a second opinion now or have my surgeon scope first and see what he sees. I have decided that I’m going to do something, but I need help figuring out the best next step. I expect to hear back by the end of the week about suggestions for who to see for a second opinion.

I also asked whether there’s a chance the scope can be done without general anesthesia. I loathe the side effects of GA; in fact, I’m more scared of the anesthesia than of having my knee opened up again. Plus, I figure I can live tweet my own surgery, if I’m awake. That would be ahhhhhhmazing.

Only kidding! Mostly.

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Author: Laura

I have a fern I named Frankenstein. I like leprechauns, practicing kung fu moves on my dining room furniture, and pretending that one day I will move to Fiji. I dislike my neighbors' kids, anything that is chartreuse, and Ben Roethlisberger.

13 thoughts on “Cashing in my bad luck

  1. I am so sorry to hear about your news that really sucks! How’s your doctor thought about doing a brace for you? I had just got fitted for an off loading brace, it has helped soo much with the pain. It takes some of the pressure of where I had the lesion. Maybe look at the Donjoy knee brace. they are really expensive because they’re custom but insurance pays for most of the time. also if you do have to go into surgery I know for me when I talk to the anesthesiologist he told me that I have a problem with opiate and that’s what makes me so sick

    • Sorry it cut me off. but what I was going to say was that the anesthesiologist ended up giving me wh at he called the Michael Jackson drug! It was great I did not get sick at all from it!! Maybe if you do have to end up in surgery again maybe ask them about that if it would help! It made all the difference for me when I was recovering. best of luck and I hope you get better news soon!!

      • Hi Jesika. I feel like I just won a game of Tetris or something where all the pieces just fell into place. All of the pain medicines that I’ve tried and had terrible reactions to have been opiates. So, duh! I don’t know why the connection was never made to the anesthesia. But now I’m going to make a point of requesting “that Michael Jackson drug,” if I have to undergo another surgery. :)

        My surgeon and I have never discussed a brace. I was given several different braces to try in PT, but I couldn’t stand to wear any of them (I think we tried a total of three). My original injury was a fracture of the lateral tibial plateau, and even now, I can’t stand to have anything press against that part of my leg. That’s nothing new, and it doesn’t hurt until I touch it. Then it feels like a deep bruise (it’ll hurt even when I put lotion on my leg). We did not try an unloader brace, but I’ve wondered about those because the damage that the MRI did show is to the articular cartilage on the top of my lateral tibial plateau–there’s a full-thickness tear there. That damage is not new either, but my surgeon previously said that he doesn’t think there is much he can do to address it. When my surgeon’s PA calls back, I’ll ask about brace options. It’s worth a shot because that’s much better than another surgery.

        Thanks so much for the info and support!

  2. I’ve had my fingers crossed for you…it’s great that the DeNovo’s growing, but I’m so sorry you don’t have an answer yet about the pain. Uncertainty stinks.

    A second opinion sounds like a smart idea; I personally prefer googling up my own second-opinion docs (looking for one who’s on my insurance, at a reputable hospital, experienced in the surgery I had, etc.), because I don’t trust that referrals mean much more than a buddy system, but of course my way is a gamble as well.

    You might want to consider seeing a PM&R/physiatrist too if you haven’t already. They were described to me as kind of a cross between a physical therapist and an orthopedist, and they use a lot of noninvasive options. They work with orthopedists, so there shouldn’t be a conflict, and they tend to take a broader look at what’s going on, whereas an ortho can get fixated on the part that he operated on.

    I hate/fear anesthesia too, and every surgery is an injury to the body, so as long as your doctor doesn’t think you’re hurting yourself, I think you can trust your instinct to avoid surgery if possible. If the second opinion agrees that it has to be the next step, at least you have some evidence now that your doctor did a good job with the DeNovo, so he’s going to do a good job with the arthroscopy as well.

    Sorry if I’m being bossy…I know how bad it is to have mystery pain, and I just wish I had some kind of answer for you!

    • Haha. Bossy didn’t cross my mind! But I wish you had an answer for me, too. :)

      In all seriousness, I do really appreciate the support and objective opinions here. I totally google all my docs, too! I don’t know how people survived before Google. What I’m thinking, though, is that the doctor I really need to see is one of the leading cartilage restoration experts in the country; I just happen to be lucky he’s in town. Unlucky that he’s not in my insurance network. But if my surgeon also recommends that’s who I see, I’ll talk to insurance to see if they can at least cover some cost since no one else in network has the expertise that I need.

      I’d only recently heard of a physiatrist (I can’t even recall in what context), but that’s a great suggestion. Actually, I got sidetracked when replying to your comment because I went to see if there are any in my insurance network. Good news; there are. I’m going to do some more research on this.

