Recovery and Rehab Update (Month 5)…Thoughts on Why I Developed Synovitis

As I near the end of Month 5 of recovery and rehab from right knee mosaicplasty, the situation that I find myself in is that certain exercises and overall exercise volume worsen my synovitis. Over the past month, I’ve been in the mode of identifying and removing exercises from my routine that flare up my synovitis. I’m also, with the support of my PT, finding replacement exercises (for those removed from my routine) that cause less knee reaction (e.g., replacing partial squats with isometric squat "holds.") 

I’m trying to get to the point where my knee stiffness and swelling start to gradually improve, or at least to the point where I’m not getting worse, while doing just enough exercise to increase knee/leg strength and stability so that my knee becomes less reactive to being “loaded” in the future.

This is a slow process with days that my knee feels slightly better often followed by days where my knee seems to worsen slightly (for no obvious reason…frustrating!). Overall, things seemed to have stabilized a bit and hopefully as I heal and get stronger, my synovitis will start to recede.

So, what went wrong with my rehab/recovery that left me with synovitis, swelling, and an overreactive knee? Well, it is impossible to know for sure. This is like an experiment with no control group. I don’t know what would have happened had I taken a different approach. That being said, my speculation is that I returned to cycling (and to a lesser extent, walking) before my knee was strong enough to absorb and recover from the load. This problem started a little more than month after the surgery. I had been encouraged by my OS and PT to rehab aggressively as long as I was not feeling pain and my knee was not overreacting. I thought I was handling the daily cycling (up to 45 minutes), but I had been taking meloxicam (an NSAID) for the first 30 days after surgery and that may have masked pain and reactivity to the exercise. When the NSAID wore off, I experienced an increase in swelling and a loss of kneecap mobility. By the time my OS, PT, and I realized what was happening and cut back on exercise…it was too late. The synovitis became chronic and I’ve been struggling to regain equilibrium (let alone move forward) ever since. 

So, the path forward as I’ve already hinted above is to slow down and be patient. Hopefully I can tilt the balance towards healing, however slow that process might be. The good news is that the grafts appear to be doing well (according to the 3-month follow-up MRI) and if I can get this inflammatory situation under control, the reward may be a full return to activity.