filling in empty hole in knee

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John Mc

Hi, I just wanted to give a progress report to those of you who are reading the postings. I am 14 mo.’s post op. (Please see postings below for a full account.) About 3 mo.’s ago, I had trouble with stiffness and over all discomfort due to inflammation of my muscles surrounding the knee due to weakness. At this time I was very active in the gym and was able to walk long distances, however just not happy with the over all feel. My Doctor recommended “Synvisc” injections with an addition of an anti inflammatory. He said that it would take 3 to 5 weeks for the effect, and he was right. I walk freely and do my exercises with no pain during my routine or at night. It has been a long road with many ups and downs, however I have so much confidence with my knee that I am going to ask my Doctor if I can start to play tennis again. Robin

Hi Dawn, Haven't posted to this board for a long time, but I read your entry with interest since like Robin I too went through a similar set of concerns. I am now 9 months post op on my ACI, and my experience is that pain still exists at the graft site, but that the severity of the pain has over the 9 months slowly (very slowly) decreased. I am continually amazed at the ultra slow speed of recovery from this operation, but I do not view this negatively because I am seeing improvements and not setbacks. My consultant has always reinforced to me that this is a 12+ month recovery cycle, so I view these continued small improvements as extremely positive. My best advice to aid recovery comes from one of my early stage physios (paraphrasing) - do as much muscular rehab exercise as you can, but always 'respect the pain' and stop. Kind regards, Simon

Hi I had an ACI repair 5 weeks ago and have had lots doubts as to its success so far. This is due to the fact that I have had the pain on the inside of my knee for over 3 years now after an accident playing netball and it has meant walking with a straight leg ever since. I had a new ACL in Apr 02 and also some of the meniscus removed. After this op the pain was still there, I was devestated. Reading your emails has comforted me somewhat but I would like to ask a silly question, are you supposed to have pain in the graft area as I am getting this pain quite often. Any advice would be gratly appeciated. Dawn

Hello to you both, Hope you are continuing to improve, and I am sorry for not getting back sooner. This must be a good sign in that I am getting back to a normal life. We are a little different in each of our injuries/problems. One of my main problems is the walking in extension. Since I have walked with a bent knee for so long my hamstring tendon and biceps fur morris(? spelling) are very tight and sore. Mainly the later, behind the knee next to the hamstring. It gives me problems when I over do. It seizes up and shoots pain all around my knee and into my ankle. I believe this is due to tendonitis. Also, there is a click in or somewhere around the graft site. However, it is less and less. I visited my OS and he believed this was nothing to worry about. As far as strengthening I am doing lots of quad sets. I have begun to do a type of quad set so that the VMO engages in its fullest extension. I sit on a bench, my leg fully extended. I put my left hand on my VMO to make sure in engages, (my injured leg is the right,) than I grab my toe with my right hand and lift slightly and engage my VMO at the same time. I do about 60 in 20 rep sets. This exercise has helped tremendously. I also am on the bike with the seat as high as possible so the VMO will engage on the down. I’m on the bike 30 to 40 mins., the elliptical for 20 to 30 mins., and the Stairmaster, (in very shallow steps,) for 10 min.. (This one really can bother my knee with the tendonitis.) All in all I am actually doing well with my VMO. I still am not to do any stairs. About a month ago I had a dramatic improvement. I’m starting to feel some what, I repeat, SOME WHAT, normal in walking. It is still uncomfortable to walk long distances. All in all I feel pretty good. I have had my ups and downs which according to my OS will continue for at least a year. Let me know how you are both doing. Best wishes, Robin

Hi Linda, Read with interest your comment about the popping and grinding probably caused by the poor tracking on the kneecap. I have a similar sensation to which my physio has recommended that I tape across the kneecap during my exercise rota. The taping involves getting the kneecap shifted across slightly to the inside of the leg. I benefit from this due to the fact that when under pressure (e.g. bending down 10-15 degrees on the bad leg) my knee rotates inwards. Taping the kneecap inwards lessens this rotation under pressure as well as pain on the graft site, though the most important effect is that it enables me to put in higher quality repetitions of my exercise rota, especially stair dips and step up/downs. I guess the inwards rotation may not be a problem for you, but if the tracking of the kneecap is, then maybe the taping, in whichever direction (!) would help. Best of luck, Simon

