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Sports Medicine

Knee complications

12/04/2006

Question:

I had a total replacement of my ACL and smoothing out of my meniscus and now 4 months later i still have a deep pain running down the middle of my calf (deep inside) and i get extremely painful cramps in my calf and bottom of my foot approx. four times a day, mostly at bed time. Also, I have numbness in my upper thigh in one specific area right in the middle (cannot feel warm or cold and is numb), is the cramping b/c of the surgery and is the numbness because of the anesthesiologist hitting a nerve when numbing my leg? i have kept myself well hydrated by the way.

Answer:

Calf pain may or may not be "referred" from the knee joint. Your orthopedist should be able to tell you whether or not your postoperative recovery is proceeding "on schedule". An examination would reveal if there is swelling in your knee joint - which would indicate inflammation and which could cause pain. If fluid is in your knee joint and has caused a cyst ("Baker's cyst") to form on the back side of your knee, this could enlarge down into the calf and cause pain there... an MRI scan of the knee would show if this was the case. Alternatively, if your calf is tender and/or swollen, a blood clot in the veins may need to be considered... a venous doppler (ultrasound) study would show this. Problems with arterial blood flow into the leg can also cause calf and foot pain - usually in response to exertion like walking but also at night - but would be unlikely in an athlete... blood pressure measurement in both legs - at rest and immediately after exercise - compared to simultaneous blood pressure measurement in your arm, would evaluate for this unlikely possibility. An additional possible cause for calf and foot pain and cramping would be due to nerve irritation - in the leg, or perhaps in the lower back ("sciatica")... a physical exam, and possibly nerve testing ("electrodiagnostic studies") would shed light on this possibility.

The basis for your thigh numbness would depend on findings from your physical exam... whether this symptom is related to a nerve injury during anesthesia would depend on the type of anesthesia you received. Since you mentioned your leg was "numbed", it sounds like the surgery was not performed under general anesthesia, which means either spinal anesthesia (numbing you from the waist down) or local anesthesia (numbing just your knee joint) may have been used... spinal and especially local anesthesia are used very infrequently for knee surgeries. You may or may not have had a "femoral nerve block" in addition to another form of anesthesia. Regardless of the type of anesthesia used, a tourniquet around the thigh is routinely used for any knee surgery to minimize bleeding during the procedure. Occasionally the pressure from this tourniquet can cause nerve damage, but this occurs very infrequently these days since tourniquet times and pressures are kept to the minimum necessary, and if nerve injury occurs, in most cases it is minor and temporary. If physical exam fails to reveal a definite basis for your thigh numbness, again, electrodiagnostic studies would provide more definitive information.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University