I have been having severe pain in my left knee of late. I have had prior surgery on the same knee (Fulkerson Procedure) and last year my then Ortho guy said his M.R.I. was clear so he shot me up three different times with cortizone.
I have made sure to take very good care of the knee and done all the physical therapy stuff but the pain has retnrned with a vengance and this years NEW M.R.I. shows 1: At least mild Grade IV chondromalacic changes of the patella.
2: No meniscal tears and
3: Mild to moderate joint effusion with a very small Bakers cyst.
Do you feel what with the prior surgery and the fact that I am 47 years old male this new pain which is quite intense that I may have to undergo surgery once again?
#1 by formerly on January 15, 2010 - 1:57 am
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The pain is probably caused by the effusion – effusions can be extremely painful. The question is: what is causing the baker’s cyst? Is it possible that you have been doing the physical therapy too aggressively, or maybe did not back off the exercises when your knee was sore? If the answer to either question is yes, then you may only need to give your knee a break and let the inflammation subside – this might take 3-6 months. You would probably limit exercises to range-of-motion, stretching, straight leg raises, or other low-impact procedures recommend by a physical therapist.
If the answer to the previous questions is no, then the most logical thing to do is to surgically remove the baker’s cyst and then switch to passive, low-impact therapy until the inflammation subsides. You would need about a year to see how this works out.
Continued use of cortisone is not a viable option. It’s really not a good idea to give a patient repeated rounds of cortisone – this only relieves the pain temporarily, and encourages the patient to continue activities that are harming the knee, which generally makes things worse in the long run.
If removal of the cyst is not effective, then you might be a candidate for a partial knee replacement. There is little point in repeating the same type of procedure since it isn’t working now.
#2 by Learn And Teach on January 15, 2010 - 7:57 am
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You have all that info and you didn’t ask your doctor? How are we supposed to tell if you need surgery again? I don’t want to sound insensitive, but rather than asking us, you should talk to your ortho, and if you don’t trust him then get a second opinion from one of his colleagues.