PKR Long Story of my Battle with a Bad Knee

[beesknee]

I pulled up the report from the Pre surgery MRI - May 2021. It looks like the main difference is the lateral Meniscus tear. I had no grinding.

It must have been torn during the operation as I have had no injury since PKR. Only have done rehab exercises to keep the knee as strong as possible.

Pre surgery I only sharp pain in knee for a few days if I ran too much. Now running is not an option and I have dull pain in knee.

I am hoping that a scope can clean it up.

Here is last year's MRI.

Impression

IMPRESSION:

1. Evidence of osteochondral grafting along the medial femoral condyle

with good incorporation of the osteochondral graft and minimal

protrusion. There is fraying and diffuse irregularity of the overlying

cartilage, but no full-thickness osteochondral defect. No underlying

cystic change.

2. Multifocal full-thickness articular cartilage defects along the

patella, trochlea and medial femoral condyle(along the anterior aspect

of the osteochondral graft) as detailed in the body the report with

associated subchondral bone marrow edema.

3. Shallow trochlear groove with patella alta.

4. Multilobulated intact Baker's cyst.

5. Irregularity along the posterior horn medial meniscus-capsular

interface likely represents injury.

Narrative

MRI of the right knee without contrast

Exam Date: 5/19/2021

History: Osteochondritis dissecans

Comparison Studies: None

TECHNIQUE: Multiplanar, multisequence MR imaging was performed without

Gadolinium contrast per the standard protocol on a 1.5 Tesla magnet.

FINDINGS:

* Menisci: No medial or lateral meniscal tear. Irregularity along the

posterior horn medial meniscus-capsular interface likely represents

injury.

* Ligaments: ACL, PCL, MCL, LCL all appear intact.

* Extensor Mechanism: Patella alta. Intact extensor mechanism.

* Joint: Small joint effusion. Intact multilobulated 1.3 x 2.1 x 4.4 cm

Baker's cyst.

* Articular Cartilage:

Patellofemoral compartment: Focal full-thickness articular cartilage

defect along the median patellar ridge measuring 0.4 x 0.3 cm with

associated subchondral bone marrow edema. Additional focal

full-thickness defect along the lateral patellar facet with associated

subchondral bone marrow edema. Focal full-thickness fissuring along the

midline trochlea with subchondral bone marrow edema. Superimposed

diffuse thinning of the articular cartilage.

Medial compartment: Focal 0.2 x 0.2 cm full-thickness articular

cartilage defect along the medial femoral condyle along the anterior

aspect of the osteochondral graft. There is good incorporation of the

osteochondral graft with minimal protrusion. There is fraying and

diffuse irregularity of the overlying cartilage.

Lateral compartment: Diffuse thinning with no full-thickness defects.

* Miscellaneous: Shallow trochlear groove. No fracture. No aberrant

vessels.

 

[zdclimber]

After reading your previous MRI report, I am surprised you had a Medial PKR. My understanding is that Medial PKR is a good option if the cartilage defect is confined to the medial compartment. If other compartments are also affected, which is true in your case, then a TKR is a better option. I am not sure if you brought it up to your surgeon prior to your Medial PKR.

 

[Jamie]

@beesknee .... it appears there is additional damage to your knee following your PKR. It is unlikely that this happened during your surgery in July of 2021. And you don't need to have an injury or any kind of event to have this type of damage in an arthritic knee. The very nature of the disease is gradual degeneration of the cartilage over time. You need your surgeon to advise you on the next step. So, I'll be interested to hear what he has to say on Tuesday. Please let us know.

 

[beesknee]

I never did see the write up of the first MRI until now, I found it on the health portal where I had it done.

I remember him doing a quick read of the MRI write up at my appointment before deciding on a partial. I am not sure he ever looked at the actual images from the MRI (I asked him if he did and he said he did). It seems I would have been better off with at most a scope. I was getting around pain free 95% of the time. I am not happy. It seems he went off my x-rays more than the MRI. The x-rays of my knee look very good.

