How to avoid another cyclops

[pknewbury]

I had ACL replacement meniscus repair, and miscellaneous clean up on my knee in October 06. Things went well until the following spring when I started to loose extension. After trying really hard to push through this, my surgeon ordered another MRI which showed a 19 x 7 mm cyclops lesion. In October 07 I had a second surgery to remove it and clean up various scarring. My surgeon said such scaring was rare (apparently correct) and rarely recurred (apparently not so correct). Unfortunately I didn't do my research on this and left things up to the surgeon. Again, things went well until spring, when I started to loose extension. After a cortisone shot gave no improvement, he sent me for another MRI, which showed a 8 x 3 mm cyclops lesion and a possible meniscus re-tear.

Since it appears that another surgery is inevitable, my goal is to avoid a fourth surgery. To sum up what I have learned so far, this would involve getting a surgeon who is experienced in arthrofibrosis treatment and proper post-op therapy. I have the good fortune to live near enough to see Dr Eakin in Palo Alto. He seems to be well thought of on this board. I would like to hear of any other surgeons in the area (Central California) that would be recommended or if Dr Eakin is considered the best in this area.

What questions should I ask and what is important to know about how the surgery is perfomed? Are there surgical options or pros and cons that I should discuss with the doctor? Is there anything I can do in advance of the surgery that would improve the outcome? How careful should I be with my knee until then?

Post op, what it sounds important is to keep the knee moving, avoid stressing it with pain, and avoid weight bearing or strenuous exercises for some period of time afterward. Continuous Passive Motion and patellar mobilizations being particularly important. It sounds like this needs to go on for a couple of weeks or in some cases much longer. Is this the standard treatment? Does the length of time you must rest it depend on how bad your case is?

I am concerned about not being able to exercise, even for a few weeks. I have type 2 diabetes and high blood pressure, both of which require lots of exercise to control (in addition to diet; I take no meds for these). With the last two surgeries I was able to cycle enough and do enough standing work to control things, but I still haven't lost the weight I gained after those two surgeries. It sounds like you have to be pretty low energy and low strength with the knee for quite a while, and this concerns me.

I would also like recommendations on a physical therapist who specializes in AF therapy. For this I am looking closer to home: Santa Cruz/San Jose area.

Additionally, I am wondering just how much of this I can control. Maybe it is just genetic (my brother had lots of scaring after smashing up his ankle)? Will all the above measures help even if genetics play a big part?

I have some comfort in that the second cyclops is only half the size of the first one. Maybe the next will be even smaller, and so on, until they are just too small to bother with.....sigh.

Any comments and suggestions are appreciated!
Thanks,
Pam