TPF - 5 weeks out and backsliding - major ROM issues, help please

[Nate]

I am 5 weeks out from ORIF surgery for tibial plateau fracture, grade 5 as well as meniscus repair and skin graft to close fasciotomy from compartment syndrome. I was sent home on 1/13 with a Bledsoe brace unlocked, and had about 30 degrees ROM on day 1. Started home PT, got to 45 degrees the following week.

Last Thursday, 1/30 I pushed really hard in PT and got to about 70 degrees. Ever since then, I have had horrible involuntary muscle contractions and muscle spasms in my hamstring and back of knee. It happens even when I'm not trying to bend my knee walking with my walker or resting passively. This has sideline me for over a week. I'm only able to get to ~40 degrees before my leg starts convulsing and I have to stop.

Surgeons prescribed Flexeril muscle relaxer but it is barely helping. PT recommended using a lacrosse ball to slowly work through the fixations. I'm trying that and it has not gotten rid of them.

I have my 6-week follow up with my surgeon next Friday and he wants me at 90. I'm nowhere near that. I'm scared because I'm losing valuable time to regain ROM and afraid I'm going to have major problems down the line. I don't know what to do.

If anyone has experienced this and has any advice or tips, I would be so grateful to hear what helped.

[Pippinp]

Hi
I am certainly no expert, but I have had a significant knee injury and 2 reconstructions after a skiing injury. Are you still wearing the Bledsoe brace? I had one on for 6 weeks after my first op and when it was taken off I only had 30 degrees of flexion ( and full extension). It took 6 weeks after the brace came off (12 weeks post-op) to get to 90 degrees and then another 4 weeks after that to get to 110 degrees of flexion. I then had further surgery to reconstruct more ligaments and a couple of months after that, got to 130 degrees of flexion. My advice would be to hang in there. I can remember being at about 60 degrees of flexion and feeing as though I'd never be able to bend my knee again. Extension is more important than flexion at the moment so make sure you work on that (if you don't get full extension, you'll walk with a limp). Do all the exercises the physiotherapist recommends. I found sitting on a table with my legs hanging down and resting good leg ankle onto injured leg ankle and gently pushing back worked well. Also doing the same thing in a pool. I also had an inflatable ring that I hooked round my foot in the pool and used to flex my leg behind me (you might need a bit more flexion before you start this one).
You will get your flexion back, just keep going with gentle exercises and don't try to push too hard too fast. Do you have access to hydrotherapy? I had this for several weeks with my PT and found it helped.
Good luck!

[Nate]

Hi Pippinp,

Thank you for your reply! I feel a lot better knowing that you continued to improve long past 6 weeks. It looks like you now good range of motion, so it's too early for me to give up hope. It's just feels so stuck and hopeless.

I'm no longer in the Bledsoe brace. During my 4 week follow up with OS, he could tell it was bothering me so he let me take it off. Still have bandages covering the skin graft sites from the fasciotomy and an ace bandage from foot to knee.

My extension is pretty good, not quite zero but close. The flexion is just stuck because of these muscle contractions. I tried getting getting back on the horse today and doing the towel under foot slow release to hang exercise where gravity pulls the knee down, and was blasted by a contraction that made my whole leg go rigid. I can sit in a low chair and do heel slides, and if I hold the bottom of my leg just above my knee I can barely squeeze out 45 degrees. I just don't know how to get these things to stop.

I'm drinking Gatorade for electrolytes, Flexeril muscle relaxer, heating pad on hamstring (not touching knee with heat), lacrosse ball for myofascial release, and supplementing with magnesium, potassium, calcium. I guess I'm just going to have to wait it out and hope they just kind of stop.

I have my 6 week appointment with the OS on Friday, which I am dreading, but maybe he can give me new PT instructions to get me out of this mess. Hydrotherapy sounds great, but I'm going to have to wait until my skim graft and surgical sites have completely healed. Not quite there yet.

Thank you again for giving me hope for continued improvement with my flexion in the months to come . I wish you all the best in health and healing.

[Bella_Gamba]

Hi Nate,

I am also a TPF5 "survivor". My fracture occurred almost three years ago and what you are going through is "normal". I would not worry about what your OS expects. I also worried before my appointments because I could never reach the goals. However, nothing could be done but be patient that recovery will eventually happen. Just FYI, we are not talking about weeks of recovery, but months, and even years. Remember that you are not just trying to recover your ROM, but your bone is being rebuilt.