Hi Simon and Linda, Sorry that I have not been able to reply more promptly. Hope you are both doing well. I will be post-op week 17 Tuesday the 11th of March. It will also be one year on the 22nd of March since my injury date. Whoopee! (Kidding.) I am able to do the bike and the elliptic at a high intensity for 30 minute's each a day. The OS recommended the stair climber, however my knee just doesn't like it at this moment so I have decided to forgo the climber for now. I still have a lot of weakness in my knee. (Which is getting stronger ever so slowly.) This contributes to the popping and cracking every so often and mainly if I have used it more than normal or if the weather is damp. I also still have some swelling if I am on it for long periods. Therefore I have bought a cane. This helps me to not limp and go into a poor gait. Question to you both. When you twist slightly does your knee get a sharp pain through out? Mainly in the tendon areas, on both sides of the knee and all around? Linda, hurray for you on your hike. 2 1/2 miles, WOW! I am lucky if I can get around the grocery store. Simon, The pain in the back of my knee has subsided somewhat and I believe we have a different situation. Mine seems to be tendon or muscle related. It is located to the inside of my hamstring tendon. You had a carbon fiber ACL, (which was never an option here, I used my patella.) When you extend your knee do you sometimes get a sharp pain on the patella? I also feel the graph site when I walk sometimes. Not like before but it is uncomfortable. Several weeks ago it would burn. That has gone away and has been replaced with a dull ache, and every once in awhile a sharp pain. This happens mainly when I have been on it for a while. I have been told that the ACI is growing and it is starting to form, hence the reason for the uncomfortable feeling. However I am a bit worried as well. (Did only some of it take, none of it, or all?) The shifting of my knee has slowly improved, however I still see the shift. The cane also helps me not to bend into the knee to hopefully get away from this shift. I also can walk freely at first, but than it is difficult to extend due to stiffness. As far as the gliding, it sounds reasonable to me. I had a time when I was putting a sock on and I felt a pop in the graft site. They say that the graft is very difficult to disturb and that it would take a serious accident to harm the site. (This is also a source of my worry regarding the site.) By the way, all of my mother’s side of the family is in London and Sussex. And my father’s side of the family is where Linda grew up. A coincidence. I want to thank both of you for putting my mind at ease and the support. A speedy recovery to you both and all my best, Robin

Hi Linda, Robin Been meaning to post since my Week # 12 check up with the surgeon. I am now in Week # 17. The Week # 12 consultation was not particularly enlightening, I sensed that the surgeon was really guessing at the probably causes of the various symptoms I described. Until he performs the arthroscopy at 12 months he will not be willing to commit himself to much. Currently, I feel the strength in my leg increasing well albeit slowly. Around Week # 10 I started a physio session on the step machine (aka stairmaster) I probably went at it too hard and for the next 2-3 days I had severe swelling and hence loss of movement. Since then I have not returned to this piece of equipment. Though in the past 2-3 weeks I have intensified many of the regular exercises I do with no ill effect. My overriding feeling is that I can now load my leg up with various resistance exercises and it will handle the stresses and strains without reacting. Linda – great to hear the crutches are dispensed with, over here they are cast aside at Week # 6, to me this highlights the variety in thinking that exists, and I am intrigued to know the basis upon which the same treatment can prescribe a 100% difference in the time on crutches. Robin – in response to a number of the points you made in your last post…. The back of the knee pain can be really severe, I am not sure whether we are suffering it in exactly the same circumstances. I only tend to feel it during attempting full flexion. Is this the same for you? The main type of pain I suffer is centred around a zone near the surface at the top of the tibia on the inside of the leg below the patella (does that make sense?) If I make any adverse manoeuvre this is the spot the gets the pain. It is really weird because I cannot see any direct cause (incision, scar tissue, graft, etc.). At best I suppose it may be a result of my ACL reconstruction (1992) or at worst I talk myself into thinking it could be a stress fracture (!!) My medials are still weak, I can see improvement but it is real slow. The physios only have me spending 15 minutes on the static bike. I think this is the way to build these up but the duration is negligible. Last Saturday I ramped it up to 30 minutes with no ill effect so I shall continue at this level. I still get pain on the graft site, this is probably the most worrying aspect of the recovery since I am not sure if this is normal. Do you still get these pains? Also, you mentioned that your knee has shifted inwards, I have had the exact same happen, it is much better now but it is a constant fight to keep the correct posture and alignment. Do you have an ever-present limp? Some days I feel I am walking freely, at least for the first five minutes, then the limp kicks in. Nevertheless, friends who spot me during the first five minutes say ‘see the limp is still there.’ Frustrating. You asked about the duration in hospital and the cast. Four days in hospital is standard in the UK for this op, and as far as my own piece of mind was concerned I appreciated this time under observation with two daily visits from the surgeon and his team. As for the cast, this was described to me to be for the protection against gliding, and I can well imagine that with the level of muscle wastage present, being able to control the leg enough to avoid catching it in any one of a hundred different ways. Was this not a problem for you? Hope all continues to go well. Regards, Simon

