TKR Lack of bend, mcl and lcl pain 10 weeks post op

[crpav]

New member and glad I found this forum. I had TKR of my left knee on 1-29-2024. Recovery has been pretty good but frustrating the past several weeks at my physical therapy appointments. About 4 weeks ago I got my bend/flexion to 115 and was happy as was as was about on pace of where felt should be. Then 3 weeks ago could only get to 112 even after the hour of stretching and session. The next week started off at like 101 then got up to 115 so was sort of happy. Next week after started at 104 then finally got up to 116 but seems no matter what my knee just is just so stiff and swollen to start then can "push" it to the 115 or so again but seems all my muscles and ligaments in my leg and tight. The inside of my knee, see below, whcih I believe is my mcl is always sore, tight and the trouble spot.

I will say my mcl has always been painful but before surgery I thought it was my meniscus which now realize was my mcl the whole time. Tendor to the touch if rubbed/pressed in the right spot. I don't have stability issues and thigns feel so much better since the surgery but the mcl and other tendons around knee are still sore and tendor. Wondering if I need to have my mcl looked at for possible replacemewnt or repair.

I have read other threads with the advice, links and other information and hope it is the case of need to let it heal more and less bending and stretching like the physical therapist aims for. Am I way over working it? He went on about the scar tissue and how by 8 weeks the tougher tissue forms then 12 weeks you will be at about where you will be if don't work and break the scar tissue up. I feel that healing is still taking place, resting, icing and elevating to let heal and swelling go down and slowly but surely the process takes up to a year and beyond.

Only 45 and still enjoy lifting weights but legs are still a no go besides light bike riding, light hip work, light hamstring curls and a few attempts on the hip sled/leg press.

Sorry for the long first thread. Just hoping to hear other's opinions. I can do most activities like walk just fine just the lasting pain. Up stairs is fine but down I still get some pain in the knee mostly the inside part (mcl? like stated above). Other than that maybe over thinking it and need to not let the thought of pt dissapointment get me down.

 

[mendogal]

Welcome to BoneSmart!

Before I leave our general guidelines, here's some specific information:

There's a big difference between normal scar tissue, which is part of healing, and the adhesions that form binding tissues together. Here's an article.

Overuse and over manipulation of post op healing tissues stresses and dries them, making them more prone to form adhesions. So yes, aggressive PT does create swelling, delay healing, and doesn't increase flexion except in the brief hours before the inflammation roars back in response to the PT.

The "window of opportunity" is a myth. Here's why.

Some of our members have shared charts of their progress regaining flexion. As you can see, for each, it returned slowly but surely.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months

Bertschb’s ROM history
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

 

[mendogal]

Welcome to BoneSmart! You are in the very early stages of an average of a yearlong recovery. I will leave you our Recovery Articles that have helped tens of thousands of other knee replacements. We are here to help you through this journey the best we can. The very best thing for your knee right now is to rest, ice, and elevate. Exercises can come later. There is no rush to achieve ROM because it will come naturally as your swelling decreases. Your OS was able to bend your knee while checking for movements during your surgery, so it will be fine. It just takes time.

Each person is different as is their recovery. Most find that the Bonesmart approach works best for them, but others find that a more aggressive therapy helps them more. It's your recovery and your choice on how you recover. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect. The following are our basic guidelines and should help get you started.

KNEE RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[NeedaThneed]

I had pain there for a while inside knee. I was worried it was MCL but PT and surgeon tested the stability and it was fine. We think it was actually pes anserine tendonitis. (I also had other tendon issues). I stopped trying to go down stairs and kept exercises pain free and it settled after a few weeks. I kept up with gentle stretches and foam rolling the muscles that didn’t hurt, playing around with various ways, to prevent losing bend/straightening. It bugs me when healthcare people forget that the rest of the knee is injured. Rather than forcing something that causes pain, my PT found different ways to stretch or strengthen - modified as things popped up.

 

[crpav]

Thank you for the replies. Very helpful and encouraging. I know I just need to slow down, let it heal and not over do it. I will say my pt is, and has been , good for a long time. In 2005 when I had my ACL replaced, damaged menescus reomved and bone damaged operated on (the startt of the downfall of my left knee) he was my pt then. Also have gone to for my right shu=oulder labrum repair sugery several years ago as well as an ankle issue last year.

I just wonder why some go to the quick over stretch and use/bend rather than heal first and ice/elevate rather than bend more and more and a long term approach. I will say I never left in pain after my sessions. He has tried different techniques as well as massage the quad as tightness there as well as calf and other areas that might all tie together in tightness in knee and bend issues. I will see how thigns go Friday at my next appointment. I have backed off to every 2 weeks from once a week so hope can end soon. I think he was hoping to get to 120+ so could get into strengthening phase.

 

[mendogal]

It sounds like you have an overall very good PT and therefore he'll be responsive to your request for a gentler approach.

(PT from which you walk out in pain is a huge no! Our more common concern is PT correlating to increased pain and swelling at night and/or a need to totally recover the following day)

My R knee problems, BTW, also started with an ACL/meniscus blowout in a martial arts injury. The differences between the surgical trauma of that surgery and the trauma of a joint replacement really do call for different approaches to PT.

 

[Layla]

Hello and Happy Three Month Anniversary!
I hope the past three weeks have been good for you. Please let us know how you're doing as time allows.
Have a wonderful week!
@crpav

 

[crpav]

Thank you for checking in and sorry for not being more active and posting updates. Been busy but pushing on.

Knee is what it is is how i will describe it. It's had it's history so the bend/flexion will be less than would have hoped and I and my PT have agreed so will just work on daily use, strengthening it and working to fix my weaknesses in the leg including the hamstrings, hip, aductors/abductors and all muscles involved.

No more pushing to force any flexion that isn't going to come he said. Sadly last check up last week only measured at 104 to start. The pain on the medial part of knee is getting better and looks to be snapping knee from tnedons and ligaments that all connect in that spot. Stretching and strengthening the adductor, hamstring and other surrounding areas is my current focus. Seems to be getting better. Also trying to get to the pool once a week at least to do the hot tub, some water walking and exercises in the lazy river then hot tub to finish.

Biking is still a work in progress as knee is just so tight to start but does loosen up. Still have slight aches at night usually at around 2 or so in the areas described above. Mostly due to how I sleep so if sleep on left side instead of my preferred right helps. Can't do back or wife will throw me out due to snoring.

All in all just need to keep working on things as still early in the TKR recovery life.

 

[sistersinhim]

It sounds like you are doing well for just 3 months out and are having a sensible rehab.

 

[Jockette]

All in all just need to keep working on things as still early in the TKR recovery life.

Yes, you are still quite early in this recovery. 3 months is 25% healed, on average.

You really don’t have to work hard to progress, you will, as time goes on and you continue to heal.

No more pushing to force any flexion that isn't going to come he said.

I’m glad you won’t be pushing to force any flexion, but I disagree that 104 is all you’ll get. That might be true, but since you are only 3 months post op, there’s a good chance it will get better. My ROM continued to improve all through my second year, and even a bit more in my third. There is no Window of Opportunity

 

[Layla]

You're welcome and no worries about checking in. Thanks for the update though, we love hearing from you!
Easy does and slowly but surely you'll get there.
Have a great day and weekend, crpav!
@crpav