I am no doctor but I feel the partial only put additional strain on the rest of the knee with all the swelling and twisting during and after surgery speeding up the issues with it. I am not in the mood to lose another year of my life with a TKR. After surgery he said the rest of my knee looked very healthy - "The knee of a 25 year old".

Currently, my knee is fairly good as I can get around ok. If I was in severe bone on bone pain prior I guess I would be happy. But after 11 months I am worse than before with weakness and stiffness. I can only push so hard to strengthen knee before it feels worse the next day.

I am not sure I will allow him to do further work on my knee as I feel he pulled the wool over my eyes and just wanted to do some type of knee replacement.

If he did not work a miracle on my knee 12 years ago with microfracture I would have gotten a second opinion and researched knee replacements a whole lot more. Now I am thinking malpractice (which I know are next to impossible to win).

He will need to do some smooth talking Tuesday to get me to change my opinion.

 

[Ghostpipe]

Same sentiments here. My old knees, with their faults, were better than these new ones. At least they were consistent, now I never know what’s around the next corner whenever I do anything more than live a sedentary life. My surgeon knew my lifestyle, and should have tried a totally different path to two replacements.

 

[Ginger1210]

Hi Beesknee i feel your frustration. I soo want to get on with life without my knee being in charge. I am improving but slowly.
My knee is noisy and feels like it has gravel inside it. This may be scare tissue as well.
It will be interesting to see if this is the issue you are currently having.
I have found a get around with my pain. If i wear a T.E.N.S machine and place the pads just below my kneecap and leave it on a low setting i am pretty much good to go. I have done this for a full day of gardening and it does help a lot. Its certainly not ideal but it works for me.

 

[WFD]

@Ginger1210 , does your TENS machine prevent or reduce swelling, in addition to reducing pain? What unit do you have and do you like it?

Thanks.

 

[sistersinhim]

It must have been torn during the operation as I have had no injury since PKR. Only have done rehab exercises to keep the knee as strong as possible.

Having had 8 scopes through the years because of meniscus tears on my knees, I'm proof that it doesn't take an injury to cause a tear in them. Just normal use can cause our knees to deteriorate. I think you need to see a totally different doctor that is out of your area to take a look at your knee. If your arthritis has spread it's only to get worse not better.

 

[beesknee]

I had my appointment yesterday. We looked at the MRI (like I mentioned, I doubt he looked at my pre-op MRI , only the write up). Anyway, he feels the meniscus looks good. The main problem is the edema (swelling) which is directly under my kneecap which he feels is causing my issues..

Cartilage and muscles are all healthy and offers plenty of cushion between bones in the knee.

Since my appointment 6 week ago where I got the cortisone shot and now I am about 25% better which point toward inflammation causing my issues. He wants me to continue work on getting my quad muscle (and other leg muscles) as strong as possible without aggravating the knee over the summer. He said that my quad being weak is putting extra pressure/strain on the kneecap which aggravates it and prevents the edema under kneecap from improving.

He said it will be and extra slow process strengthening my quads because pushing too hard will set me back but not pushing enough will result in stagnation. He suggested lots of bike work along with my regular daily exercises. Also, I should look into water therapy - low impact exercises. I have worked out with weights all my life and it is frustrating that I can't push the knee harder to speed muscle build up.

After summer, if I am still about the same, he would do a scope and then more rehab, then if the same, talk about total knee replacement.

I guess the good news is I am not really in much pain, just the swelling and aching after and active day or exercises. This weekend we spent two days boating so was very active. moving around the boat, dealing with ropes, ladders and anchors was all ok. The one thing that bugged me was when driving I like to kneel with my right knee on the seat so I have a better view of little kids bobbing in water that fell off their tubes - after a few minutes my knee was hurting in kneeling position. I can work in yard for hours without issue except I favor the good leg while bending pulling and pushing.