Hi Simon, I am really glad that you posted. I have the same problem as you, and have been frustrated. I too have pain in the back of my knee and notably on the outside of the back of knee. I thought that it was my hamstring tendon, however it is something in the back of my knee next to the hamstring tendon only deeper. It is a sharp pain at times when I twist or try to walk normal, and burns when I stretch it, and other times it just nags me. I feel that I am constantantly trying to stretch it...(what ever it is.)This started with my ACL surgery in April. Extension has been a problem when I walk. I can stretch into extension with no problem, however my muscles are so weak that I can't walk in full extension. And I am told that my medialis is weak and causing the patella to have a click when I walk. I am told that will disapear when it gets strong enough. And it has, but returns when my leg gets tired and I start to loose strength. I have been in physical therapy since March working on all those muscels. (March was my injury date.) So it shows you that these muscels are very stubborn. I will see my Dr. on the 30th and see what he has to say. Has your Dr. told you anything about the pain in the back of your knee? And are you still having stiffness and swelling? I also have aches coming from the graph site. I feel it more when the weather changes. Nothing like the pain before the surgery, more like a nagging pain. Mainly when I am resting, not when I walk. How about you? I still am stiff, but am working thru a lot of the scar tissue and getting good flexation. I am still on one crutch, and off of it mainly around the house. My Dr. wanted me off completely 2 weeks ago, but I am just not strong enough even though I have been working on it religiously. I use the crutch so that I am able to walk with a proper gate. I had been walking since March with a bend in my knee, and it has caused my knee to shift inward. Now that I don't have the pain associated with a poor walk I am tring as best as I can to correct the problem and if I walk without the crutch I don't have the strength to keep the knee in a correct postition at all times. However, I am getting stronger very slowly. I am able to use the crutch less and less. I am very happy uptil now. Wow, you must be in England. I was in the hospital 1 day, and I understand many of the Dr.'s send patients home the same day. I believe it has alot to do with the insurance here. They are still having a problem accepting the procedure. Why the cast? I am doing plenty of quad sets, leg lifts etc.. On the bike for a good 45 mins. which has saved me. I am loooking forward to getting on the stairmaster. When did you start? Thanks Simon. Hope to hear from you soon, Robin

Hello Robin, Glad you are doing so well! It is good to hear about people that are doing well. I am on one crutch for at least another week. Slow and steady. Hey, if I get off that crutch in another week, I will still be ahead of what I was told. I was told a full 12 weeks of crutches. I started working on steps yesterday. I think I will rename myself “Lurch”! I get up there, but it is a lurch up. My knee is wobbly, has no muscle strength and is unstable, but there was no pain! I would have been in pain doing those steps prior to surgery. I am actually starting to think that this has worked. I know I still have a long way to go, but it is better. I am riding the bike twice a day 20 minutes at a time with resistance now. It is nice to work up a sweat again. I am only 5% of flexion away from where my other knee is. That is good too. Hopefully the hour and a half twice a day I spend working this knee will get that muscle strength back. Since there is still some swelling, I am guessing that it will be awhile for the VMO to come back. I did have my surgery done here in Colorado. There are a few really good OS’s around here. I lived in Garden Grove until I was 14, then we moved to Mira Loma. I lived there until I was 18. My Grandmother lived a block off PCH on Beach Blvd for 20 years. We used to visit her and walk to the beach. It was very close to Huntington Pier. My Grandmother lives here in Colorado now. We have been in Colorado for 20 years now. It doesn’t seem like that long! You have a great weekend, and keep me posted. Lurch (Linda)

