PKR Medial PKR Left knee, Tuesday 4th June
- Thread starter RoboPop
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Rockgirl4
Former BoneSmart staff member
Hi @RoboPop. I just wanted to share what I was told in 2016 and again in 2018. Feel free to ignore, as I am in no way giving medical advice or claiming to know everything. I've just lived this twice!
Back in the summer of 2016, I was in the middle of a 10 month rehab from my MACI surgery in Dec. 2015. I was doing 2-3 hrs of aggressive PT, 3X a week (that's a nasty post for another day!!). I developed severe pain almost exactly where you describe. Without a picture, it's tough to know for sure, but I'll tell you what I was told....
1) My surgeon and PT said it's probably textbook tendonitis due to overuse of the patellar tendon---IF it's mostly below the knee, on the front of the leg. It's a common problem after that level of PT and large amounts of exercise. It's considered an overuse problem--almost no one can relate it to any sort of injury. It tends to come out of nowhere and can be VERY hard to resolve. It happened again in the summer of 2018 after a microfracture surgery on my other leg, as I was trying to get back in shape as fast as possible before my right TKR that winter. I had extensive ultrasound therapy both times, lots o direct ice massage, and since the advice of complete rest doesn't have the best track record for getting rid of it, our plan was to back off of everything by 50% (do half the sets and half the weight). Granted, that aggressive PT is what got me in the position in the first place, but I didn't know any better back then. I am happy to say it worked both times. It's not wise to ignore this pain. Patellar rupture is a real possibility and not uncommon. I was told tendonitis is usually that overuse injury you can never neglect or expect to just resolve on its own....and I feel for you. It was sheer misery.
2) Another idea---Because I can't see exactly the area you're referencing. There's a chance it's inflammation of the peroneal nerve that runs down the front/outer shin. I had so much scar tissue from 7 nasty surgeries on my right leg, so it was almost a guarantee that my pain in THAT area was peroneal nerve inflammation. I had it injected (cortisone and lidocaine injections) 2-3X before getting relief. I've had to reduce much weight I lift on the leg ever since. The diagnosis later by my new TKR surgeon (after he performed the TKR in 2019) was there was loads of scar tissue--actual adhesions--wrapped around the head of my fibula bone, and that's where that branch of the nerve runs down your leg. I've since had issues with this again, but mostly in the upper ankle area instead. It's all that same branch of the peroneal nerve though, and all related to the number of adhesions and reduced mobility in that right leg.
My 2 TKR surgeons have been the best at explaining what all of that pain was about those 3 years. First, they said I had BOTH problems independent of each other. The areas affected just happened to be side by side anatomically. Each said the tendons were overused by too much exercise and too aggressive of PT, plus the nerves were unhappy because there had been so many procedures (7 in 8-9 years). Now I'm dealing with the adhesions that don't let my lower right leg move well, and I occasionally see a chiropractor who specializes in lower extremity problems. He does a great job of helping all the bones in that right lower leg move with each other, limiting friction and fascia pain. I've always had a "sticky fascia" problem, likely having to do with my psoriatic arthritis.
Best of luck to you, and I'm sorry this is still on-going and stalling out your recovery. I think you'll get there with some modifications though.
Back in the summer of 2016, I was in the middle of a 10 month rehab from my MACI surgery in Dec. 2015. I was doing 2-3 hrs of aggressive PT, 3X a week (that's a nasty post for another day!!). I developed severe pain almost exactly where you describe. Without a picture, it's tough to know for sure, but I'll tell you what I was told....
1) My surgeon and PT said it's probably textbook tendonitis due to overuse of the patellar tendon---IF it's mostly below the knee, on the front of the leg. It's a common problem after that level of PT and large amounts of exercise. It's considered an overuse problem--almost no one can relate it to any sort of injury. It tends to come out of nowhere and can be VERY hard to resolve. It happened again in the summer of 2018 after a microfracture surgery on my other leg, as I was trying to get back in shape as fast as possible before my right TKR that winter. I had extensive ultrasound therapy both times, lots o direct ice massage, and since the advice of complete rest doesn't have the best track record for getting rid of it, our plan was to back off of everything by 50% (do half the sets and half the weight). Granted, that aggressive PT is what got me in the position in the first place, but I didn't know any better back then. I am happy to say it worked both times. It's not wise to ignore this pain. Patellar rupture is a real possibility and not uncommon. I was told tendonitis is usually that overuse injury you can never neglect or expect to just resolve on its own....and I feel for you. It was sheer misery.