The problem is the knee always feels stiff and puffy and I need to be careful not to twist or jump down on that leg. Also, going downstairs if a slow process although I can take a step or two down without the sharp pain I had 6 weeks ago before the cortisone shot. I can go up stairs on a good day slowly without hanging on. Any kind of running is out of the question. I have iced every evening except 2 days since surgery.

I feel the PKR made the rest of my knee worse with all the swelling as I have knee pain in places I never had before. If I had to do it over I would have had a scope and rehabbed. Because before this my knee was way better condition. I could run a little and it would only get bad if I really overdid it, then I would be hobbling for a few days.

I am going to seek a second opinion. I know mostly I am screwed, but I want to see what another doctor says about me getting a partial to begin with and also want to know what he/she feels are best next steps.

I believe someone here has a list of knee doctors - if so, please DM me the name or names of knee replacement doctors near Ann Arbor that would help me get started and be much appreciated.

My current doctor is on the other side of town where we used to live, so if anything, a guy more local to me would be good. Also, a doctor near here would be in the University of Michigan health system completely separate from Ascension Health System the current doctor is in. Thanks for all the support everyone!

 

[partialfixFeb]

@beesknee

FWIW, I think that what your surgeon suggests makes a lot of sense.

I too have had to switch up my activities/exercises/PT recently to strengthen my quad without taxing my kneecap as it got aggravated recently.

In a nutshell, if I feel it in my kneecap, I stop per my PT. Period. She says it is crucial to protect the kneecap and I'm not going to chance pushing it and end up facing a TKR if I can help it.

I stopped walking on anything other than flat trails for now. I started regularly cycling and using the elliptical. Within a couple of weeks, I noticed improvement.

I know that I am missing out on some of the activities that I love, but it doesn't mean forever. And, I am grateful to at least be able to work up a good sweat on the bike and elliptical. It could be worse.

The fact that your knee is structurally sound seems like awfully good news to me. That fact, and the fact that the cortisone helped, tells me that improvement is within your control by modifying activities for now until the knee inflammation settles down.

I am sorry you have had this prolonged setback. Fingers crossed that your surgeon's report was accurate and that following his advice will help give you relief and gradually get you back on track to your pre-op activities.

I get that it does seem like this recovery takes forever (and it does) and, believe me, there are many days that I am so OVER my life revolving around my knee. But, unlike you, I have been through this before so I know firsthand how unbelievably normal my healed knee feels which I never expected. (Not trying to brag, I know that I was one of the lucky ones.)

Just my 2 cents. I'm no expert. Everybody's different.

 

[beesknee]

I stopped walking on anything other than flat trails for now. I started regularly cycling and using the elliptical. Within a couple of weeks, I noticed improvement.

I have access to recumbent bikes at the health club, heading there now. I also, have a health club refurbished elliptical at home. I did 30 minutes on the elliptical on Saturday and knee was fine next day. I actually had some workout muscle soreness in legs the next day which is good. Yesterday, I did 15 minutes and had to stop because I could feel some straining of knee. I have learned to quit exercises when knee feels pain.

Also, I can bike outside now but we have a few hills around house that could overstrain knee so I have held off. I carefully log all leg exercises, reps and weight on a phone app, so when I am feeling good I don't over do it and maybe increase things just a little.

Over resting leg would be know good for me as quad and leg muscles would only get weaker so I have to push as much as possible without pushing too much. Which is not an easy balance.

 

[partialfixFeb]

@beesknee

You are correct, it is not an easy balance.

Like you, when I started using our new gym elliptical/cross-trainer, I had unexpected muscle soreness (happily) and no harm to the knee from it. Of course, my natural inclination is to regularly increase my tension and length on the elliptical but my knee tells me some days to hop off after 20 minutes or less and lessen the tension. And, I force myself to take recovery days...which I hate.

The only thing I *try* to do cardio-wise religiously is to cycle at least 10-15 minutes. FWIW, my PT explained that those of us with PKR's still have knee cartilage and that cycling, unlike walking and the elliptical, brings the most blood flow and, thus, nutrients to the knee to help keep the cartilage healthy. I never thought of that, but I guess that makes sense given the bend required with cycling. I have to trust her. Can't hurt. Time will tell.

