Scar tissue removal - is it the right thing to do?

Does anyone know anything about TENEX? I thought this newer procedure was to help with this.

Yes, I am headed for a TENEX procedure in the next few months but right now I'm banking on UltraSound & Injections/excission to locate & remove dead patellar tendon tissue. My understanding is that if the patellar tendon was pushed aside during TKR, rather than cut, this wouldn't have happened but working around the tendon would have taken more time. However, I'm not an MD so seek local counsel.

My current surgeon (the fourth) craftfully excises the dead tendon and hopes that healing will rebuild it with vibrant tissue. That's the theory... but with age, tendons heal more slowly or not at all. However, it may be working because I am able to use the treadmill every other day versus not at all. After 15 minutes of treadmill the TKR knee is inflamed and heads toward pain level 10 so I stop. My dog cuddles next to my knee because it's so warm.

In a few days I have another UltraSound scheduled and will know if the excised tendon is growing back.

Tenex is a more aggressive approach and I declined because I'd have to use crutches for 7-10 days.

To the original question, the MUA didn't last long because of scar tissue that filled in but I briefly enjoyed ROM of 125. The scar tissue removal process didn't last long either, the scar tissue grew back again. I've resigned myself to persistent pain, an inflamed knee, limited ROM of 95 degrees, and endless rage that I agreed to the TKR procedure. I choose pain over couch potato but sooner or later the pain will win.

I understand! I am 57 and had a TKR in Jan 2023 left knee. I was SUPER active before (yes kayaking as well) and my healing and progress is very slow. I did prehab for 3 months and then have been doing intensive PT since surgery. I have no opinion on what you should do---too many people have opinions about what I should be doing and ask me why I am not healing better/faster. I just wanted you to know there are other people like you that were athletes before and are struggling after. I could list all the things I have tried but there is no way to definitively determine what works and what is not really helping. I know you said your surgery is tomorrow and I hope that provides some relief!

Hope all goes well…. The good thing is you know what to expect I don’t know if that’s good or bad lol…let us know how you’re doing …

Well.... I am back to update.
Thursday, June 22, 2023, I had my scar tissue removal surgery.
I am 5 days Post Op. So far, doing well. I am walking without the daily pain and aching that I was in prior to surgery. When I say pain, I mean daily, every waking minute pain. That is gone. I do have pain with movement and stretching. The pain is from the trauma to the knee during the surgery.
I did stay overnight in hospital on Thursday for observation of my knee. I was released at noon on Friday, attended a 3 pm session of PT. I am taking a different approach for my therapy this time around. A more gentle route. My therapist is amazing. Dr. Paul Krutchesky at ENC Wellness in Washington NC. Check his website. He specializes in myofascial release therapy, cupping, dry needling and IASTEM. He is treating me mainly with stretching. When I went in on Friday just after surgery, he measured, I was at 70 flexion, after one session he got me to 90 flexion. I will be going 3 to 4 times a week for at least the first 2 months. I am determined not to let my knee lock up again. I have a lot of work to do but I am ALL in. I cannot tell you what it has felt like to sleep at night and the feeling of that elephant sitting on my knee is gone. So my original question was Scar tissue removal.. is it the right thing to do? as of right now... ABSOLUTELY. I will return with more update in the coming week.

Good for you …. So happy for you got relief… at the end of the day that is all we are looking for …. Mfr works I have been doing over a year I started out going 2-3 times a week now just as needed ….,which is like once every 4 -6 weeks …. Keep on moving forward

Thank you very much for the detailed update. It is wonderful to hear you describe the improvement! Please continue to share as this helps all of us.

Good for you. I hope readers contemplating a TKR will take your advice. Post-op, and IMO, nothing helps the recovery more than stretching and lengthening flexion (and extension of course, just the opposite measure where you should get to zero if possible). It's not hard to do. It is uncomfortable with some pain, of course, but far better than letting scar tissue develop.

I'm glad you had a positive outcome and that you shared it here. Best wishes on the rest of your rehab!

Update- More information after Post Op appt w/surgeon on 7/18/23. I asked what he found when they opened my knee back up.
He located severe Synovitis.
PA shared with me that they cleaned all of the Synovitis out. I have attached some photos that the PA shared with me of what Synovitis in the knee looks like.
I had never heard this term, so of course, I had to research. I share all of this in hopes that it will help someone going forward. This has been a 4 year journey for me with pain. My knee is better post the removal of the Synovitis. It is stronger, my bend is better than was. It was at 75 pre surgery, currently at 90. I am in continued therapy, I chose a more gentler therapy this time around no aggressive therapy this time. Previously the aggressive pushing and forcing on my knee only elevated the swelling and pain. My therapy this time consist of myofascial release, massage, cupping and gentle bending. I am now able to climb stairs with full weight going up and am working on coming down... that is in process, I am almost there. I sincerely hope this helps someone that may be experiencing what I have been through. There is a lot of information out there relating to Synovitis

What is synovitis?
Synovitis (or synovial inflammation) is when the synovium of a joint becomes inflamed (swollen). The synovium, which is also sometimes called the stratum synoviale or synovial stratum, is connective tissue that lines the inside of the joint capsule.

A joint capsule, also called an articular capsule, is a bubble-like structure that surrounds joints such as the shoulder, elbow, wrist, hand, knee, foot and ankle. It is composed of a tough, outer layer called the fibrous stratum and a soft inside layer (the synovium). Contained inside both layers is synovial fluid, a viscous liquid that lubricates the joint to reduce friction on the articular cartilage during motion.

I am like so many of you with chronic pain post tkr. My left knee tkr was august 2021. Everything looks normal on X-ray but no explanation for constant lateral pain on outside of knee and joint clunking. Have tried acupuncture, mfr, shockwave therapy, 2 nerve ablations and now new pain doctor is doing monthly manipulation for 3 months. First one was useless. Surprisingly riding a bike is the least painful activity. Otherwise walking, swimming, stairs give level 6-7 pain. Use lidocaine patches, ice, massage, diclofenac, bio freeze to get by. I am better than before the surgery but this knee is running my life! I suspect patellar clunk syndrome but need mri to confirm and none of the 3 consultants I have seen have wanted to do it. Their advice has been so sorry, nothing can be done; could do arthroscopy but 50-75% chance pain would be less; to I need a revision. Anyone experienced patellar clunk syndrome and had it treated successfully?