I met with my OS again today, 11 days after my surgery. Over the weekend I had only done PT once each day instead of twice, and iced it 3 or 4 times instead of my normal 7 or 8 times, as we were busy running errands, seeing family, going to chruch, etc. And yesterday (Sunday), it got pretty sore in the middle of the day even though I don’t think I have used it that much. I actually took about 400 mg of ibuprofin. I’m not feeling 100% anyway, with a head cold and very light stomach quesiness, so maybe that’s related?

Over all the Dr. seems pretty happy with my progression. He also showed me where a plica was that he removed — something I saw in the RX but that I had missed in the 1st post op. It ran diagonally, with the high end on the lateral aspect of the knee, about midway on the patella, inferiorly, to the area of the patella tendon. I’ve been sore along the ITB, but also on the surrounding tissue. And I’ve got a lot of bruising in that area.

The Dr. said to just use my swelling (effusion) as my guide — not so much the pain/discomfort, as that will probably move around the next few weeks. But if after I do my PT, I’m more swollen than before, to back off a bit. He said I could start to increase my walk/cycle times a minute at a time, but to make sure I listen (or watch!) my body.

He said that this would not be a 2 – 3 week recovery as you often see for pro atheletes after a scope, because he had done more work, espeically with the plica removal and partition clean up. He expects me to start some light running in 2 to 3 weeks.

So since my PT appointment a few days back, I’ve stuck to the exercises I was given:

– 5 min stationary bike no resistence
– 5 min treadmill (at 3 – 3.5 mph),
– patella mobilization (medial and inferior)
– quad presses (30 x 5 sec hold)
– hamstring presses (30 x 5 sec hold)
– knee to chest (10 x 5 sec hold)

And I’ve been icing it 7 or 8 times a day.

I feel like I could walk and ride further, but I’m going to hold off. I don’t want to push it too much yet. There is still swelling and still some pain/discomfort. I usually feel stiff when I 1st start pedaling but then it loosens up rather quickly. Also, the patella mobilizations are still a bit tough to do because I’m still tender/sore.

I’ll see the Doctor on Monday, as well as the PT, so maybe I’ll be able to bump up the ride/walk times then.

Another “tool” I used before I opted for surgery was the patt strap.

These are stretchy foam like bands that you wrap around your leg. The picture above shows it wraped over the patella tendon, but I used to wrap mine about 1″ above the top of the patella.
Supposedly, for ITBS, wrapping tightly 1″ above the knee puts enough pressure on the ITB to move the pressure point off the bony protrusion on the lateral aspect of the knee and therefore reduces/eliminates ITBS pain.

You have to get it pretty tight, and then they tend to roll a bit. These are generally more used for ITBS or patella tendonitis than for patella tracking issues, but I think I had a little bit of both going on.

I used these for a few months, sometimes just for the 1st 15 or 20 minutes of a run, and then would take them off. (They’d start to irritate me since I had to put them on so tight!) At 1st I tested these vs. the shields brace, but eventually started using these straps exclusively, as they were less likely to cause the patella to rub the femur like when I applied the shields brace buttress improperly. I could also wear these while biking, unlike the shields brace.

I eventually stopped using these straps as well as I neared and then reached my plateau of running 30 – 40 minutes and biking 60 minutes.

/Sean

As I said before, I should have started this knee blog a long time ago. So over the coming weeks, I’ll try to post about some of the things I’ve done over the past year+ as I’ve worked on this issue (chondromalacia patella, caused by patella formal tracking syndrome).

One thing we tried early on was the Shields Patella brace. This is a brace that wraps around the knee, and uses a “butress” to hold the patella in place. See the following pictures:

I actually think this brace was somewhat useful, but I only used it for a few months. It was really too tight to use while biking, but I was able to wear it while hiking and running. (Hiking up steep inclines or steps was somewhat uncomfortable.)

Early on when I was still pretty tender from the bone contusion on the underside of the patella and on the condyle femur, it seemed to keep the two bones from rubbing so much, so I was able to be more active.

As I got better, though, it seemed to cause more irritation than help. This was most likely due to putting the buttress in the wrong place. So to me, that is really key. You have to get it just right for it to work. I would recommend it to anyone that suffers from poor patella tracking, but that you should work with your PT the 1st few times to get it right.

This is an alternative to McConnell taping, which I only tried once. My PT thought the brace would be easier to use than having to tape the knee all the time, and that it would “hold” longer than tape, but I know several people have reported good success with taping. So I recommend trying both to see what works for you.