I would add Vitamin D3 and K2 to your supplements (together with Ca and Mg) these are the most important supplements to rebuild bone.

You may find some of my posts on recovery (started writing them after my second surgery to remove the metal implant/screws) in the "Bone breaks around the knee section".

Take care,

Bella

[Nate]

Thank you so much Bella. I guess 6 weeks is still pretty early on. I'm just scared of missing these milestones because I want to be able to walk, swim, and ride a bike. I would have an easier time accepting that this injury is going to take months or years to rehab if my surgeon wasn't setting goals that I don't seem to be able to meet.

I have a lot of injuries, though, so I guess it makes sense it's going to be slow. My swelling is still really bad in my knee, probably because of the compartment syndrome. My skin grafts are still healing from the fasciotomy, and I still feel a burning in my knee after ROM exercises, probably because of the torn meniscus. And the bones are still healing, three breaks in total, including TBF.

My appointment with my OS is on Friday, and I'm really nervous about what he is going to say. I don't want him to tell me I have to jump back into surgery. I want more time to try and heal.

Thank you for reassuring me that it my ROM is likely going to continue to improve. I read some of your other posts and it looks like you have really good ROM now, so congratulations! I wish you all the best in health and healing in the months ahead. Hopefully we are all headed towards brighter days.

[Bella_Gamba]

Nate,

Just to put things in perspective. After my first surgery, it took 6 months to be able to do the complete turn on a stationary bike (at PT I would only be able to go back and forth as I could not complete the circle).

Ask your OS if it is OK to wear compression socks (thigh high). In my case, I would wake up at night with intense cramps and tingling. To the extent that I was sent to see a neurologist. I figured that this helped when I fell asleep with my compression stockings (serendipity). When I mentioned this to the neurologist and OS they did not think this would help but I do. Maybe this would help your "muscle spasms".

Also, FYI I only regained my "normal" ROM after being treated by a fascia massage specialist several months later (maybe took 8 months to reach the same ROM as my good leg).

But remember, everyone heals at a different rate, so these are just my data points.

Good luck with your OS appointment on Friday,

Bella

[Nate]

I'm now 3 months out from my original surgery and really struggling, both physically and mentally.

Since my last post, I had to go back to the hospital as they suspected an infection in my knee. They were right, pseudomonas. They put in an antibiotic spacer, did a gastric muscle flap and skin graft, and put in a Picc line for cefepime antibiotics twice a day. Also on levequin orally.

The infection was a huge setback, and now at 12 weeks I have just about 65-70 degrees flexion. My wound is still bleeding in places and they've extended my antibiotics for two more weeks. I don't believe the infection is gone. The surgeon also now thinks I will need a TKR within two years. I'm 39.

I feel like my life is a nightmare and I can't wake up. In January everyone said "you're young, you'll bounce back." Everything has gone wrong since then and I feel like I am losing the will to live. I don't want to do this.

I am back to physical therapy and he seems to think I will still make some progress. But it feels hopeless. I was a runner, skier, hiker, yoga, about as active as it gets. Now I am nothing.

[Pippinp]

Hi Nate
I only just read your most recent post as I don't look at kneeguru very often. I really hope that you are feeling better than you did when you wrote that. How is the knee? Has the infection settled - that was really bad luck but hopefully the antibiotics have worked. I know this is not how you imagined you would be, but you can do this. Life won't always be this way and you will get better, even if you do need a TKR. You may well be able to return to some of your sports - I saw my orthopaedic surgeon in January and despite being 2 years post injury he said that he would still expect continued improvement, so I bet this applies to you too. Even if there are some things you can't do (I can't ski - yet), you will find other things that you can do that you will learn to love.
Keep your chin up (I don't know if people say that where you live!). You really can do it and when you do, you'll be really proud of yourself and although your life may be different, you may find that in some ways it has changed for the better.
Sarah

[kawi_girl]

Hi Nate,

I really feel for you with your physical and emotional struggles. If it's of any help, try checking out this site: injuredathletestoolbox.com
There is a lot of good advice there, plus you can read Heidi's story...she's been through a lot, too.
Maybe it will help you wrap your head around what you are dealing with. I can't advice you regarding your knee issues as I'm no expert. Just thought some emotional support might be of value.
Keep fighting. One moment at a time.