Help reading MRI & broader diagnosis

[vickster]

Pain and heat are signs of inflammation. When you say high pain, do you take meds to manage it? Which ones? If not or the pain is controlled, it may not be as bad as your brain thinks

Ref the supplements, I use the high dose/max strength cod liver oil (1000mg). I tend just to buy whatever is on deal at the time, Holland and Barrett, Superdrug, Boots at the mo as the 6 month supply was on special.
Vit D, I have the 25ug (1000iu) ones from Holland & Barrett, the dose recommended by the rheum.
I've never looked into the other things, I generally see supplemts, esp high cost ones, as snake oil. I'd be better off losing weight and addressing my diet to be honest.

Don't get too hung up on the grade of cartilage wear as there's not a direct or linear correlation to pain and function

https://www.kneeguru.co.uk/KNEEnotes/ar ... hanges-are

This explains the grading, 3 can mean the bone is almost exposed

https://www.kneeguru.co.uk/KNEEnotes/pr ... age-damage

The letter you posted before says full thickness in the trochlea, but it could be a small area. There could also be some fibrocartilage covering the exposed bone (this is the case for my grade 4 lateral and medial defects, still need to discuss the implications at my surgery follow up next week).

Mild medial and patella wear is positive.

Joint space or lack of in one or more compartments is also important. If that's depleted in one area, the brace might help off load the damaged compartment.

Im sure that getting those pesky muscles strong and balanced will help as much as possible. My surgeon doesn't favour bracing if the muscles are sub optimal, getting those all strong and less tight (also glutes, hip flexors, low back etc should also help knee pain and sort any gait issues). In a more inactive or elderly person unable to exercise possibly of more use.

Clare Robertson suggested I see an orthotist, having seen the costs and discussed with another physio and specialist, I didn't pursue.

You should certainly look into hydrotherapy, exercising in the warm and supportive water provides the ability to exercise more effectively. Are you directly addressing the bursitis with the physio? Could be hindering progress?

[vickster]

Just seen we've cross posted.

Yes, I think for me it was the worth the outlay for Clare, ultimately she's a Consultant level clinician. She's very knowledgeable and was very thorough and provided some useful suggestions. Just make sure you have all your paperwork, scans etc. I possibly had a referral from my physio who recommended I see her.
I'd definitely do that before shelling out 5k or whatever for Lipogems. What effect is expected, did you say?

xc2xa340 for physio is pretty reasonable, xc2xa350+ here in SW London

I'd steer well clear of the crosstrainer, it puts a lot of forces on the outside of the knees esp if your muscles aren't tip top. I've been told not to go anywhere near one for 4-6 weeks post op. It's the one thing that was really hurting my knee pre op.
Rower is good as long as there's nothing restricting flexion and it doesn't hurt around the knee cap.

Lots of the weights machines are nasty for knees too. Including the leg press which requires deep flexion done properly which could aggravate the PF joinf

I stick to cycling (upright or recumbent), walking on the treadmill at a decent pace with increasing incline.

Exercises wise, I'm now doing bridging, step ups, wallslides, balancing on one leg, SLRs, hamstring stretches and the usual post op rehab stuff as I'm short flexion and a bit of extension.

You could also try Pilates to work on all the muscle groups, I've been doing it for a month or so pre op (finally gave in to my rheumatologist nagging and joined a low cost brand new gym that has classes included). Just let the teacher know that you have a bad knee and ask for adaptations for any of the exercises you can't manage comfortably.

Add swimming too and core work if there's a weakness there.

I can't squat as I have very tight calves which refuse to improve so I just don't bother (would probably upset my knees anyhow)

[BigMac82]

Thanks Vickster.

Taken your advise and held back on the Lipogems for now. Need spend longer trying to improve my strength to make sure this isn't still the issues or contributing.

Will get in touch with Clare as I have some SimplyHealth allowance I can still use up. Thanks for the recommendation.

After reading around a bit and watching a bit of YouTube lol, I've started taking Vitamin D, Omega 3, Turmeric and Botwellia. See how it goes, my stomach tolerates them quite well so far.

In terms of pain management, usually an Ibuprofen will get me pretty much pain free, just don't like take them often and too many give me ulcers. Has your GP given or recommended anything? I've not actually seen my GP as was luckily covered by company BUPA policy throughout.

Exercise is my challenge at the moment, the quads kick in well enough on the simpler exercises but ideally to add more weight/stress to the muscles - something the physio is pushing for but with minimal pain.

I haven't seen the physio yet since the MRI, wanting to continue his course of exercise ready for our next appointment. I think I will mention the Bursitis though. I do remember when he previously gave me a massage in the pes anserine area I felt some relief for a few days. Most of the time I go he pushes and pulls me around and checks strength/flexibility etc. Out of all things mentioned in the MRI, is the Bursitis the element you think I should push the Physio on?

He's always been sure it's not Bursitis, so may have surprised him to see that report (I shared with him).

Hope your surgery goes well

[vickster]

I don't think Clare accepts Health insurance but maybe Simply Health works differently, do you use it to offset any spending on healthcare regardless?

In terms of anti inflammatories, have you tried the topical ones like Voltaren Emugel, less impact on stomach. Especially on inflamed areas like the bursitis?
Also ask your GP if taking a Stomach protector like omeprazole might be helpful during the times you need anti inflammatory medication.
My GP doesn't really advise on medication now I'm under a specialist, she prescribes following his instructions as needed. She prescribes me omeprazole which I take with celecoxib (which is gentler on the stomach than naproxen for example but still carries risk when taken long term, I've been on it for 2 years, albeit now a lower dose)

If you've found deep tissue massage offers relief, have you tried using a foam roller or tennis ball to release trigger points. Ask your physio for pointers as well as targeted exercises. Maybe you need to focus on stretching and gaining muscle balance rather than too much on strength?
Maybe the bursitis is recent, it's essentially down to overuse, I get it in my hips when I overdo certain stuff.

I had my surgery about 4.5 weeks ago. All seemed to go well, surgeon said was broadly as expected from the scan, although the trochlea defect he microfractured was worse than anticipated. The large defect on the femur is still covered in fibrocartilage where we thought that had broken down. I'm rehabbing the knee in the gym