2) Another idea---Because I can't see exactly the area you're referencing. There's a chance it's inflammation of the peroneal nerve that runs down the front/outer shin. I had so much scar tissue from 7 nasty surgeries on my right leg, so it was almost a guarantee that my pain in THAT area was peroneal nerve inflammation. I had it injected (cortisone and lidocaine injections) 2-3X before getting relief. I've had to reduce much weight I lift on the leg ever since. The diagnosis later by my new TKR surgeon (after he performed the TKR in 2019) was there was loads of scar tissue--actual adhesions--wrapped around the head of my fibula bone, and that's where that branch of the nerve runs down your leg. I've since had issues with this again, but mostly in the upper ankle area instead. It's all that same branch of the peroneal nerve though, and all related to the number of adhesions and reduced mobility in that right leg.
My 2 TKR surgeons have been the best at explaining what all of that pain was about those 3 years. First, they said I had BOTH problems independent of each other. The areas affected just happened to be side by side anatomically. Each said the tendons were overused by too much exercise and too aggressive of PT, plus the nerves were unhappy because there had been so many procedures (7 in 8-9 years). Now I'm dealing with the adhesions that don't let my lower right leg move well, and I occasionally see a chiropractor who specializes in lower extremity problems. He does a great job of helping all the bones in that right lower leg move with each other, limiting friction and fascia pain. I've always had a "sticky fascia" problem, likely having to do with my psoriatic arthritis.
Best of luck to you, and I'm sorry this is still on-going and stalling out your recovery. I think you'll get there with some modifications though.
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RoboPop
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Thank you. It would definitely seem I’ve been overdoing it. I intend to back off the golf and lower body weight training. I’d be interested to know if people think light resistance pedal turning on my static bike would help or hinder my current predicament?
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I think zero to light resistance is good. The main goals are to reduce inflammation, preserve and enhance range of motion, and to give the muscles some exercise without endangering tendons.
Another way to spare your tendons is, with any strength exercises, to avoid extreme flexion or extension.
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Ouch! I just used to lie on my tummy with my leg off the bed. I used to read the paper like this and gradually increased the time I could tolerate up to a maximum of 10 minutes at a stretch. I now have full extension. I didn't use any weights or resistance bands until about 5 months.
I think you need to treat your knee more gently and just relax into the extension stretching.
RoboPop
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Evening Bonesmarters. Thought it was time for an update.
Since my last post I backed off all weight bearing exercises, cut back on my static bike workouts, and generally took it easy. I also paused my golf club membership. Mid October I headed back to Portugal for a few weeks and admit to a handful of rounds of golf, but only with a buggy, and wearing a knee support. This didn't seem to aggravate my knee any worse than it already was. A couple of weeks after getting back to the UK, I had my six month review with my Consultant on the 12th November. He asked me how things were going, and I said in terms of successfully relieving the bone on bone pain I had, things were good, but in terms of quality of life I was no better off. He was quite taken aback by this because from my X Rays everything looked perfectly aligned in the joint. When I described the issues with the pain and stiffness under my kneecap he examined the joint and came to the conclusion I'm suffering with Patellar Tendinopathy.
He's not 100% sure on why I've developed this problem, but it might be a combination of overdoing things, and the joint now being realigned? The outcome is that he's referred me for four sessions of Shockwave Therapy and Physio. He's also booked a follow up Consultation in the Spring to see if the situation's improved. I've had this type of therapy 10 years ago when I had an Achilles problem that ultimately required surgery. The unfortunate thing in terms of getting the therapy is that they cant fit me in until February. Rather than waste two months that I could be carrying out some remedial exercise, I booked an appointment with my local GP surgery to see their Physio. She's a fan of Shockwave Therapy and is positive about the possible outcome of my treatment. In the meantime she's given me an exercise sheet to get me going, and will see me again in a couple of weeks to check on progress and revise the Regimen. I'm a week into the exercises, and it's too early to tell if they're helping. However I'm feeling better now I've had a diagnosis, and course of action, but am resigned to a long road ahead as I work on the new problem. So in the meantime I am only doing the exercises I've been instructed to do when it comes to my knee, and also a couple of weekly upper body strength sessions which don't involve loading my legs. I'll update further as things progress, and as it's likely to be in the New Year, I'd like to wish all Bonesmarters a Merry Christmas & Healthy New Year.
