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TKR crepitus in my knee

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Mary is right on the mark with her response. The noise--which sometimes sounds like velcro ripping is adhesions or scar tissue. If it is bothering you and affecting your lifestyle, it can be removed. Mary had her scar tissue removed arthroscopically which is 'minor surgery"--if any surgery can be considered minor!!

I had extensive scar tissue in my knee and had it removed with an open procedure. It is call an "open lysis of adhesions". I do have a thread with that name as the title. I could not ride my bike because my kneecap was scarred down and would not move. It was agonizing at times.

I was unable to do anything but table exercises at my pt for 8 weeks. After that, it has taken a good six months to fully recover from that surgery. I still have some crackling in my knee, but my knee cap moves freely, so I am pretty happy with the conclusion of that surgery. My doc says that he gets the best results with an open procedure--although many docs prefer the arthroscope which is much less invasive.

Removal of adhesions is a conundrum---if you have surgery to remove them, more adhesions form after the surgery. In my case, at least I was able to keep the knee cap free. I think that if you find a doc you like and respect, you will feel more comfortable with the advice---perhaps someone who is experienced with revisions would be best for you. Kelly
 
Hi Elizabeth,

Where are you in NH? If you are near Lebanon, my OS is exceptional. He is going to be moving to Alice Peck Day Hospital in February. I have been with him for 10 years and he has been persistent in helping me overcome my challenging knee issues, which included removal of extensive scar tissue just this August. His name is Dr. John Houde. Great bedside manner and overall wonderful human being. If you are anywhere nearby, I would start with him.

Good luck and let me know if I can help!

Dawn
 
I'm not sure how I stumbled upon this thread, but I'm glad I did. In an earlier post, I read Dhare's story about her scar tissue removal process. I must live nearby - I'm in Vermont about 50 min. from DHMS. I'm 6 mo. post op and still can't do steps. I had an MUA 2 mo. post op, and I've made gains, but overall it has been a very slow process. My OS has offered scar tissue removal surgery twice now. I've balked both times. I decided I should at least learn what it is about. I'm presently trying the Graston PT technique designed for scar tissue removal. I think I'm doing a little better. I was glad to see the video clip on scar tissue removal.

Anyone have suggestions for what to do about sleep issues related to click after click after click every night? Takes me 2 hours to get to sleep.

RTKR 7/12, MUA 10/12
Arthriscopy 6/83
 
The only thing that prevents the knee "cracking" at night is keeping my leg straight. I find a comfortable position on my stomach or side (with pillow between legs) --- obviously, am still having the same knee cracking issue. Am going for a second opinion at a major medical center at the end of the month.I want to be sure I am not doing damage by letting this , persist! Will post the results, am wishing it would just "stop" as I still have some periodic numbness in my other leg (foot) (from peroneal nerve damage). I am just so sick of thinking about this, would love to have a "forgotten knee."
 
Elisabeth, I had an "Open Lysis of adhesions" which is a removal of "scar tissue". you can look on my thread for some of the results. I had to be very careful afterwards, but I have had a good result.
 
I figured out how to find my way back to this thread. I wish I'd discovered this a while back. I'd have saved myself a lot of rigorous PT and exercise routines if I'd known in October what this thread is telling me now about my condition. I am just now digging in and learning about arthrofibrosis, creptis and the like. Frustrating to be 7 months post TKR and still doing worse than before the surgery. Now it is starting to make some sense. Skigirl, I'll try to find your thread about having Open Lysis of Adhesion. I'm hoping I can avoid that, but the tightness in my calf and thigh along with sometimes feeling like somethings stuck around the kneecap, makes me nervous. I'm now trying the Graston Technique and my new PT has taken a different course steering away from aggressive exercise to just gentle. Maybe there's some improvement. Hard to say. Some days I'm game to try to get up stairs normally - often when it is above freezing, and others its still stiff. I really can't go down stairs normally.
Can any of you comment on this? Every night I spend 2 hours of crack, crack, cracking before I finally can fall asleep - is all the cracking breaking adhesions? Is it helping me or is it just making me very tired?
 
