LOA #2- what is the best thing to do post op

[casey2291]

Hi,
I had surgery yesterday to remove my hardware from a high tibial osteotomy and to scope my knee to see how my new cartilage looked following my ACI surgery. The good news is that my new cartilage looks good and the OS had no trouble removing the hardware. However, he did remove a large band of scar tissue from the medial side of my knee. This is the same place that I had scar tissue removed in March 2008. My OS had thought that my pain was from my hardware but now that he removed scar tissue, I am convinced that my pain was from the scar tissue qnd probably not so much from the hardware. I talked to my PA today about what I can do to prevent the scar tissue from growing back again and she said that there is not really anything that I can do. She said that sometimes they prescribe a cpm machine, however she didn't offer that to me. I have also talked to my OS after my first LOA to see what he suggested that I do to prevent scar tissue from returning and he basically told me that there is nothing that I can do. Can anyone give me any suggestions of what I should do at home to prevent this from occurring again. I read something about taking anti-inflammatories. I have some celebrex and am wondering if I should start taking that. I thought that I worked really hard after my first LOA to prevent scar tissue from regrowing, but apparently I didn't do enough. Any suggestions would be welcome. Thanks.

[conno11y]

Good luck, Casey. I can't say that I have overcome my arthrofibrosis yet, but I had an LOA on Sept 22nd with one of the 'specialists' listed on this site. I detailed his prescribed rehab in a post-op diary:

viewtopic.php?t=44455&hilit=arthrofibrosis

Were you having problems with range of motion as well as pain?

As far as the CPM goes, I had one after my surgery, but it was mainly to keep my leg elevated. From what I read in the CPM brochure, it will move you through your current range of motion, but it won't push you hard enough to gain any additional range. You'll have to do that on your own.

Ice, elevate, and move your knee and then move your knee some more. Keep us updated.

[casey2291]

Hi,
Thanks for your response. My OS is not an arthrofibrosis specialist, but I wasn't sure that scar tissue was my issue. My OS thought that my pain was from my hardware. I did not fully gain all of my flexion after my last LOA. I was about 5 degrees off from full flexion but could get full flexion if I pushed on my knee. I regained full extension after my last LOA. Thanks for the info about the cpm machine. I am at maybe 80 degress flexion right now and I am 2 days post op. My extension looks good so far. I will not see my PT until next week. I will check out what you wrote in your post op diary about rehab. did your OS tell you to take an anti-inflammatory on a regular basis after your LOA?

Good luck as you fight the battle of arthrofibrosis!

[missmyknee]

Hi Casey

I have always been on an anti-inflammatory after my scar tissue surgeries. My OS, Dr N, used to put me on Voltaren but the last 2 yrs has used Celebrex. There was a study done on anti-inflamms and adhesion growth. Celebrex did the best job in prevention. This studay is posted on a thread in this section. That is my "guess" as to why he may have switched. I was on Celebrex right after I woke up from surgery. I was on double dose sometimes. I am still taking Celebrex and my surgery was in April. Sometimes I have had cortisone shots and sometimes have had to do a medrol dose pak.....strong anti-inflammatories. It is an inflammatory process that produces scar tissue growth, so that is why you try to keep inflammation down. Icing your knee is another way to control inflammation and not doing aggressive PT .

Make sure you read all about arthrofibrosis on the HUB, starting with Dr Noyes tutorial. /KNEEnotes/articles/general-articles/20 ... rofibrosis

Pam

[casey2291]

Hi Pam,
thanks for the info. I actually started taking celebrex yesterday for pain because I either had a bad reaction to the anesthesia or the percocet that I was taking. But, now after what you said, I will continue to take it to help with inflammation. I have read all the stuff in the information hub about arthrofibrosis. Can you further explain what you meant by not doing aggressive PT? does that mean not pushing your ROM? I am anxious to start pushing my ROM but I'm not sure if that is the best thing to do or not. I have 17 staples in my knee and I am also worried about making my incision bleed if I push my knee too much. Thanks.

[conno11y]

I also wonder what it means to not do aggressive PT. I have concluded that it means to watch how your knee responds to your PT. If you get swelling and increased pain after a PT session, you've done too much. If you don't have an adverse reaction, maybe you can try to do a little bit more next time. My PT will not push my knee herself. She says that she could hurt me, but that I cannot hurt myself by pulling on my knee.

I read posts on here that say that PT for AF should not be painful. But for me, I don't gain ROM unless I push myself to a high level of pain. My knee never swells in response to PT and I rarely find increased pain afterwards, so I have decided to continue doing PT with pain. I don't push through sharp pain, but I push through very uncomfortable stretching/pressure pain.

You just had surgery, so I would ask your OS specifically how much you should be doing. My original OS told me to 'do what I was comfortable with' after an exploratory arthroscopy. This was terrible advise that lead to my AF because I basically sat on my butt doing no dedicated ROM work for a couple weeks.

How is it going?

[missmyknee]

Hi Casey

Make sure you get your OSs permission to take the Celebrex.

The key thing to remember when rehabbing from AF is gentle PT. This means no cranking on the knee by PTs. Cranking on the knee can cause micro tears in tissues setting off inflammation and scar tissue growth. Passive motion is done for flexion such as heel slides and wall slides or the use of the ERMI flexionator if your PT has one or when the PT does passive over pressure-not cranking. If your knee reacts by increased pain, swelling, and heat , then it is becoming inflammed and PT needs to be adjusted so that it calms down before advancing again. PT for AF is not measured in amount of reps or weighst but rather how the knee reacts to the exercises. When the knee tolerates it well, then it can progress. PT for AF is a very slow and long process sometimes involving going back to step one several times because of inflammation. Strengthening comes at a later time when the knee is no longer inflammed. PT is always done in a painfree zone. You can have some discomfort but not pain !

Back on KNEEguru in the AF section read Dirk Kokemeyers rehab for AF /KNEEnotes/articles/general-articles/20 ... -tutorials. Dirk explains the process of rehab and inflammation.

Pam