Since my last post I backed off all weight bearing exercises, cut back on my static bike workouts, and generally took it easy. I also paused my golf club membership. Mid October I headed back to Portugal for a few weeks and admit to a handful of rounds of golf, but only with a buggy, and wearing a knee support. This didn't seem to aggravate my knee any worse than it already was. A couple of weeks after getting back to the UK, I had my six month review with my Consultant on the 12th November. He asked me how things were going, and I said in terms of successfully relieving the bone on bone pain I had, things were good, but in terms of quality of life I was no better off. He was quite taken aback by this because from my X Rays everything looked perfectly aligned in the joint. When I described the issues with the pain and stiffness under my kneecap he examined the joint and came to the conclusion I'm suffering with Patellar Tendinopathy.
He's not 100% sure on why I've developed this problem, but it might be a combination of overdoing things, and the joint now being realigned? The outcome is that he's referred me for four sessions of Shockwave Therapy and Physio. He's also booked a follow up Consultation in the Spring to see if the situation's improved. I've had this type of therapy 10 years ago when I had an Achilles problem that ultimately required surgery. The unfortunate thing in terms of getting the therapy is that they cant fit me in until February. Rather than waste two months that I could be carrying out some remedial exercise, I booked an appointment with my local GP surgery to see their Physio. She's a fan of Shockwave Therapy and is positive about the possible outcome of my treatment. In the meantime she's given me an exercise sheet to get me going, and will see me again in a couple of weeks to check on progress and revise the Regimen. I'm a week into the exercises, and it's too early to tell if they're helping. However I'm feeling better now I've had a diagnosis, and course of action, but am resigned to a long road ahead as I work on the new problem. So in the meantime I am only doing the exercises I've been instructed to do when it comes to my knee, and also a couple of weekly upper body strength sessions which don't involve loading my legs. I'll update further as things progress, and as it's likely to be in the New Year, I'd like to wish all Bonesmarters a Merry Christmas & Healthy New Year.
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Thank you for the update I'm sorry to learn this.
Yes, patellar tendinopathy is one thing we see among members who do strength training - either in aggressive PT or on their own - too early. Sometimes, though, it really can simply be a matter of the entire body structure re-adjusting post op. And as there's no way to know, there's no point in self-recrimination!
The good news is you have the diagnosis and a treatment plan, so here's to a wonderful 2025 for you!!!!
Yes, patellar tendinopathy is one thing we see among members who do strength training - either in aggressive PT or on their own - too early. Sometimes, though, it really can simply be a matter of the entire body structure re-adjusting post op. And as there's no way to know, there's no point in self-recrimination!
The good news is you have the diagnosis and a treatment plan, so here's to a wonderful 2025 for you!!!!
RoboPop
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"Yes, patellar tendinopathy is one thing we see among members who do strength training - either in aggressive PT or on their own - too early. Sometimes, though, it really can simply be a matter of the entire body structure re-adjusting post op. And as there's no way to know, there's no point in self-recrimination!"
Bit of both I fear :-(
Bit of both I fear :-(
RoboPop
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Good afternoon Bonesmarters. I hope you’re all well.
It’s been over a year since I last updated my “progress” following my Medial PKR in June 2024
2025 has been a difficult year with no real progress in my recovery from the pain in the outside of my knee, radiating from just under the kneecap. Last November it appeared I had a diagnosis of patellar tendinopathy, and was prescribed a series of shockwave therapy treatments, and associated physio. Unfortunately due to the lack of available appointments the treatment didn’t begin until February of this year. I had several sessions on and off throughout the spring, bit with no noticeable improvement. I eventually came to the conclusion that we were not treating the actual problem, so then wrote to my surgeon ahead of a forthcoming follow up appointment, suggesting he send me for an MRI Scan before I saw him. In response he referred me for an ultrasound examination, which didn’t really determine any issue with my patellar tendon. At my follow up appointment I asked him if the problem could be in my patellar cartilage, but he assured me he had carried out a thorough examination of all parts of the knee joint during surgery to determine the viability of a PKR rather than a TKR. He concluded from the examination that a PKR was the required course of action. This left him at a loss as to what was causing my continued knee pain, and referred me to a colleague for a second opinion. At my referred appointment and examination this consultant suggested it might be an Iliotibial Band friction issue due to the realignment of the joint. The next step was an MRI Scan to examine the joint soft tissue. After the scan I had a follow up appointment last week and the outcome is I have a degenerative tear anterior horn of the lateral meniscus. His experience of surgery on this area of the meniscus is it’s likely to produce a negative outcome, and therefore he’s not prepared to offer a surgical treatment. I’ve now been referred back to my original consultant for a consultation in February.