Thanks bottomshollow, looks like I don't even remembee the name of my own thread!!

I always felt that the left knee sounded like velcro ripping apart, but, yes, that is the sound of the adhesions stretching and breaking. A friend tried the Graston technique as well.

I did find some relief from a lymphatic massage therapist. She did wonders for me.

Yes, my pt was very gentle with my knee after the surgery to remove the scar tissue. I can now hear sounds in my knee, but my kneecap moves freely, so I don't have the pain. Was it worth it? Yes. Kelly
 
Hi there,

Reading Kelly's thread and others who had similar experience, plus the heartfelt recommendation from OS was what led me to the revision and adhesion removal. My only regret was that I didn't do it sooner. I would have saved myself months of looking for the thing that would end my search for extension.

Hang n there and let us know what you decide. I never had the cracking feeling, although I am getting something like that now occasionally, but it never lingers.

Be well,

Dawn
 
Hi all - thanks for your comments and support. Went to Mayo Clinic yesterday to have my crunching knee assessed. OS said he has been practicing for over 30 years and much of that involves post-op complications from other OS. Anyway, this is what he said:
1. The problem I have is called "patella clunk syndrome." He drew a picture of the "ball" of scar tissue, where it is in my knee and how it is attached. (I guess my OS was right in that it is scar tissue but did not give it a name) Could not find this in our library - maybe it has another name?
2. He looked at the knee XRays I brought, said the knee replacements themselves are in good position
3. There is no immediate danger of leaving things as-is but recommends having it taken care of (surgically removed). The danger is that it may wear away the back of my knee cap -- making the surgery more extensive but still not a whole revision. The damage (and pain) is caused when the knee "crunches" - which happens when I straighten my leg while in bed or trying to stand from a normal height chair. I can walk, dance Zumba, play pickleball - i.e., "standing" activities, with no crunching or ill effects.
4. This surgeon does the surgery by incision, not arthroscope -- takes about 6 weeks of rehab "not as bad as the TKR."
Questions - anyone else have this issue? the surgery to correct it? what about having it done by arthroscope? I just cannot bear the thought of having more surgery. I welcome any and all help and advice
 
Hi Elizabeth and thank you for your thread. I developed the KLUNK 18 weeks post op after an ideal recovery. The KLUNK came on suddenly and I have been miserable since. Saw my OS 2 weeks ago and he was shocked and said it was a big band of scar tissue. When he pressed on 'it' the KLUNK went away. Not sure if its patellar klunk as OS didn't use this term but our symptoms sound identical. For the time being my OS has sidelined me from all activities, wearing compression stockings, taking the max daily dose of ansaid allowed and applying heat. Plan is to revisit in 2 weeks. OS says orthroscopic surgery is a good and reliable fix but also has a wait and see attitude. I am curious why your OS prefers an open surgery? Also do you think the problem gets worse over time and hence the preference for open vs. orthoscopic? Also do you find the KLUNK an unacceptable outcome? For me this is a big disappointment as it is restricting my favorite activities...cycling and yoga. I wish my surgery was scheduled for tomorrow. Anne
 
