post-traumatic arthritis

[amyzilla]

Anyone else dealing with post-traumatic arthritis? I injured my knee 3 years ago in an accident - torn lateral meniscus and blown ACL. I've had several surgeries on the knee since then, including insertion and removal of a bunch of hardware for a femur break (same accident). Now I'm having increased pain on the medial side of my kneecap and I have some new, louder rice crispies (I know it's called crepitus, but I think "rice crispies" is more fitting). It feels more unstable lately, and I keep getting unexplained bruises along the medial side of my kneecap. I have an appointment with my knee doc in a week or so. Has anyone else had arthritis like this that set in so soon after injury? I guess I shouldn't be surprised, since my knee was pretty beat up, but it's really annoying.

On a related note, has anyone tried synvisc?

[amyzilla]

P.S. I'm 26 - perhaps a little young to have so many arthritis issues.

[lhowemt]

MY PT friends say it's been found that arthritis is quite common post-ACL injuries (and repairs). Perhaps due to the trauma that also usually results in the meniscus tears.

[drmark]

The incidence of arthritis is associated with articular surface injury, loss of the menisci, and flexion contracture.

I think of it pretty easily

the ACL is there to protect the menisci. The menisci are there to protect the articular cartlage. When your articular cartlage goes, then you get arthritis.

[Vinman]

a very high percentage of ACL tears go on to early onset arthritic changes, including mine. It sucks but it is a fact of life after any major joint trauma.

Basically the cartilage surfaces impact each other and cause "bruising" which eventually leads to the death of the cartliage cells and progresses to erosion of the joint surface and arthritis.

[amyzilla]

Hmm, sounds like it's more common than I thought. I've known for a year or so that I have arthritis in there (following a CT scan), but I'm surprised at how quickly it seems to be getting worse. Unfortunately my stomach doesn't tolerate NSAIDs, so maybe I'll see about trying Synvisc or something.

[cold_smoke]

Yes, common after-effect of ACL surgery as noted.

I went with the healing response surgery to reduce the possibility of arthritis on my second tear (new knee), because it was not completely seperated from the femur, still felt stable in most situations, & doc's stability tests confirmed. (I ultimately left it to him to make the call when he could do further tests when i was knocked out and see for himself once inside).

I decided that a pretty tight ACL along with no arthritis was better then really tight with chronic pain. I have a hamstring graft in my other leg that they say is loose (as this type does typically stretch more then others with time), but it feels fine other then the subsequent arthritis.

Obviously not an option for everyone who needs ACL surgery, but my case worked out.

edit to add: Synvisc has proven beneficial to a friend with major knee issues where further surgery was ruled out as an option.

[Mofro261]

My left knee hasn't been treated kindly in the last two years with a couple of acl repairs (last in may 08) and a partial resection of the medial meniscus jan 08. I've been really good about rehab though and the leg is strong, but I wanted to get back to running again.

I've tried on and off to run from about 4 mos-6 mos post op, but was getting shut down with tibial pain from the patella tendon graft site so I wouldn't push it and delay another month. A little before thanksgiving I got a tread mill to ease back on a softer surface, and only try every other day. Usually run 4min, walk one, etc 4 miles at a time, buildling up to 15 or so miles a week. I got a little over ambitious in the 4th week and went for an hour, 7 or so miles with a little speed up to some 6-6.5 min/mi pace. It began hurting the next day and hasn't been the same since, also haven't run since.

Hurts just walking now, when I get up in the morning, or when I completely contract the quad. Kind of a burning feeling or just a lack of padding feeling in there, no sharp pains or catching. Feels a little better the more I walk on it, until I sit down again and then it aches. Ibuprofen doesn't seem to really help much.

In full disclosure I have skied 12 of the last 14 days and it's been ok on skis, powder is friendly.
Just a bummer to have to deal with continual knee pain.

[TuaDog]

I had my acl repaired with a patellar tendon graft nine years ago and recurring tendonitis at the graft site has been something I've had to manage ever since.

The good news is that if you stay on top of it, you can keep the pain to a manageable level that won't restrict you in your activities (except for running). Keeping both your quads and hamstrings strong and limber is key. Try and focus on strengthening exercises that don't cause you pain, and stretch a lot. When I do this the pain goes down significantly.

Also, it should be noted that I gave up alpine skiing and switched to telemark full time since my injury. In doing so I've found that my tendonities is not nearly as severe. An aggressive alpine stance can put a lot of force on your patellar tendon. I think an agressive tele stance distributes your weight more evenly through your muscles.

[amyzilla]

The good news is that if you stay on top of it, you can keep the pain to a manageable level that won't restrict you in your activities (except for running). Keeping both your quads and hamstrings strong and limber is key. Try and focus on strengthening exercises that don't cause you pain, and stretch a lot. When I do this the pain goes down significantly.

Yeah, I probably should have mentioned that I had ankle surgery ~ four months ago. Two months of non-weight bearing atrophied my quads and hammies, despite my best efforts to keep doing quad sets and stuff. Since my original knee injuries, I've had to use my stationary bike three or four times a week in order to keep my knee relatively happy. I took two weeks off from the bike after this last surgery, but since then I've been back at it. Most of my latest knee issues developed after I started weight bearing again, so it's probably a muscular thing. I'm not sure if that explains the increased crepitus though. I'll be seeing my knee doc tomorrow, mostly just to get the new symptoms documented for legal reasons.