Sometimes I think it was my determination to push myself athletically that got me into this situation in the first place. In hindsight, I ran too many miles daily for many, many years, played lots of single tennis matches, did insufficient cross-training, and rarely took recovery days. I was never good at pacing myself but it sure felt good at the time. I don't ever want to go through surgeries like this again so I am being smarter about it without becoming sedentary.

Glad you are letting your knee dictate your activities. Not easy.

 

[Ginger1210]

@Ginger1210 , does your TENS machine prevent or reduce swelling, in addition to reducing pain? What unit do you have and do you like it?

Thanks.

Hi WFD. Not sure if it reduces swelling but it sure helps with pain management. I have even used it a work under my trousers all day and it does help. The model i have is called Auvon T.E.N.S. massager. it is rechargeable and lasts all day.. As i mentioned its not the perfect answer but you find what works for you.

 

[Ginger1210]

@beesknee

You are correct, it is not an easy balance.

Glad you are letting your knee dictate your activities. Not easy.

Hi Partialfix. I too did way to much sport which i think caused my right PKR. I thought i was invincible and always pushed my body to limit 20 years of Kickboxing and Grappling plus running right into my mid 40`s. I now know i should have retired at 40 and eased off a bit. Hindsight is a great leveler.

 

[WFD]

Thanks, @Ginger1210 .

 

[beesknee]

I believe someone here has a list of knee doctors - if so, please DM me the name or names of knee replacement doctors near Ann Arbor that would help me get started on second opinion. Would be much appreciated!

 

[Pumpkin]

@beesknee
You can start your search for a surgeon using the surgeon locator at the top of the page in the blue banner.
You will want to search for a surgeon specializing in revisions or complex joint reconstruction.
Good luck in your search,
Chris

 

[beesknee]

Thanks. I tried that. 19 doctors come up in the Ann Arbor area. The only information on all the doctors given is that they are Orthopaedic Surgeons nothing about their specialties. 2 have photos.

I entered there names in ratemds and most have little information there, reviews they have are very mixed and I don't think any specialize in knee replacements.

Any of the rate Dr. sites will have lots of bad reviews because unhappy people are more likely to post reviews than satisfied patients.

Maybe I'll post in our local facebook page and ask for personal referrals.

 

[Pumpkin]

Do a google search and take a look at their web sites for information about the surgeons specialities.
You can also give the offices a call and ask for surgeons specializing in knee replacements.

 

[Jamie]

Pumpkin is correct. To best use the Surgeon Locator (or a Google search, for that matter), you have to use the search just to get the names of surgeons in your area. Then you must go to the website (sometimes a hospital site) for each and find the area that talks about their specialties. You then look for the words "knee revision" or "knee reconstruction" as the key that they may do revision surgeries. Once that narrows the search, you can call each office and ask if the doctors do complex knee revisions. If you find several in your area, you may want to meet with each of them to see how many knee revisions they do and their success rates.

My only resource in Michigan is in Detroit, which seems fairly close to Ann Arbor. Here is that information:

Detroit, Michigan

Beaumont Hospital seems to have a group of orthopedic surgeons who do complex revisions, but their web information wasn't clear about the individual surgeons' expertise. So, I think you should call their customer service specialists at 800-633-7377 and ask which surgeon does the greatest number of complex knee revision surgeries. Let me know what you find out as I don't currently have any surgeons on my listing from the Detroit area.

I did locate one revision surgeon, broken link removed: https://dmcmedicalgroup.com/providers/sam-nasser-md-faoa/. There are phone numbers to contact his office at the linked website.

Please let me know of any surgeons you find an meet with, so I can add them to my list. I maintain this list for the US that is separate from our Surgeon Locator. Sadly you are correct that all the many "surgeon rating websites" out there are pretty worthless when you're trying to find the right doctor for your situation.