Anne, My "clunk" also came on suddenly at exactly 9 months and from the first clunk it has persisted (and bicycling ability stopped) - a clunk for every movement - I googled it ("patella clunk syndrome" - get better google results if you use the quotes) and there are more potential complications than the OS told me, but I still believe limiting that particular movement is how I need to live right now (e.g., am getting out of the chair with my leg straight). I have been exercising my upper body, so am fortunate to be able to use it to do this. I will continue all other "upright exercise." - zumba, walking etc. The OS I went to was not mine, but I went for an opinion in another medical center. When he said he does it by open surgery, he intimated that others do it differently (I should have asked more questions regarding this). He said this is a rare complication of TKR (it figures!!) I learned online that it is a complication of a different type of knee surgery. He has 30 years of experience and sees many types of complications and has seen - perhaps 50 - of this issue in his career. It seems logical to me that only removal can help -- he drew it on a piece of paper and there is a "ball" of tissue. Well ---- the next page of my story ( I am lucky to have insurance that allows me to go to multiple OS) - I studied other OS's closer to where I am right now (I have some geography challenges that I won't go into here). I found one (of several) who is highly rated and his specialty is OS as well as arthroscopy and sports medicine. The review says he does many types of arthro procedures as well as TKRs. I called and they have a cancellation tomorrow - so off I go, better equipped with more questions (I always write them down). IF he identifies this issue (I am not telling him) AND he has performed the procedure more than a few times to get rid of it arthroscopically, then I will probably consider having the surgery by him.... else I will keep looking for someone who has - last resort will be the open knee procedure. I will post what I find out from tomorrow's appt
 
Hi Elizabeth and thank you. I am so looking forward to your update. I respect my OS. He's at HSS in NYC and is a maniac knee guy. I have full confidence but still wonder. If it wasn't for this wonderful forum, I would be saying....why me!?!? Good luck tomorrow. Hope you get some forward closure. Can't wait to compare notes. Anne
 
Although my problem wasn't exactly like yours, I had open surgery to remove scar tissue. Honestly for me, that part of it was not an issue. My incision healed pretty quickly and absolutely nothing like recovering from the original TKR.
 
My OS, who is a knee specialist, told me that he has had better luck with the open surgery. He feels that too often the arthroscope does not clear out all of the adhesions and you end up having another surgery.

I was glad that he did an open with me because I had extensive adhesions and he worked for 30 min to get them all out. My patella issues are now gone and I can ride my bike easily again. Like Dhare, my incision healed very quickly. Kelly
 
All - thank you for these comments (open vs closed etc) - I will take it all into my thought process. And, Anne, when I go for my consult today, I am going to ask about your OS approach. I believe your hospital has a better OS reputation than mine -- and you may have something different than mine --- and I am not accustomed to doctor shopping as I am doing -- however, I was an RN and I have seen it all. I always ask as many questions as I can think of - the more I ask, it seems the more information is forthcoming. I am vey curious (and would ask) the reasons for your OS treatment with these measures --- why heat? what will this do to improve the scar tissue? is this an activity to stop additional scar tissue and will end up with surgery anyway? For me, it was 9 months after surgery that this started, and has persisted with no change for over 5 months. Am wondering if others who so kindly responded - and had scar tissue issues resolved with surgery -- did you have the same symptoms? I LIVE to be active and this knee was doing so well for so long!
 
I liked the OS I saw today, explained things well. Mostly agreed with OS at Mayo. He even examined my knee! (rarely happens with an OS in my experience) I can leave the scar tissue alone or have it removed. He would do it arthroscopically. I can make the call at any time. I have good ROM and the tissue is not doing any harm. Danger of arthroscope is that it may scratch the smooth metal surface of the implant that would eventually cause damage. I am not accepting this risk, at least not now. Both OS's looked at my op report and both told me I have good solid implants. The only thing that bothered me about the discussion is that this OS called the issue "cyclops" which (online) looks different than patella clunk (or klunk). It looks like the cyclops thing happens after ACL, but I need to read more, may be one and the same. He described it the same - said he sees this about every 5 years (been in practice over 20 years = done this only 4 times?) btw, I did a search on patella clunk on the HSS in NYC website... there was something about MRIs, but the last sentence said the tissue was removed m my arthroscopically. If anyone knows of issues that may result from my "wait and see and perhaps wait forever" attitude, I would appreciate their stories.... will tell my story of what I learned about peroneal nerve entrapment later. Thanks -- all - for your support
 
I like your approach, gathering information and then making an informed decision. Good work. K
 
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