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Hi Nabi,

Your question about surgery is a difficult one, and there is no easy answer. However, it's important to have scans to make sure that the ACL graft has been positioned correctly. It can be helpful to see a different surgeon who is not associated with the first, to get advice on the ACL graft positioning.

After the scans you might consider arthroscopic arthrofibrosis surgery. However, surgery stimulates the healing response again, and arthrofibrosis is a condition of over-healing. So, as you have experienced, the outcome might not be good, and might even be worse.

If the surgeon follows the methods that are outlined in the Surgical Checklist, especially not using a tourniquet and not using a mechanical shaver, that reduces the risk since there is less damage done, but we still can't predict the outcome. It seems that the Hoffa's fat pad is almost always inflamed and fibrotic, and cutting it is not advisable.

Losartan was shown to reduce arthrofibrosis for some people in some research, but other research has not found a positive response. An individual's reaction to it likely depends on the biological pathways that are dysregulated, which determines what will help.

If you can find a surgeon who is willing to consider the arthrofibrosis-aware surgical methods then you might decide the risk is worth it. We're happy to meet virtually with a surgeon if they want to discuss this, and we can also point you to a couple of experienced arthrofibrosis surgeons in Europe and the US.

Please feel free to ask more questions.

All the best,

Kayley

Hi Gardener,

I agree that infections in the mouth are a real risk for joints, especially when you have a prosthesis. I can't give medical advice, but I hope that your dentist has prescribed oral antibiotics that target the specific bacteria causing the infection. They may need to test what type of bacteria are there.

If you're taking antibiotics this should control the infection so it doesn't disperse in your blood and travel to your knee. However, if your knee develops more symptoms then it would be a good idea to have a needle aspiration of the synovial fluid in the joint, which is then tested for infection.

Your knee may feel worse for a while in any case, because your body's "army" (immune system) is fighting the infection in your mouth, and the "ammo" (inflammatory cytokines and cells) travel in your blood to your knee.

I hope that helps,

Kayley

Hi Kayley - Thanks very much for your feedback! Yes, the recurrence of the PVNS was ruled out with the latest MRI beginning of the month. I have a rheumatologist appointment for next week and am planning to ask her/him for a cytokine panel blood test as recommended in IAA website. My surgeon recommended physical therapy to me for 4-6 weeks to see if my knee condition will improve before a surgery decision is made. I will definitely ask my surgeon if he is open to engage with IAA. Thanks again!

Erkan