Ligament instability after TKR?

Mpirrucel,

You mention "ligament instability". Do think an unstable ligament is the underlying cause of the condition you have? If so, why do you or your doctors think so?

I had two TKRs nine and eight months ago. In the posterior-lateral region of my left knee there's a tightness of what I perceive to be sinewy soft connective tissue -- I'm guessing either a ligament tendon -- which becomes very painful at a certain point of flexion. For many months it would audibly "snap" or "pop" as if it were getting momentarily hung up or caught on some other anatomical part in the back side of my knee, and then suddenly painfully release. While it no longer snaps to the same degree it once did -- a condition I never had pre-surgery -- it's still very painful when I go up or downstairs, get into or out of a car, get dressed, or try to stoop or squat. My primary care physician just yesterday gave his approval for me to have an MRI done on both knees -- my other knee is having a similar but not identical problem in the same postero-lateral area -- to see if any of the soft tissues in the affected areas can be seen and a proper treatment prescribed.

I really don’t know if ligament instability is the real problem. That is what the third doc thought. First doctor did not and said neither arthroscopy nor revision would get rid of pain. He Didn’t know why it happened. He based his opinion on how my knee looks and kneecap moves. There is an area on the lateral side that is swollen and warm 24/7. Use cbd cream at night also. Have requested another opinion at university of San Francisco.

In most TKRs, the posterior cruciate and anterior cruciate ligaments are removed. This sounds like your PCL is still there. That would be very unusual.

And the PCL and ACL are really only required for athletes. I've had TKRs and don't notice any difference with these ligaments gone.

The snapping or popping of soft connective tissue inside the rear outside aspect of my knee seemed to have a diagonally slanting orientation to it. I could even put my finger tips right on it as it jutted out just below the surface of my skin and feel it suddenly shift or slide almost as a guitar string would. Based on this physical sensation analysis, and after consulting diagrams of the inner anatomy of the knee, I suspected it MIGHT be the popliteus tendon. The surgeon thought it might be be also, but couldn't confirm it. He did confirm, however, that my ACL had been removed, but not my PCL. He did say it could be one of several different tendons or ligaments as the sensation occurred in an anatomically complex area of the knee.

Hello. I had a TKR nearly four months ago and am experiencing a very similar issue and believe it might be related to a tight IT band. I found some helpful information on the American Association of Hip and Knee Surgeons website --
https://hipknee.aahks.org/wp-content/uploads/2021/01/IT-Band-Handout-knee-Jan-2021d.pdf.
According to their site, "The IT band can become irritated during motion of the knee as it rubs back and forth over the end of the thigh bone or top part of your knee replacement. Continued irritation can lead to inflammation causing pain, tenderness, and swelling over the outside portion of your knee." I also have knock knees which can exacerbate this issue.

Although I have very good range of motion and flexibility, I have pain on the outside portion of my knee with a loud popping sound when I bend, flex or go down stairs. Not so much going up. I'm continuing to ice, do lymphatic drainage massage for inflammation and swelling and have started to wear a neoprene compression sleeve. I am also restarting PT to try to help loosen the IT band and break down the scar tissue which I think is exacerbating the issue. Hope this helps you and that you can get to the root of your problem soon.

oceanspruce,
I had severe pain in a similar area after TKR and there was an orthopedist who was going to excise my popliteal tendon and he wrote in a patient portal that he had told me that I could be worse off however he had never told me that so I cancelled the surgery. I am glad that I did cancel because I went to another Orthopedic Clinic and they did an ultrasound and saw right away that I had what is called a fabella bone. This is a fairly rare bone that not everyone has and not all doctors are looking out for it. Sometimes after TKR this bone can cause a lot of pain. I could feel a little lump under the skin.
I had surgery to remove this bone and it immediately took the awful pain away.

I thought I should share this with you since your issues sound similar to what I went through. Maybe you could get an ultrasound to see if this is a possibility.
Katrina

Thani for your response. I had the 3 months of PT post op but then still uncomfortable. Tried acupuncture and shock wave therapy 6months post op. No help. Did MFR for two months earlier this year and no help either. A sleeve sometimes helps or makes it worse. Taping is the best as it takes the edge off but can’t use every day. Hopefully my fourth consult may have some answers besides doing a revision.

Thanks Katrina for this information! I am scheduled to possibly get a fibular head manipulation by an osteopath later this month although we have to see if that is appropriate. I looked into the popliteal tendon issue and had ultrasound and then cortisone injection into it. Lasted about 3 days so that’s not the problem. I will ask the osteopath about the fabella bone. Did you mean fibula bone?

I have an orthopedic appt next week seeking an answer to my weakness in thigh muscle Iv’e lost my ability to climb stairs

After three months TKR I am suddenly getting more lateral knee pain as you’re describing. I’m sorry for your ongoing pain and wish you the best.
Beth