      I have no problem with my surgeon; I think he’s done a good job with me, and you’re right that I now have radiographic evidence that he did a good job with the DeNovo. It’s not that I don’t want HIM to perform another surgery; I don’t want ANYONE to perform another surgery.

      Thanks for stopping by with the helpful suggestions and support! How is your knee doing?

      • Looking forward to a helpful second opinion for you!

        My knee’s probably OK…who knows? Moving into week 7 and still trying to get the muscles to wake up, but they’re so weak that there’s very little I can do to move things along. I’m going to ask about home e-stim, taking a third weekly PT session, and whatever else there is when I have my first post-op later this week.

        • I hope your post-op appointment went well! Are you still in a brace? I was able to lose mine about 8 weeks post-op, and I recall it was such a good feeling. I had the e-stim several times, and it did seem to work to get my VMO firing. I hope you received nothing but good news at your appointment and that they gave you some ideas to wake those muscles up.

          • Still in a brace, still on crutches, heading into week 12… Any extra push I put in ends up setting me back, and I think I’ve lost about five weeks of progress by trying to put just a little more weight on the leg earlier this week. Got the e-stim; got my third PT per week; doing nothing but rehab, rest, more rehab every day at home…what else is there? I can’t keep doing this for zero result!

            • Oh, my! I’m so sorry to hear that you’re having a hard time. Also sorry that I didn’t see the comment earlier. How are you doing now? Any progress of late? What kind of rehab exercises are you doing? I know that when I started some of the closed chain ones, I had a bit of a setback for a few weeks. Were you allowed to bear weight after surgery, or were you NWB? I think being able to bear weight immediately made a big difference for me. I’m sorry I don’t have any real ideas. I hope that you’ve seen some improvements over the last couple of weeks! I’m pulling for you!

              • Funny you should ask just now…because after 6 weeks of NO progress, I’m suddenly just today able to take some steps on a single crutch or even a cane. Nowhere near where the other DeNovo folks seem to be at the 3 month point, but a major leap ahead for me!

                My protocol looks very similar to what I’ve read in your posts…I just wasn’t able to meet any milestones. I’m hoping the slowness has more to do with the complicated history of my knee than the progress of the cartilage; the surgeon’s sending me for a 3-month MRI to see if anything interesting is going on in there.

                If anything made the difference, it could only have been taking a rest…my e-stim broke and had to be replaced by mail, so I took two days’ vacation from it, and here I am suddenly with a leg that doesn’t feel like a dead weight stapled to my hip!

                I saw in your latest post that pain is still a problem. I tried out Arnica gel and believe it calms things down a bit–the one I’m using is Boericke & Tafel Arniflora. It’s an even simpler formula than the one my surgeon suggested I try, so I believe it’s essentially harmless.

                Thanks for the support. If you knew how many times I explain to my husband “well, what Laura did was…” when we’re trying to figure out whether I’m pushing too hard or not enough…well, you’d either be flattered or creeped out. :)

                • Haha. Flattered, I’m sure. I’m glad that someone has found my experience helpful! And thank you for your suggestions and encouragement! It takes a village, right? :)

                  I’m so glad that you made some progress! I hope that is has continued over the weeks since you wrote. Have you used the e-stim once you received the replacement? Or did you continue without it? I’m curious what your MRI will show. There is such variation about what doctors say can and cannot be seen at the different stages during recovery. I find it kind of fascinating. For your sake, I truly hope all is well!

  3. It is a complete shock when you are told that there is no obvious reason for you pain. I went nearly five years without an answer to a neuro-muscular problem that I have. That time was definitely very trying. Not knowing is usually worse that knowing something, which at least gives you a path to follow.

    I just underwent screw removal from the Elmslies on both knees. I also had my right knee scoped and cartilege under my pattella cleaned up. All of this was done yesterday, so I am still in the rest and recovery stage at home. However, the scoped side seems to be doing OK. I can even bear my complete weight on it. I am using the crutches to purposely “slow me down” so I will heal better right now. I am on smaller pain medication than I needed with the Elmslies. I just wanted you to know that the so far, the scope seems very minor compared to the previous surgeries, in case you decide to do that.

    Right now, a second opinion and checking on a physiatrist sounds like you have a plan. Best wishes.

    • Thank you for the well wishes and reassurance about the scope. I appreciate you stopping by! I’ve decided to pursue a second opinion with a well-known expert in cartilage restoration, and I have an appointment two weeks from tomorrow. That just sounded like the right next step, so in the meantime, I’m crossing my fingers.

      Can you tell any difference having the hardware out now? I hope your recovery has continued to go well!

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