week post microfacture bit confused

[jhallum]

Hi.  I'm unique that I'm not the one having knee problems, but my wife is(28 yo, 5'2" 145').

We are in sort of the same boat that Charlie is, she had a plicadiagnosis, and we went voluntarily to remove it because it was causing a large amount of pain.  That was Tuesday afternoon.

When she came out, the doc told me that "Oh, by the way, we also saw some cartilage loss, so we did some microfracture work on the 7 mm medial of the plica, and, oh, by the way, she's on crutches for 2 weeks instead of 2 days.  Enjoy your forced vacation from work."

Like Charlie and Jake, we're pretty annoyed by the whole situation, but I'm also worried about recovery (just today I've started to do the research on this, and never quite realized the depth of the recovery time).  I suspect that I'm probably overreacting, because the scope of the procedure was not large (only the area of a square cm or so). But:

She isn't on a passive motion machine, just basic range of motion PT (leg lifts,etc), and we've been quoted an estimate of 2 weeks at 50% weight bearing, instead of the 6-8 weeks/months I read about on line.  We don't have our first PT session at the hospital until next Thursday.

On the other hand, there is no pain, just some swelling, and she has very good range of motion already after a few days, and she can lift her leg on her own.

I'm hoping that when we talk to him next he will be very clear that this was a precautionary procedure to prevent something more drastic from having to be done in the future, but until then I remain a bit pensive about adequate recovery, not knowing much about the different varieties of the procedure. 

Anyone have any insights they'd like to share?

Thanks for reading my gripe session 


Jeremy

[John1]

Hi Jeremy,

First of all, I'm a little confused by what you wrote: "so we did some microfracture work on the 7 mm medial of the plica". You need to find out more precisely what the surgeon did and make sure it was actually microfracture. He could have just debrided (cut away) some loose flaps of cartilage.

The recovery from the microfracture depends a lot on the location and size. The idea is to not allow any compression force on the area where the microfracture was. If the cartilage defect was on the medial femoral condyle right where it rests on top of the tibia when standing, then you should be nonweightbearing for 6-8 weeks. If the defect was in the groove where the kneecap moves, then you can get by with putting weight on the leg as long as you don't bend the knee and allow the kneecap to press against the spot where the microfracture was. If the damage was just where the plica was rubbing, then 2 weeks on crutches may be long enough because that location may not have a lot of compression forces acting on it.

Passive motion is good after surgery because it allows nutrients to circulate inside the joint. Passively moving your wife's knee through the range of motion several hundred times a day may be just as good as using the CPM machine.

It sounds like your wife is doing well so far. Please let us know how the recovery goes.

John

[SallyW]

I had microfracture done 2 days after Jess did. My defect was 1 cm by 6 cm in the medial condyle area (weight bearing). Like Jess, I went in for the operation expecting a simple partial meniscus removal; came out with my OS telling me he had "poked some holes" in my knee because I was "bone on bone" and a "fake cartilage" would form over time. He told me I wouldn't feel like walking for about a week, and to take it easy for 8 weeks...no other instructions. I was walking 4 days post op (it HURT, but I walked 'cause he didn't specifically say not to), and I did take it easy for the 8 weeks. Other than that - no limitations, no PT - nothing.

I'm not upset that he did the microfracture without telling me ahead of time - I knew that the MRI wouldn't show *everything*; he simply found more than he expected...and I really wouldn't have wanted him to scope me, then wake me up and send me back for another operation for the microfracture! He did it, it bought me some time while I investigated longer lasting options (OATS for me).

I started having major problems about 3 months post op, we tried various treatments, and my doc didn't seem to offer much hope of my feeling much better - ever. Depressing. Even though I'd heard from other sources (here) that things would continue to get better for about two years, I wasn't happy with my outcome...and the durability of microfracture concerned me - that it wouldn't hold up unless I switched to swimming (I do NOT LIKE water!!!!!!!).

I had OATS a few weeks ago (different OS); he said that I had some fibrocartilage, but there was still a fairly substantial area where nothing had grown, and probably wouldn't have at this stage.