Based on the above diagnosis, my take on the possible future choices I face are either put up with the pain, knowing that cartilage doesn’t repair itself, or go for a full knee replacement? I won’t know for sure until February. I have to say I’m really disappointed with this diagnosis as I agreed prior to the original surgery to let him make the decision in theatre on whether I needed a TKR or not, and to proceed with whatever he deemed necessary.
The surgeon I was referred to said at my level of activity I wouldn’t be happy with a TKR, and advised to just manage the pain. I guess what I’d like to know from people who’ve had both procedures, how do the two compare in terms of onward quality of life? My current pain never really goes away, but heading for my 70th birthday fitness is still a huge part of my life, and I wonder if I’m heading for massive shift in my expectations of what I’m going to be able to maintain?
Merry Christmas to all
It’s been over a year since I last updated my “progress” following my Medial PKR in June 2024
2025 has been a difficult year with no real progress in my recovery from the pain in the outside of my knee, radiating from just under the kneecap. Last November it appeared I had a diagnosis of patellar tendinopathy, and was prescribed a series of shockwave therapy treatments, and associated physio. Unfortunately due to the lack of available appointments the treatment didn’t begin until February of this year. I had several sessions on and off throughout the spring, bit with no noticeable improvement. I eventually came to the conclusion that we were not treating the actual problem, so then wrote to my surgeon ahead of a forthcoming follow up appointment, suggesting he send me for an MRI Scan before I saw him. In response he referred me for an ultrasound examination, which didn’t really determine any issue with my patellar tendon. At my follow up appointment I asked him if the problem could be in my patellar cartilage, but he assured me he had carried out a thorough examination of all parts of the knee joint during surgery to determine the viability of a PKR rather than a TKR. He concluded from the examination that a PKR was the required course of action. This left him at a loss as to what was causing my continued knee pain, and referred me to a colleague for a second opinion. At my referred appointment and examination this consultant suggested it might be an Iliotibial Band friction issue due to the realignment of the joint. The next step was an MRI Scan to examine the joint soft tissue. After the scan I had a follow up appointment last week and the outcome is I have a degenerative tear anterior horn of the lateral meniscus. His experience of surgery on this area of the meniscus is it’s likely to produce a negative outcome, and therefore he’s not prepared to offer a surgical treatment. I’ve now been referred back to my original consultant for a consultation in February.
Based on the above diagnosis, my take on the possible future choices I face are either put up with the pain, knowing that cartilage doesn’t repair itself, or go for a full knee replacement? I won’t know for sure until February. I have to say I’m really disappointed with this diagnosis as I agreed prior to the original surgery to let him make the decision in theatre on whether I needed a TKR or not, and to proceed with whatever he deemed necessary.
The surgeon I was referred to said at my level of activity I wouldn’t be happy with a TKR, and advised to just manage the pain. I guess what I’d like to know from people who’ve had both procedures, how do the two compare in terms of onward quality of life? My current pain never really goes away, but heading for my 70th birthday fitness is still a huge part of my life, and I wonder if I’m heading for massive shift in my expectations of what I’m going to be able to maintain?
Merry Christmas to all
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I'm sorry it's been such a hard journey for you.
My personal experiences indicate that with or without surgical intervention, a badly torn meniscus inherently destabilizes the weight bearing load, leading to increased wear and tear osteoarthritis:
My R knee surgery in 2001,following ACL and medial meniscus tears, led to early onset traumatic osteoarthritis. That created chronic pain with prolonged weight bearing, occasional sharp shooting pain, and overall it progressed slowly. I attribute that to my relative youth at the time.
My L knee decades later had a spontaneous tear of both medial and lateral menisci and despite conservative treatment it remained frighteningly unstable. I never knew when a bit would float off or a tiny flap get stuck in place creating excruciating pain and an inability to bear weight. That led to my earlier L TKR
My personal experiences indicate that with or without surgical intervention, a badly torn meniscus inherently destabilizes the weight bearing load, leading to increased wear and tear osteoarthritis:
My R knee surgery in 2001,following ACL and medial meniscus tears, led to early onset traumatic osteoarthritis. That created chronic pain with prolonged weight bearing, occasional sharp shooting pain, and overall it progressed slowly. I attribute that to my relative youth at the time.
