Steve A. Mora MD, Orange County ACL Surgeon. After I continued to have knee pain, that doctor gave me me two cortisone injections, 40ml each, into both the medial and lateral sides of my knee, near the surgical portals. 2017;5(4):229-236. doi:10.1055/s-0037-1608666, Hunt SA, Jazrawi LM, Sherman OH. He graduated from Anaheim High School in Orange County CA. Loss of knee extension can be a big problem. Arthroscopic knee surgery is a useful surgical procedure to manage and treat many common knee conditions. Reasons to have arthroscopic surgery on the knee joint include cartilage injuries, meniscus tears, ligament problems, and a variety of other conditions. The advantage of arthroscopic surgery is that as a minimally invasive technique, people tend to return to their activities more quickly, with less pain.. Normally, pain steadily decreases after surgery. Other possibilities include poor rehabilitation, cartilage defects, sub chondral edema from degeneration/arthritis (common), poor patella mechanics, poor range of motion, AVN (rare), IT band syndrome, pes bursitis, intra-articular ganglions, plica bands/synovitis, persistent tear that was incompletely treated (unusual). The surgery went well but the patient still has pain even though it’s now 2-3 months later. Hence, that remaining meniscus is more and not less likely to tear again. Dr. Mora’s practice focus on sports related trauma, knee ligament and cartilage repair, shoulder rotator cuff and instability, hip arthroscopy and partial knee replacement and ACL reconsctruction. Increasing pain may be a sign of arthrofibrosis. Treatment of infection requires prolonged antibiotic treatment and can require additional surgery to clean out the joint.. J Am Acad Orthop Surg. Patients with dynamic instability may be more prone to injury and may require surgical treatment. 2013;84(1):5-12. doi:10.1016/j.jhin.2012.12.014, Tartari E, Weterings V, Gastmeier P, et al. While this all sounds gentle and noninvasive, it needs to be understood that your body will react to the trauma of surgery. After long walks, I still ice my knee (read about my ice pack after knee replacement). Biggs A, Jenkins WL, Urch SE, Shelbourne KD. Patients can help by marking their knee in the area that hurts or writing down their symptoms in detail. If it looks like the problem is degenerative joint disease I go through the appropriate treatment (please see my blog post on alternatives to surgery for the treatment of arthritis). But it is so painful and I am just not making any progress. All of it. He is team doctor for the Anaheim Bolts pro indoor soccer team and Foothill High School. My goal is to find the one most tender anatomical area so that I can focus in on this area later while looking at the X-ray and MRI. Hello Knee pain Guru, I fell of bike almost 2 and half months ago and my knee is still swollen, I had no fracture but my doctor says I might have hurt delicate muscles, I can feel the fluid above my knee and little bit below the knee, Is it normal that it is still swollen almost 2 and half months after … It is well established that typical arthritis pain does not warrant an arthroscopic surgery; numerous studies have shown that the benefit of arthroscopy in these patients is no better than with nonsurgical treatments. Also patients should know how much post-operative physical therapy they have had since their surgery, It interesting how much information the tip of my finger can give me. Treatment of SONK can be very frustrating, and many patients find the pain worse than the pain they had prior to arthroscopy. Medically reviewed by Kashif J. Piracha, MD, The Best Exercises After Your Knee Arthroscopy, Causes and Treatments for Bilateral Knee Pain, Knee Arthroscopy: What to Expect on the Day of Surgery, Microfracture Surgery for Stimulating Cartilage Growth in Your Joints, Here's What Can Go Wrong During a Knee Arthroscopy, What You Need to Know About Arthroscopic Surgery. I have been doing physiotherapy at home 3 times a day, walking, and practicing yoga 3 times a week. Adding insult to injury is the fact that almost every patient has had a neighbor or co worker who had the “same” surgery and who was back doing everything in “2 weeks”. Is the medial tibial condyle tender? DISCLAIMER: The information on this website is provided as a service from our physicians to our patients and the general public. If you have knee swelling further out in the recovery period consider asking your physician about using a wrap at home to gently compress the area. If it is the heel of the foot will not reach as close to the buttock as the opposite side. Persistent swelling is one of the most common symptoms after knee arthroscopy. This is called subchondral edema. It is easily correctable with therapy. I hope your results are better than mine. One Way to Get Your Knee Bending After Surgery Is With CPM, The Osteotomy Procedure Is an Option for Joint Surgery. That means that the remaining meniscus is smaller, but still taking the same pressure. Using this scope and the camera attached, they