Sometimes I wonder if I would have had more success if I would have been NWB and done PT following my microfracture op...dunno. But on the other hand, since it seems that microfractures don't last very long, aren't durable - does it make sense to spend so much time on rehab from a procedure that wasn't very good to begin with? At least OATS has a fairly long life...

[blackbeltgirl]

Jeremy -

The rehab protocols for microfracture vary.  The area I had microfractured was hige - my all medical standards.  I was told to drop the crutches as I felt comfortable - it was about 5 days.  I didn't start formal rehab until 2 weeks post-op, but had a set of exercises to do at home to start rebuilding the quad and regain range of motion - I started the day I got home, and did the exercises 3x each day for the first 2 weeks.  AS to the CPM, if your wife already has a full range of motion, don't worry about it.  I don't know anyone who's had a CPM after microfracture.  But as I said, every doctor is treating the individual patient, and will work based on his own knowledge and experience.

Cartilage loss, treatment, rehab, etc. seem to be very variable.  People can have very small lesions (like your wife's or even smaller) and find even walking to bring agony.  Others can be walking around on a bald joint, and not notice for years.  Our pain levels cannot be predicted by the size of the damage.  Yes - it is definitely frustrating to wake up and find out that your expected rehab has been extended.  I wasn't angry or annoyed, just surprised.  The, when I realized how long the recovery is, I started worrying that I wouldn't feel any better at the end.  But most of us come t hrough the other side.  If, in the worst case scenarios, it either doesn't work at all, or it wears out, your wife will still have the additional treatment options.  But most insurance companies will require you to try microfracture before approving OATS or ACI anyway - especially with such a small lesion.

If the two of you go through the next couple of months with a positive attitude, it will help.  There's no point wasting energy wishing it hadn't been done, being angry because it was, or frustrated with the recovery time.  It's been done.  Now it's time to focus on making it a successful procedure.  My case was more extreme, but Ihave an extensive document of all the questions I've asked my OS since my procedure.  If you'd like to see the list of questions, send me a PM and I'll pass it along.

Jess

[jhallum]

Hi Jeremy,

First of all, I'm a little confused by what you wrote: "so we did some microfracture work on the 7 mm medial of the plica". You need to find out more precisely what the surgeon did and make sure it was actually microfracture. He could have just debrided (cut away) some loose flaps of cartilage.

The recovery from the microfracture depends a lot on the location and size. The idea is to not allow any compression force on the area where the microfracture was. If the cartilage defect was on the medial femoral condyle right where it rests on top of the tibia when standing, then you should be nonweightbearing for 6-8 weeks. If the defect was in the groove where the kneecap moves, then you can get by with putting weight on the leg as long as you don't bend the knee and allow the kneecap to press against the spot where the microfracture was. If the damage was just where the plica was rubbing, then 2 weeks on crutches may be long enough because that location may not have a lot of compression forces acting on it.

Passive motion is good after surgery because it allows nutrients to circulate inside the joint. Passively moving your wife's knee through the range of motion several hundred times a day may be just as good as using the CPM machine.

It sounds like your wife is doing well so far. Please let us know how the recovery goes.

John

So we finally got to see the medical report on  Thursday AM, thanks to our PT.

There was a loss of cartilage about 7mm  by 1-2mm (PA) on the right medial femoral condyle.  There was only about 30% of cartilage left in the area, so he debrided as you said, as well as he did what was termed a partial microfracture of the area. 

The surgical report didn't say where on the condyle it was, so I don't know if it is weight bearing or not.  She is definitely feeling more pain post PT.  We are doing the range of motion exercises as well as 5 min on a recumbent bike. 

Thanks for the advice, it's really helpful!

[John1]

Hi,

I don't think it could be 1-2mm wide. That is too small. Maybe 1-2 cm wide. If that were the case then it would be cartilage missing in an area 7mm by 1-2cm. The (PA) I'm guessing means posterior-anterior The missing cartilage is aligned from front to back.

30% of the cartilage left. I guess this means that 70% of the thickness in the damaged area was missing. It sounds similar to the was my defect looked. Mine wasn't rubbed down all the way to make a smooth bone surface.

I'm not sure what a partial microfracture is. Maybe he only microfractured the area that was the deepest, where the thickness of cartilage was missing the most.

Good luck,
John