My L knee decades later had a spontaneous tear of both medial and lateral menisci and despite conservative treatment it remained frighteningly unstable. I never knew when a bit would float off or a tiny flap get stuck in place creating excruciating pain and an inability to bear weight. That led to my earlier L TKR
@RoboPop
I’m sorry to read of your struggles with your PKR. My Patellofemoral PKR has not been a success, so I understand your feelings and your search for a solution. My search has not had a happy ending.
Is it possible for you to get an appointment for another opinion, with a surgeon who has no relationship with the ones you’ve seen so far? Sometimes someone totally different can see things that others do not. That’s what I was able to do, but it still didn’t help me find a solution to my issues, and we each of different reasons why our surgery was not successful.
We have members who had PKRs revised to TKRs, here are some of their threads:
I’m sorry to read of your struggles with your PKR. My Patellofemoral PKR has not been a success, so I understand your feelings and your search for a solution. My search has not had a happy ending.
Is it possible for you to get an appointment for another opinion, with a surgeon who has no relationship with the ones you’ve seen so far? Sometimes someone totally different can see things that others do not. That’s what I was able to do, but it still didn’t help me find a solution to my issues, and we each of different reasons why our surgery was not successful.
I really don’t know why you would be told this but I would think this doctor is not the one for you right now!
We have members who had PKRs revised to TKRs, here are some of their threads:
Welcome back, @RoboPop. I can understand you are struggling with this decision.
Since you were last on the forum, we've implemented a two-tier membership program to help us support the important work BoneSmart does. You are currently a Basic Member, which means you may search the forum and read others' thread. You may also continue to post here in your Recovery thread about this recovery.
If you'd like more advice from the our staff, you will need the Insiders Club. As an Insider, you will receive personalized support to quickly answer any questions or concerns you may have as well as access to our educational library.
As a non-profit organization we depend upon these small contributions to keep BoneSmart available.
Best Wishes, and we hope to see you join the Insiders Club.
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Since you were last on the forum, we've implemented a two-tier membership program to help us support the important work BoneSmart does. You are currently a Basic Member, which means you may search the forum and read others' thread. You may also continue to post here in your Recovery thread about this recovery.
If you'd like more advice from the our staff, you will need the Insiders Club. As an Insider, you will receive personalized support to quickly answer any questions or concerns you may have as well as access to our educational library.
As a non-profit organization we depend upon these small contributions to keep BoneSmart available.
Best Wishes, and we hope to see you join the Insiders Club.
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Hello Robopop,
Welcome back to the forum. I am sorry it's under the circumstances you shared above.
I can imagine your discouragement after 1.5 years of recovery. Preparing and going through surgery and still not gaining the relief you hoped for. Anyone who's as active as you mentioned you are would struggle with being told to "just manage the pain". That's not what you want / need to hear. Consider that you might not need to lose your current activity level, but possibly only adjust it. Maybe trying some new activities in lieu of some of your current activities. If doing so will allow you the freedom to remain physically active, without the pain, you can still have a full active life. Total Knee Replacement may just be the step forward you need to take for a better quality of life, rather than settling. I wish you clarity in weighing out your choices and peace with whichever path you decide to take. Please keep us posted and let us know how the February consultation goes.
Wishing you a Merry Christmas!
@RoboPop
Welcome back to the forum. I am sorry it's under the circumstances you shared above.
I can imagine your discouragement after 1.5 years of recovery. Preparing and going through surgery and still not gaining the relief you hoped for. Anyone who's as active as you mentioned you are would struggle with being told to "just manage the pain". That's not what you want / need to hear. Consider that you might not need to lose your current activity level, but possibly only adjust it. Maybe trying some new activities in lieu of some of your current activities. If doing so will allow you the freedom to remain physically active, without the pain, you can still have a full active life. Total Knee Replacement may just be the step forward you need to take for a better quality of life, rather than settling. I wish you clarity in weighing out your choices and peace with whichever path you decide to take. Please keep us posted and let us know how the February consultation goes.
Wishing you a Merry Christmas!
@RoboPop
I agree that an opinion from a doctor that has no affiliation with your current doctors could be very beneficial.