can … Some experts believe that the edema (fluid) is due to micro fractures of the bone in the area of the over load. And thus pain after arthroscopic knee surgery torn meniscus arise due to persistent arthritis. Dealing with joint pain can cause major disruptions to your day. I can usually make a diagnosis just based on a good history. In these cases, patients may have an arthroscopic surgery but may have to manage ongoing pain from arthritis that does not improve despite the surgical procedure. Pain is quite common, most often in the area where you had pain before surgery, in the soft tissues below the knee cap, over the athroscopy wounds and occasionally the whole knee. Also patients should know how much post-operative physical therapy they have had since their surgery. It is also extremely helpful when a patient brings in their Op report, Pre-operative MRI and surgical pictures. What’s weird to me is, my neck, shoulders and arms are very stiff. Antimicrob Resist Infect Control. I am in an outpatient clinic now and I am working really hard. Even if you feel good I’d recommend icing your knee as a preventative measure to reduce inflammation. 2018 Jun 1;19(1):179. These subchondral fractures cause inflammation within the bone and significant pain. Drainage or bleeding from the incisions 3. What are some types of knee surgery? He is currently practicing Orthopedic Surgery in Orange County. The usual scenario is one where a patient had arthroscopic knee surgery for a torn meniscus. Get it filled when you go home so that you have it when you need it. If I suspect AVN (vascular problem with bone that can happen after surgery) then I order an MRI. Probably post meniscectomy degeneration/arthritis. A surgeon inserts a tool called an arthroscope through a small incision. 2002;10(5):356-63. doi:10.5435/00124635-200209000-00007. I spend a lot of time trying to understand the current symptoms but I also ask about the symptoms before the surgery. But not everyone finds relief of their knee pain after surgery. What I see more often than not is that not enough therapy was done or perhaps the patient expectations were unrealistic. Thank you for taking the time. As you can see dealing with a patient that has already had surgery is more challenging than one who has not. If you have or suspect you may have a health problem, please contact us for an appointment, or consult your physician. In the weeks and months after surgery, pain should decrease gradually. It is very hard if not impossible for an MRI to distinguish surgical changes from a persistent meniscus tear. The advantage of arthroscopic surgery is that as a minimally invasive technique, people tend to return to t… This will prevent it from getting too bad. Typical symptoms of infection include: If the infection is untreated, there can be serious repercussions. For example I might say “lets try a steroid injection today, more therapy aimed at improving quad flexibility and 10 days of NSAIDs. There are cases where severe swelling will occur due to overload following arthroscopy for degenerative meniscus tears. *Is there a history of morning stiffness of the hands (rheumatoid disease)? Patients can help by wearing shorts or sweats that can be pulled up high to the evaluation. But not everyone finds relief of their knee pain after surgery. I had arthroscopy surgery done on my left knee two weeks ago. In order to do a good exam I like to examine the whole leg from the hip to foot. My knee hurts at night, but I can handle it with Tylenol. Dr. Mora’s family heritage is Peruvian. The pain settles usually within two to three weeks, but may take upwards of six weeks. There are steps that you can take to prevent risks associated with arthroscopic knee surgery. I will start by saying that half of these patients are fine and just need more time to get better. This will cause anterior pain and effusion. While these are often common after knee surgery, see your physician if they persist, because they, too, may signal the development of this painful condition. 2000;2(3):158-63. Patients can usually borrow the surgical photographs or perhaps even get their own copy. Knee replacement patients are given powerful narcotics to numb the post-surgical pain. This postsurgical pain relief is critical for effective participation in physical therapy and rehabilitation. You can request an appointment with me by calling 714 639-3750 or going to my web page www.MyOrthoDoc.com. As is always the case, your doctor should provide specific instructions regarding your recovery from arthroscopic knee surgery. Your knee will be swollen, and you may notice that your skin is a different colour near the cuts (incisions). Arthroscopic knee surgery has a very low complication rate (less than 1%). The paste will harden and provide support for the damaged bone. Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. He then completed a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. Braces and medications can also help with the symptoms. As I said above most of the time you can nail the diagnosis even before you touch the knee. Pain is normal after knee arthroscopy. But when that happens, you don’t have to just put up with the pain. One of the great advantages of knee arthroscopy is that you may start walking on the operated knee right away. Chin Med J. Is the patella tender with crepitus? Friberger Pajalic K, Turkiewicz A, Englund M. "Update on the risks of complications after knee arthroscopy" BMC Musculoskelet Disord. How much weight should I put on my leg? Some of the procedures he performs include Cartilage transplantation (Genzyme), partial custom knee replacement, OATS, tibial osteotomies, meniscus transplant, knee ligament reconstruction, shoulder reconstruction, elbow arthroscopy, hip arthroscopy, platelet rich plasma and adult stem cell injections. These pictures allow me to see the state of the articular cartilage and the severity of the treated meniscus tear. Joints. In addition, some patients who have an arthroscopic surgery have persistent swelling as a result of lingering inflammation from the trauma of surgery. In the 3rd month, I began walking on the beach, twice a week. N Am J Sports Phys Ther. Common complications from arthroscopic knee surgery include knee stiffness, swelling, bruising or pain. Once I have all the above information I put together a differential diagnosis and present it to the patient. I then spend just as much time doing a detailed physical exam. In most cases a good ear to listen and the tip of my finger are the best diagnostic tools. The trick is to know when things are fine and moving a little slow or if indeed progress has stopped and a problem does exist. Patient engagement with surgical site infection prevention: an expert panel perspective. *Is there pain with stair climbing (patellofemoral disease or tightness)? These X-ray films are very important because they tell you information that the MRI does not. 2009;4(1):2-12. Arthroscopic surgery is a minimally invasive surgical procedure that is used to see inside your knee joint, and repair or remove any damage. My care was transferred to a civilian orthopedic clinic, and the doctor there discovered an IT band issue, which was sorting out by some Voltaren gel and my physical therapy. Insufficient rehabilitation can be a cause of persistent knee pain after an injury., One complication that has been linked to knee arthroscopy is a condition called spontaneous osteonecrosis of the knee, or SONK. This condition is most often found in middle-aged women who have a knee arthroscopy. In this manner inaccurate expectations can be addressed early. It is not unusual for a new MRI to say “meniscus tear” in the area that was already treated with meniscectomy. Eventually, that pain does settle down, but often the only way to find relief is to limit weight by using crutches for weeks or months after knee arthroscopy. SONK is a condition that causes inflammation within the bone. My knee is swollen,sometimes red and my degree of the bend of my knee is 80*and my surgeon finally put me on an anti- inflammatory pill,but my,knee and feet still swell after being up on them for long periods of time and after sitting for periods of time its swollen and stiff. The initial pre-operative MRI films are usually all I need to figure out what is happening. Sign up and learn how to better take care of your body. Worseni… In order to protect their joint and reduce pain, people often limp or develop an abnormal gait. Once the problem is taken care of, patients may need to correct these mechanical abnormalities of knee function. However, there are times when patients with osteoarthritis may have problems that can improve with arthroscopic surgery, or your surgeon may not be aware of the extent of arthritis until the time of surgery. Knee arthroscopy requires admission to hospital and an anaesthetic. ... Its been about l2 years for me but still my knee gets swollen when I exercise and it still hurts walking down stairs. It is very hard if not impossible for an MRI to distinguish surgical changes from a persistent meniscus tear. Arthroscopy is one of the most commonly performed procedures to help diagnose problems in the knee and shoulder, including arthritis.It's a … You will feel tired for several days. He completed his training at the UC Irvine where he earned top of his class honors with his induction into the Alpha Omega Alapha Medical Society honors. by Steve A. Mora, MD Orange County Knee Specialist. Biomechanics of Multi-ligament Knee Injuries (MLKI) and Effects on Gait. N Am J Sports Phys Ther. ANSWER: Although it’s uncommon, a small percentage of patients continue to have chronic knee pain after knee replacement surgery. *Is there pain and swelling with long walks (probably degenerative/arthritic problems)? Patients appreciate it when you write down the plan as well as “the next step”. However, for how long after knee replacement surgery is it still normal to feel pain? Most of the time, rest, ice, and pain meds are enough to help you feel better. 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