Danielle had an exploratory knee arthroscopy

October 19, 2016

I had an exploratory arthroscopy about three weeks ago now for a knee problem that has sadly been going on for over 3 and a half years. It was never a sharp pain but felt uncomfortable like the kneecap was moving at the wrong angle and also like it was sinking when I straighten it- generally very strange feeling.

It all came on after a long tennis match and sadly has been a constant issue that I have felt walking and never goes away. After referral to a number of consultants and specialists I had an exploratory arthroscopy where they respected my fat pad and plica. Three weeks on I’ve been religiously taking anti inflammatories, icing and trying to knee my leg up but it still looks swollen and feels like the kneecap is sinking.

Is this normal, do you have any advice on what I can do? Im a bit worries at the moment this thing may never go away but trying to be positive. It’s had such a huge effect on my life- I used to play competitive sport and now feel uncomfortable walking for 5 mins to a shop.

Thanks, D

October 19, 2016

Poor you.

This is super tricky to give a decent guru-esque response to because it all depends on what you have done before in terms of decent rehab.

Failing at decent rehab, having pain below your knee cap and worse when fully straightening your knee can all be indicative of fat pad issue.

What’s done, has been done and can’t be reversed.

The post op swelling is very normal- fat pads are highly vascular and neural – they swell and become painful. Ice, elevation and anti inflams  are the right way forward. Try not to fully straighten you knee – keep it “soft” as this stops the knee pinching the fat pad.

One key bit of advice is seeing a decent Physio post op – there are some key do’s and don’ts and you now need to maximise a really good and functional recovery.

Let me know where in the country you are and I’ll get you a name.

Chin up 🙂

Danielle gives the Guru more info…

I’ve done a lot on the rehab front, VMO strengthening and biomechanics and am working with a physio who has been highly recommended to me from the surgeon I’ve seen and a physio consultant who solely focusses on patellofemoral pain. The thinking behind the arthroscopy was that we needed to rule out the knee, I’d done a lot of work on pelvic dysfunction but my symptoms were not improving at all. I think we expected to find some cartilage as I’d had 3 MRI’s and a CT scan (the first MRI showed low level fat pad activity but those since hadn’t). It was thought that the knee problem may be causing issues with the pelvis. Actually following injuring the knee I was able to continue with sport for a while with tape but ended up having stress fractures in my navicular. Since that I’ve given up tennis, running etc.

I’d also looked at other causative factors hip, back etc but none were found to help. I was referred to pain management which I was quite disappointed with as all they would prescribe me was pain medicine- which doesn’t seem quite right when you can see the physical problem.

Will continue with the anti inflam/ ice / elevation programme. What I don’t get is if it has been trimmed why it would still be problematic- surely there is less of it?

Hopefully will see some progress soon, I know it’s early days. Just a bit depressing, my 50 year old mother had an arthroscopy for a meniscus and was walking as normal the next day.

Thanks for your reply anyway I appreciate it 🙂

The Guru…

Ah – sounds as if you’ve been thought the mill, and still have a few more turns to go!

But I think you’re in safe hands.

Managing your expectation is key – this is totally incomparable to what your Ma has had done. Not even in the same chapter!!

Due to the really complex innervation of neural structures and their blood supply, any messing around with your fat pad will give you what you’ve got today – no more and unfortunately no less. The word “trimmed” conjures up visions of precise, delicate and minimally-not-that-invasive type stuff, “I’m just going to trim half an inch of your hair”…but the reality is that it’s far more aggressive, burny, pokey and pushy stuff happens – it’s why you’ve still got lots of swelling and pain.

I always let my patients know this is more like 6+ weeks post op not 3.

Time’s a great healer – it’s what the body does best, give yours a chance and extend your time frames

PS next time you’re around anyone ask them to have a squizz at your infra patella branch of your saphenous nerve….

Guru Responded

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