Patient Testimonials

Victory over patella baja and arthrofibrosis including new patellar tendon

Melissa Pease, a patient of Dr. Frank Noyes at Cincinnati Sportsmedicine and Orthopaedic Center, was so pleased with her care that she posted this story on the Knee Guru web site on 2/21/06.

Victory over patella baja and arthrofibrosis including new patellar tendon

I have a functional knee after six surgeries at Cincinnati Sports Medicine to correct severe patella baja and arthrofibrosis! I feel so fortunate to be walking normally again. By reading the experiences of others on this website, I was pointed in the right direction for treatment of these conditions. I hope this story gives others some comfort, knowledge, and hope.

My patella baja and arthrofibrosis resulted from a "routine" surgery in November 2004 to remove a ganglion cyst, part of which was growing under my patellar tendon. After beginning physical therapy 5 weeks after surgery and immobilization, I became stuck at 70 degrees of flexion.

My husband I and sought a second opinion at Duke University in February 2005. The news we got was unexpected and alarming. I was told I had a very serious knee condition that would be difficult, if not impossible, to treat. The orthopedic surgeon (OS) used the word, "disaster" to describe my knee. I had severe patella baja and my patella was completely frozen into place by scar tissue (arthrofibrosis). He correctly recommended that I not have the manipulation procedure scheduled with my original OS. This OS at Duke made it clear he did not want to be associated with my case, but that I should find help quickly. As he was backing out of the examination room in what would be the last time we spoke with him, I was furiously writing on the back of a magazine the names of surgeons throughout the country he thought might tackle my case.

This news was devastating and frightening. I thought, "I am an athlete, runner, hiker, and cross- country skier. I also have a three-year-old and one-year-old to keep up with! Who is going to help me if a premier institution like Duke won't even try?"

I recognized one of the names on my magazine list from growing up in Cincinnati - Dr. Frank Noyes. It was so comforting to find the Keegeeks Bulletin Board and learn there were others dealing with the same conditions. From the online conversations or "strands," I was able to understand the causes, unpredictability, and difficulty of treating my diagnoses, as well as a list of surgeons throughout the country who are qualified to treat it, which included Dr. Noyes.

My first appointment at Cincinnati Sports Medicine was in March 2005. I was afraid Dr. Noyes might not take my case. When he came into the room, there didn't seem to be a question that he would try to help me. He confidently stated, "We know exactly what to do," to address my condition.

I was immediately introduced to his therapy staff to begin quad strengthening and treatment of my lack of extension at 11 degrees. This serious problem with my extension was barely mentioned or addressed by my original OS. I observed how a proper physical therapy room should function - with doctors dropping by at least a couple times a week to check on their post-surgical patients, communicate with therapists, and adjust treatments. The therapists at Cincinnati Sports Medicine (two of which had worked there over twenty years) are well-versed in techniques and protocols that they themselves have developed to address issues like lack of extension. I began the painful process of "hanging weights" - propping my heel up on a towel or foam roll and setting 20 lbs. of weight on top of my knee for 10 minutes. I faithfully followed instructions to do this and other exercises 6-8 times a day.

Shortly thereafter, I was put into an extension cast. This is a torturous process where a grown man pushed down on my leg with all of his weight to straighten my leg, then casts it into place. I was brave until it was all over and then needed to break down and cry.

Dr. Noyes ordered an MRI and my patellar tendon was not discernable. When Dr. Noyes did my first surgery in April 2005, he found that my patellar tendon was merely a fragment of scar tissue. I had a series of four surgeries to prepare for an anticipated patellar tendon reconstruction. These surgeries included scar tissue removal, z-lengthening, releases, and an innovative procedure to address an unusual skin healing problem. Because of being immobilized and losing range of motion (ROM) for several months, I didn't have enough elasticity in the skin on my knee for an incision to heal. Dr. Noyes twice put a balloon in my knee that was gradually injected with saline (used for mastectomy's) to grow additional skin. At some point, Dr. Noyes moved my patella back up into the correct position.

I was having an average of one surgery per month. This was a very difficult time for me personally and for my family. I temporarily left my home in North Carolina and moved in with my mom near Cincinnati while my two little girls went to live with my husband's parents in Kansas for four months. I was weak and underweight. I was down to 94 lbs. from and original weight of 111. I began seeing a psychologist while in Ohio to help me thru the depression. The uncertainty of the outcome was stressful and difficult to bear. After the first two surgeries, Dr. Noyes conservatively estimated that I probably would not achieve more than 70 degrees of flexion. Fortunately, he proved himself wrong and after the third surgery I immediately gained 30 degrees and then another 10 degrees gradually.

I was doing therapy literally all day long. By the time I had finished one round of stretching, several exercises, hanging weights, and icing it was time to start again. I didn't use the CPM for long before I got an "Ermi" (End Range of Motion - www.GetMotion.com) machine at home. The Ermi is indispensable for patients trying to increase range of motion. Every therapy room should have one.

I was conservatively prescribed a prednisone pack only once to try to reduce scar tissue formation. I was not given any cortisone injections. I remember getting up every few hours at night to use the CPM machine - I worried scar tissue would form in my knee if I lay unmoving for too long. During one surgery, Dr. Noyes noticed signs of infection. The infection was localized and not too serious, but it warranted a "pick line" - a semi-permanent intravenous line sticking out of my arm for many weeks to inject powerful antibiotics directly to large veins in my chest. It was scary laying in a steel, windowless room having this line inserted into my body.

Finally, my knee was ready for the patellar tendon reconstruction in August 2005. It was more accurately a tendon creation in my case. What Dr. Noyes did, I think is amazing. For tissue, he used strands of hamstring from my good leg in addition to cadaver tendon. He felt it was important to use my own tissue because it would heal much quicker and become much stronger. He drilled holes thru the length of my patella to thread this tissue thru. He wired it up for 6 months to support the tendon as it healed, although I could still work on my full range of motion on the Ermi.

I moved back home 4 weeks after this surgery and continued a daily therapy routine on my own at home and at the gym. I worked to teach myself how to walk again, which took a few months and was much more difficult than I anticipated. I used a treadmill at the gym to concentrate on the mechanics of my good leg, trying to make my "bad leg" do the same thing.

The wires were removed in Feb. 2006. I have about 115 degrees ROM, no chronic pain, my patella in the right spot, and a new patellar tendon. One hundred-fifteen degrees might not sound like a lot, but it is SO functional compared to 70 degrees. I can walk without a limp, step in and out of the shower, and go on day hikes with my family. These things are all so huge! I expect to be able to cautiously cross-country ski again next year. I have another year of therapy and strengthening ahead, but I will be home with my family after a really long, tough, year.


Melissa’s original post and many replies from other patients may be read at http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=24680.0