I had forgotten to include the diagnosis and RX my OS gave me to give to my physical therapist:

diag: plica –
suprapatella partition
infrapatellar plica lateral

Rx: PT early scope rehab
advance activities accodring to effusion
2 x week 1 mo

To translate, the diagnosis explains the pictures I placed in an earlier post. And basically we are to “take it as it goes” in terms of swelling (effusion) and how my body feels…

I had my 1st physical therapy appointment today, meeting with Bruce up in Chapel Hill. Bruce is who I’ve worked with the past year or so, working on patella tracking (patella stretches, VMO strengthening, ITB stretches, etc.) so he knows my full history.

The 1st thing we did was take some measurements of both legs. “bopd” is the base of the patella.

So what this shows is that my Right thigh is significantly smaller than my left, and this stems from the past year with the injury, I’ve significantly used my left leg more, from everything to sitting down and standing up, hiking, steps, etc. We’ll need to work on this as the knee heals up and allows me to.

We also took some measurements. My R knee flexed at 100 degrees, while the L knee did 140.

Bruce then did a few minutes of patella mobilization, both medially and anteriorly.

I then did 5 minutes on the stationary bike with no resistance, and 5 minutes of treadmill with 0 incline, walking at about 3.0 mph.

We then did 20 minutes of elctrostim and ice simultaneously, mostly to help reduce swelling. In the future, we’ll use electrostim to assist in strengthening the R thigh.

For now, Bruce wants me to do the following:

• Continue to ice knee several times a day. To this end I got a “bodyice” by dynatronics from him, as it seemed this was a better product than what I was using at home — a cheap gel pack and/or crushed ice.
• Walk on treadmill, no incline, 5 minutes, twice a day.
• Ride stationary bike, no resistence, 5 minutes, twice a day. I’ll need to put together my trainer and put a slick wheel.
• 30 x 5 sec hold quad strengtheners
• 30 x 5 sec hold of hamstring strengtheners
• 10 x 5 sec hold of knee to chest stretches (or as far as mine will go!)
• 7 minutes of medial patella glides
• 5 minutes of inferior patella glides

I had surgery on 9/7/2005… The Doctor had wanted to do a lateral release last August, but I decided to go the PT route. But it became obvious that I wasn’t going to get back to the levels I wanted to be at — i.e. to be able to train for and compete in 2 to 3 day adventure races. Maybe I’ll never get there but I at least needed to try to improve the current situation.

I asked the Doctor to do an exploratory scope with minor clean up, but that if he found anything major — i.e. anything that would take months of recovery, to not do it. Anything minor, meaning 4 – 6 weeks of recovery, he should do.

So he went in and this is what he found. The most surprising thing is the upper left picture, which is a “gap” in the tissue of the knee underneath the supra patella pouch. This gap was tethered to several places, perhaps to keep it from separating more. The Dr. thinks these tethers were limiting the patella’s movement, so he trimmed off the tethers and got rid of the gap. He’s fairly optimistic that at least this will help a fair amount. I may still need an LR some day — only time will tell. The other pictures are standard grade 2 chondromalacia, and he cleaned all the loose ends up, etc.

Here are the “after” pictures where everything is cleaned up.

“Smooth as a babies bottom…” Well, not quite. The resolution of this image isn’t quite there but the lower left picture does show a bit of a bumpy surface.

(Originally written on 9/12)

I should have started a “knee blog” a long time ago, so I’d have more history. I’ll give a very brief one now and maybe expand on it later.

* age 1 – slight club foot required cast for on R foot for 6 weeks
* age 18 – slid tackled into cement block wall playing indoor soccer. Initial diagnosis was displacement fracture but after going to a specialist he said the knee cap had grown from two centers and that I just had a severe bruise. Just needed a few months of rest.
* age 23 — training for 3rd marathon, the one in Atlanta on Thanksgiving, when on last long run, knee got sore for about 10 minutes during run but then was ok for the last couple of miles. Then it got really sore that night and remained sore, had to drop out of race. Thought it was ITBS.
* Then struggled with lateral R knee pain for next 10 years, off and on, though was able to complete many short and long adventure races, triathlons, do lots of hiking, etc. It was always just balancing soreness with training level.
* In July of 2004, backing off no longer helped and I got so sore I could barely move my leg. MRI revealed bone contusion on femur and patella — diagnosis was patella tracking issues. Next 8 or 9 months was tons of rest, ice, and PT to strenghten VMO, stretch ITBS, Rolfing work, etc. Slowly got back to running 4 – 5 miles and mountain biking up to 90 minutes, but always felt some tenderness. I put off surgery for a few months as we had several trips planned that I didn’t want to ruin.

It’s now 5 days after surgery and I’m walking without crutches and starting to use the R knee a bit more. Running errands yesterday was probably a bit much as it did get tired and sore, but I iced it and elevated it for some time when we got home and it feels better today. Still not driving.