[SponsoredByDuctTape]

Also, it should be noted that I gave up alpine skiing and switched to telemark full time since my injury. In doing so I've found that my tendonities is not nearly as severe. An aggressive alpine stance can put a lot of force on your patellar tendon. I think an agressive tele stance distributes your weight more evenly through your muscles.

Interesting. Do you have any thoughts as to the differences between tele and alpine as far as knee injuries go? I tele'd about 30 days one year when bumming, but I can't recall if the falls felt more or less strenuous on the ACL and meniscus. I'm coming off a tibial plateau fracture, torn MCL, avulsed ACL and meniscus tears/damage. I was considering snowboarding when I come back, but I never thought about going tele full time. Any thoughts?

[watersnowdirt]

I've had/have arthritis in lots of spots. It definitely sucks. Advil certainly helps, but sounds like that's a no-go for you (is Advil an NSAID??)

Joints are a weird thing - I can mountain bike for hours and be ok, but walking on pavement for just a while can cause pain sometimes.

Nothing to add, but I'll be checking in to see if any has some good suggestions!

[altagirl]

I have some arthritis from various knee injuries as well - and I can't do NSAIDs either. Find whatever activity you can do without pain and keep your leg muscles strong. It can take a little trial and error at the gym - I know some leg press and leg curl machines just don't feel right. Don't be tempted to work through it - if it hurts, stop and try and make adjustments or switch to something else. Speed skating has felt great on my beat up knees and done a great job of building up my leg muscles. If biking or the elliptical trainer or whatever you like feels okay you should do it regularly - that seems to help keep things feeling good too.

And for pain - icing and elevating generally do the trick. I have to be pretty desparate to take painkillers because they tear up my stomach.

If you're getting a lot of rice krispies, I'd check with your PT and make sure your patella alignment is okay. If your muscles atrophied, chances are your VMO got weak and when things are imbalanced you get a lot more crunchies. So make sure you're keeping up with the PT for that if it's an issue, which I would really suspect it is after any significant atrophy.

[Vinman]

Interesting. Do you have any thoughts as to the differences between tele and alpine as far as knee injuries go? I tele'd about 30 days one year when bumming, but I can't recall if the falls felt more or less strenuous on the ACL and meniscus. I'm coming off a tibial plateau fracture, torn MCL, avulsed ACL and meniscus tears/damage. I was considering snowboarding when I come back, but I never thought about going tele full time. Any thoughts?

as for alpine vs tele:

a tele turn which is basically a lunge position will put more of a shearing force on arthritic conditions and may not be the best choice for those with arthritic knees. even though and alpine stance may put more force on the tendon which I am not actually sure of. There will be less shear force on in the articular surfaces and the patello-femoral joint. There will also be less knee flexion and anyone with an arthritic knee will tell you deeper angle of flexion will equal more knee pain.

[amyzilla]

I saw my doc today and he's thinking the same thing I was - that the muscle atrophy is probably causing my problems. He is a little concerned though that I might have a medial meniscus tear, so I'm going to have an MRI done sometime soon (pending insurance coverage). He thinks I might have a meniscus issue because some of the new snapping sounds are coming from that area, and it's where I've been having pain & bruising lately.

Mostly, though, the doc said the things I've heard plenty of times already: I don't have full extension anymore, most of my lateral meniscus has been trimmed away, I have lots of scar tissue, and it sucks that I had to have a rod put in my femur through my knee. He also noticed my ACL is a little looser than the last time he saw me, but I suppose that's pretty common. Anyway, my knee pain & instability is most likely related to all of those things, plus a little muscle atrophy. Blah.

I'm trying to think of ways to build muscle mass again without pissing off my knee. Last time I built it up, I ended up with all sorts of repetitive motion injuries (like IT band syndrome). I think I'm going to try some low-impact stuff. I'm going to try and find time to use my stationary bike daily (as opposed to every other day), and probably do some physioball stuff. I'd love to try yoga or pilates, or swim, but I probably won't have time to do that for a while.

[amyzilla]

I had an MRI last week, so I thought I'd update this thread. The doc didn't see any new tears or anything, so he thinks this is just a "flare-up" caused by my muscle atrophy. He basically said my knee is a mess from all the scar tissue, and because of the femur rod that had to go through my knee. He told me to work out a lot (which I'm already doing), and if it's still bothering me in a few months, he said I might want to consider having it scoped to remove a bunch of the scar tissue. In the meantime, I'm hoping I can get my insurance to approve a shot of Synvisc. Otherwise I might see about using anti-inflammatories for a bit, even though they mess up my stomach. I think the benefits might outweigh the risks... :P

[splat]

Have you considered prolo therapy?
My knee was doing stuff like that and it all ended 10 days after getting prolo.
But that was 6 years ago for an injury that occurred skiing 16 years ago.
I'm just dying for someone else here on the board here to get prolo.
I have a long article about prolo half-written and waiting for some testimonials.
I plan on getting it to both knees again after my surgery next month to promote healing of my meniscus.