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Dr. Mark can you explain??

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As some of you know i had my surgery on Jan 7th 2010...for cartilage clean up on right knee..and was told after surgery it was Tibial Femoral Arthritis due to trauma (fell)...surgery went well..healing up with no problems thus far...How ever i went to the surgeon for my follow up on Feb.11....and explained to him my calf and knee still hurts like hell after walking 3 blocks....so he sended me to physio for 2 months and said that if that doesn't work he would try bracing it??...which i started last Tuesday....there the physiotherapist did some podding around and this is her outcome

1.she said the muscle on the inner right knee is no longer working and that it prob stopped working the day i fell 3 years ago...she didn't give me the name of the muscle

2.she also said because that medial side muscle is not working the muscles on the lateral side of knee is pulling my kneecap in that direction...and goes on to say that is why my knee hurts and feels tight when i walk....

OK now my question to you is...wouldn't the surgeon have noticed this during surgery the the knee cap was being pulled??? Is what the therapist says does it make sense or is this just another wacky theory?? Is there anything that be can be done if the therapy fails??? why the surgeon didn't notice this before surgery is beyond me

I just want my life back...i have not been able to walk for 3 years without pain in the knee and calf

NOw...she doesn't know what is causing my calf to swell but her theory is the swelling is causing the muscles in the calf to contract and spasm and says that this is causing the blood not being able to get through...Hence why they prob did so many ultra sounds for blood clots....she says i don't have tendonitis or compartment syndrome....

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You need long standing X-rays to determine how bad your alignment is, and then correction of the malalignment.

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Thanks Doctor Mark i'm gonna contact my GP on Monday....my last final question is does this theory sound correct???

2.she also said because that medial side muscle is not working the muscles on the lateral side of knee is pulling my kneecap in that direction...and goes on to say that is why my knee hurts and feels tight when i walk....

and then correction of the malalignment.

oh great that sounds like alot of fun....is that a Lateral release???

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MR 412: How old are you? Gender? When and what was your injury? Which side of the knee did they tell you had arthritis on? Do you have pain under your knee cap?

Can weak muscles cause maltracking of the patella? Yes, if you are 13 yo girl, then therapy might help this (my wife is therapist). Doubtful that your fall caused your VMO (or vastus medialis obliquus muscle) to quit working. Is the muscle she says isn't working a different size than the other leg?

Have you ever had a episode of your patella dislocating? Did it dislocate in the fall?

Bracing? Is it an unloader brace for the arthritis?

How much swelling are you having in your calf? Is that leg much bigger than the other? When did the swelling start?

If the doctor did a knee scope, and you had a maltracking patella, it would be evident during the procedure. Also, there would most likely be some arthritis on the patella as well.....

I'm just sayin.....aj

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HI ajfreeze thanks for your response

the answer to your questions:

I am 45 female...3 years ago I was walking fast to make it to the bank before it closed i slipped and fell on ice that was buried under snow..my left knee slammed straight down and my right knee medial side slammed on the ice with leg laid out (best way to explain it is to picture your medial side knee on the floor and see how the rest of leg lays out....lol...it took me a couple minutes to snap out of it and realize what happened and pull my leg back in and hop to the bank which luckily was only a few feet away(it happened in their parking lot) i had a little bit of tenderness and discomfort rest of day...then the next day or 2 i started to get extremely sharp shooting pains on medial side of knee and then about 2-3x i couldn't bend it or straighten it without excruciating pain...so i went to the ER and they told me i had torn my meniscus and put me in a immobilizer and told me to wear it til i saw the surgeon....i only lasted 2 days in that damn thing..it kept falling of me....However a month later i was on the back deck sweeping off the ice and snow so that my old dog could get down the ramp builded over stairs to do his business....again i slipped and fell pretty much the same way i did the first time.....Lucky Me....in the meantime i still hadn't heard from the surgeons office....long story short...it was a 3 yr battle to see the bloody surgeon....during those 3 yrs things gotten worse...the locking became more the sharp pains wouldn't subside...

Walking became difficult,the knee was tight feeling, ached,almost like fighting to go that extra step to the finish line... then April last year out of no where...i was laying in bed talking to a friend on the phone and i stretched my leg and i let out a scream...right on the back of right calf right dead center i felt a real quick snap...almost felt like a charley horse but this was more of a snap of your finger quick snap, hurt for a sec, then a weekishy later my calf swelled up, and has been swollen ever since...they have done 4 ultrasounds to look for a blood clot but negative...ever since that snap i have not be able to walk any more than 3 blocks without my knee and especially calf screaming at me...I finally got in to the the surgeon and got surgery done...turned out it wasn't a torn meniscus...he said i had tibial Femoral Arthritis due to trauma when i fell and that the cartilage was peeling like and orange so he cleaned it up and behind the knee cap....SO i thought great now I'll be able to walk freely once again...WRONG....still can't walk anymore than 3 blocks without calf and knee screaming at me...the calf becomes sooooo tight extremely sore and knee becomes sore....once i get to that 3rd block..my right leg comes to a dead stop complete halt and can't go any further...then i have to either take little baby steps to get to my destination or shift all of the weight to my left leg and trend lightly on my right leg...the only 2 choices i have...So when i saw my surgeon on Feb 11th for my follow up he suggested that i try physio for 2 months if that don't help then he would try bracing it...he didn't say what kind....so like i said i went to my physio and it my last post explained what the therapist thinks...

So no my patella did not dislocate that i am aware of?? nor did it dislocate when i fell that i am aware of??

and yes she said the muscle on left leg is there but isn't there on right leg...she showed me the muscle and showed me where the muscle isn't working

also which i explained to the surgeon and therapist and GP...ever since where i felt that snap in the back of calf...it never changes or jumps to different spots...i get spams in the exact same spot where i felt that snap and behind knee (no bakers cyst was present)...i know it sounds far fetched ..but it's right dead center of calf inch by inch area is the amount of spasm...nobody GP therapist or surgeon...has no idea why my calf is swollen...and yes it is noticeable compare to the left calf...that's why they did the ultra sounds as well..if you slide your hand straight down the inner side of leg to center of calf that's where the swelling is...and the spasm only comes if i do just a wee little overuse...if that makes sense to you??

I am hoping the therapist is right...but with the luck I'm having I'm not to optimistic...this is becoming extremely depressing for me...i just want to be able to walk again..i have walked all my life..everyone in my family has a drivers license but me..had no desire..I would rather walk than drive...but now its becoming a nuisance to the family as i have to ask for rides now to get groceries, shopping etc...they getting tired of it...I JUST WANT TO WALK AGAIN!!! any suggestions would be helpful as i am at my wits end with this...tears are becoming more frequent,frustration is getting more frequent, but I'm not willing to give up yet...I'm determined to find a answer and fix this!!!!!

ps sorry for the long post..explaining this on internet is harder than in person...lol..

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