Robin, WOW! You are moving along faster than me. I will still have the crutches for at least two more weeks. Today is 9 weeks post op for me. I played sports all through High School, and have played on many rec leagues since. I also ski. I do some backpacking and hiking as well. The backpack trip prior to the racquetball event I noticed some knee soreness in both knees while going downhill. I was on top of one of Colorado's 14,000 ft mountains with a 55 lb backpack. Both knees were achy for a week or so after the trip. I think that the racquetball two weeks later just finished that knee off. The first OS I saw did a scope on the knee and while there did a Lateral Release. I am still confused as to why since I have never had trouble with kneecap tracking. Once it was done there wasn't much I could do about it though. He also did some shaving etc on the lesion area. Took some cool pictures of it as well. I had some laxity in the ligaments, but no tears. The Lateral release rehab protocol was three months long. I was on crutches for three weeks from that. I had to go back and get the sample for the Carticel people since the first OS did not think about it. When I was no better, and in fact getting worse after the LR, I searched out a new OS. My flexion is 135 now. I guess I have another 10 degrees or so to go to get to where the other knee is. It actually feels pretty good. Since it still complains when I put full weight on it, my OS said not to. I do not wish to have done all this for nothing, so I will do nothing that might disturb that jelly like stuff in there. That is the stage he says it is at. I am slowly adding resistance to the bike, but my knee doesn’t like very much, so we are not pushing it. I am not supposed to do anything that causes pain. Working through stiffness and tightness is okay though. My knee puffs after I exercise, but 20 minutes of ice usually takes care of that. The knee is still slightly larger than the other, but the OS says that it will be a few months before that goes away. The muscles in that leg really shrank, so until they come back I expect that the knee will feel very unstable and week. I was amazed at how much more they shrank with this surgery compared to the first one. My knee seems a lot less sore in a general sense since the implant, but until I start really using it, I think it is too soon to tell. My PT guy seems to think that I will be able to hike a 14ner this August if I keep at the rehab. We will see. I am not going to rush it since the stuff in there only starts getting hard after a year. It is still changing for two years! I saw my OS on January 6, and will see him again on January 27. Hopefully the crutches will be gone then. Keep me posted on your progress. We can gripe about how boring the knee exercises we are allowed to do are. Where in California are you? I grew up in the Orange County and Riverside area. I graduated from Norco High School. Linda

Hello Robin, I did mine playing racquetball last Christmas. I suspect that I already had trouble and just finished it off then. I saw the doctor today, and he has cleared me to begin walking normally with the crutch support and then weaning off the crutches. YEA!!! I will also begin some pool work this week. My lesion was 3 x 2. I grew up in California, but now live in Colorado. I was able to ride the bike for a full 10 minutes the same night I responded. I have been doing 10 minutes twice a day every since. I have really been in rehab every since my first surgery last January 22 as well. It usually takes me a little over an hour twice a day to do all the exercises. How has your last couple of weeks been? I hope you had a great holiday! Linda

Hello Robin, I am 7 weeks Post Op Christmas day. I am still using the CPM machine. It is maxed out at 115. I use it 4 hours a night. I attempt to sleep in it, but usually only dose. I started PT two weeks ago. I really don't do much. Some band work, sit on the stationary bike and move the pedals back and forth (Yesterday I was able to pedal backwards for 5 minutes, and then pedal forwards for 5 minutes! It was the first time I was able to go all the way around.), some ball things ect. . . Not much. My range of motion is 120. I do not know what the passive ROM is. I have been doing straight leg raises and quad sets since the day of the surgery. I do those often throughout the day, and the other stuff twice a day. I am weight bearing with a straight leg on crutches at 75%. The OS won't let me bend my knee when I walk with the crutches yet. Where are you at? How big was your lesion? Feel free to email meat my regular email address. I will be gone until January 6. I am spending the holidays in Amarillo, TX with my boyfriends family. I hope you are having a wonderful Christmas, and that your New Year proves to be a healing and healthy one for you! Linda

Hello Susan, That was great news! I am glad to hear that the microfracture is still growing. Hopefully getting everything cleaned out helps for awhile. In a couple of years I think there will be more options available as well. Take care of that knee and happy healing! Linda

Hello, I had the ACI (Cartilage Implant)surgery on Nov 6. This is the one where they take a biopsy in a scope procedure, send it off to grow, and then implant it in an open knee procedure. I am 6 weeks post-op now. The pain wasn't too bad. I am partial weight bearing with crutches. I was told yesterday that I have six more weeks of crutches to go. So far the hardest part is to not over do things. I feel well enough to do alot more than I am allowed, but if I do, I risk damaging the implant. It is really tough to be good! I can't tell you if it is successful or not yet. I am still several months away from knowing that. I can tell you that my knee hurts much less now than it did before the surgery. I did speak with several people that had success with this surgery before I tried it. Whatever you have decided to do, I wish you luck! Linda