Basically, to recap, I had 3 distinct problems before surgery:
- Sharp pain caused by inflamed plica - this one was the real show stopper in life as it made me limp and really hurt
- Grinding noise (but perhaps no pain?) caused by degenerated patellar cartilage
- Irrritation and soreness on patellar and quad tendons close to the knee
Since the operation I now no longer suffer from 1 and 2. This is a massive step forward! Now, if I do too much, I feel it in the tendons and fascia around the knee - but I no longer get the savage pain that the plica caused. I also no longer get a grinding noise when the knee is bent under load and the nasty 'crack' when rotating the upper leg with lower leg planted has gone.
I would say it took 8 weeks for the majority of the post-ops symptoms to go. At that point I had full range of motion and could compress the joint fully without pain. I would say 12 weeks until I could kneel (sitting on heels pose) - thus placing full body weight on fully compressed joint without pain that was caused by the op.
I still (now) find a static, fully extended concentric contraction of the quad uncomfortable - partly because I still suffer from some tendinosis - but also because lost muscle bulk around the quad/knee means this forces the underside of the patellar down too far. As my physio points out - this will probably will improve as muscle bulk returns - and its not a hugely useful functional movement anyway.
One downside is that I have a pea-sized knot of scar tissue on the the edge of quad tendon (caused by the incision where the RF went in) - this did not respond to mobilisation or ultrasound and is pretty fixed now - in the longer term it could be a problem as it creates a weak link in the chain
So..what can I do now? I have build up to being able to:
- Cycle 11 miles - cycling is lovely - I never did much before so it was not a contributor to the tendinosis and seems to put the knee into a very 'comfy' place for exercise. Has also helped to fill the hole that losing running left
- 90 mins of yoga
- Walk up to 10 miles (but around 6 miles is most comfortable)
- General life is much more comfortable (I'm a teacher and am on my feet most of the day)
- Swim (a bit) - does seem to flare up my tendinosis though
- General physical work is now all fine (gardening, moving firewood etc etc)
- Push out the cycling further
- Try some more swimming - but very cautiously
The physio suggested (with caution) badminton and squash since both of these have limited amounts of running but are good for strengthening thigh muscles - lots of squatting, lunging and flexibility. I'll need to start these carefully and use some support (pro wrap + neoprene) at first. They will be much more intense that what I am used to so far
The exercises I found most useful during and post rehab (still doing them) are heel slides to get the knee warmed up and mobilised first thing and squats with a medicine ball at my back (all other squats seems to place too much load on the joint - causing clicking and flaring up the tendinosis). I still do these plus a range of stretchs twice a day - first thing and in the eve after exercise
I don't think I will ever be able to fully get rid of the tendinosis/scarring on my pat/quad tendons. My plan is to be able to do as much as I can and enjoy it - I won't be running marathons or trekking coast to coast (UK not US :) - but that doesn't mean I can't do and enjoy some sport most days. Here are some tips I use for managing the tendinosis to a bearable level:
- Unless bad - some gentle motion is often beneficial (and has a big psychological boost)
- When I do get a bad flare up - Voltarol Gel is by far the best thing at getting down the pain - don't think there is ever much inflammation in there as no heat - but the gel does still seem to have a pain reducing and calming effect on the tendons (interestingly oral Voltarol (diclofenac) does nothing and hurts my stomach. The gel seems to get to the problem area and does not hurt my stomach. My guess is that this is because tendons have limited blood supply - so an oral treatment may not be very effective. Conversely the gel is absorbed in to the tendon area but not the blood (as much) meaning I get reduced side-effects.
- Ice is great too but makes the joint very stiff. So good for numbing down the joint - but does not seem to do anything to reduce the flare-up duration and makes the joint un-comfy if I need to be mobile after icing
- Avoid large chunks of stamina type exercise. I try and never let myself get into bone-tired, plodding it out, repetitive motion type exercise - like when I ran or hiked long distances. It's when I get into that situation that I am most likely to get a flare up. For me it is better to say "I'm going to take 45-60 mins exercise and whatever I can do in that time will be just fine"
- Be careful to warm down and stretch my quads as soon as possible after exercise
- Avoid long periods of sitting on a chair in one position. Cross legged on bed/sofa is much better for using the laptop than sitting at a desk
So given that the surgery seems to have nailed the two things it targeted and done nothing (unsurprisingly :) for the one it didn't I would say that it has been well worth the discomfort and rehab time. I reckon I will be able to find a manageable balance of exercise/sport that keep my happy whilst acknowledging that the dodgy knee tendons are pretty much there to stay (perhaps they will improve more over time - I'll just have to see)....