week post microfacture bit confused

[charliecoops]

Hi,

I think I had a microfature (sorry about spelling) a week ago on my femural chrondral? I went into surgury for a simple arthscopy on a little knee pain, expecting a little cartillage trim on the medial meniscus and came out of surgury with a drain and OS telling me I had this prosedure done that I know nothing about (microfacture?). I went to have this surgury because my physio was concerned my rehab was not going well - I had a ACL reconstruction and Meniscus repair almost a year  ago.

I am posting on hear because I am confused - I dont really know what I had done because I have left hospital with no notes - can't get hold of OS or his secretary and the club doctor who will have notes sent to him is away for 2 weeks! Is it normal to leave hospital not really knowing what is going on?? I am only 24 and did my acl when I just turned 23. I played pro rugby but lost my contract because of injury - I still see physios for rehab but this latest surgury has me really confused - will I be able to play again - or will I not even be able to play active sports. From my research it seems this proceedure could mean my activity levels are limited from now on.

Please help - I dont know what rehab I should be doing, when I left the hospital the Hospital physio was pleasant but seemed really vague on my exercises - i dont even have crutches? The rehab seemed to be standard arthscopy rehab nothing specific.

[blackbeltgirl]

Charlie-

Welcome to the club, sorry you needed to join us.

LOTS of people here went in for one procedure, and woke up with microfracture.  That part is not unusual.  Mainly because it is easy to see overall degeneration of cartilage on x-rays, but focal lesions (potholes, basically) are not really visible on MRI or x-rays.  Especially if you're not specifically looking for them.

That said, you should have received some post-op instructions.  Have you been instructed to use crutches for any amount of time?  One (highly published) physician recommends 6 weeks non-weight bearing.  Many other doctors make different decisions, based on individual cases and experience.  If you haven't had any instructions, use the crutches until you are told differently.  Many people are also given some basic exercises to do at home before they start formal pt.  You can do straight leg raises (SLRs) what's called 4 ways.  If you've been in physio for a while, you probably know what I'm talking about. 

The one thing that drove me nuts, is that I expected to be mostly recovered 6 weeks after my surgery.  That was before my surgery.  Microfracture is more like 6 months.  Don't get me wrong - it gets better.  But for the first few months I was really upset, because I didn't understand the procedure, the recovery process, etc.  I hurt more post-op than I did pre-op, and I was frustrated that my OS made me worse instead of better.  I'm almost 7 months post-op now, and I'm definitely better.  I'm nowhere near good as new, but I'm an extreme case, and no one expected me to be good as new from this.  Lots of pro athletes undergo microfracture.

The web page should give you a basic description of the procedure, so you understand what your body is going through.  Feel free to ask questions - you will find people here at a variety of stages post-op, including 1-2 years post-op.  Be patient with the knee, and be persistent in getting a return call from the OS.  It is irresponsible of the surgeon to send you home without instructtions to properly care for yourself to ensure the success of the procedure.

Jess

[shadehawk]

Charlie,

Hi, maybe this site might help you with this procedure also:
http://www.steadman-hawkins.com/knee_microfracture/overview.asp

If you read all through this document there is a rehabilitation protocol also.

Good luck to you,

Shade

[charliecoops]

Thanks Guys,

My surgeon actually rang me after my post. Apparently my defect is at a point on my knee that isnt weight bearing when walking - I must have fallen on it when knee was in flexion therefore no crutches are needed for walking. The OS did speak to me post op and day after but must have still been effected by anesthetc because my memory stinks. Apparently I have a long and boring rehab programme now for the next 6 months and I wont likely be able to play for  year. That will be two years out of the game but at least it is likely that I can play sport again - it will probably have to be on a recreational level. By the way how long till I can get the stiches out?

[blackbeltgirl]

Many surgeons in the US use dissolving stitches.  Otherwise the standard is 10 days on the stitches.

Welcome to the club.  I was weight bearing immediately, as tolerated, despite the size and location of my lesions.  Some of it is the surgeon's preference.  A lot of professional athletes in the US have this procedure done, and return to pro sports.  Of course, that may be more true of baseball players than football (american), where the risk of the knee going nuts is complicated by people jumping on top of you.  Rugby probably carries the equal or higher risks.

Good luck with your recovery, and again, don't be afraid to ask questions.  The first few months can be pretty frustrating, and it helps to know that "it's supposed to be that way".

Jess

[John1]

Hi,

Welcome to the microfracture world.  It won't be too bad. The time goes by faster than you think.

Microfracture causes a blood clot to form where your cartilage is missing. The blood clot contains stem cells from the bone marrow. These stem cells can differentiate into chondrocytes (cartilage cells that produce the collagen in the cartilage). Unfortunately, in practice you end up with a mixture of good cartilage and fibrous tissue. For some people this is durable and provides pain relief for a long time. In others in deteriorates after a few years. It's debatable what factors effect this. Ligament or meniscus injury, age, knee alignment and location of defect are some of the factors.

The general idea with rehab is to prevent shear stress and compression to the microfracture site where the cartilage is forming while trying to get strength and flexibility back. Motion is also good for the knee. Intensity levels should be increased very gradually, like over 6 months, before a return to regular sports activities. I am still only using the stationary bike at resistance level 1 or 2 (out of 20) at 10 weeks post-op, but I ride for 1-2 hours per day. The motion is more important at this point than getting my strength back.

It sounds like maybe because of the size or location of your cartilage defect that your recovery could be quicker than others, 4 months rather than 6-12 months. But you really just need to wait and see what your body tells you, rather than setting a time line for yourself.

In addition to the link that Shade posted, you should also check out the video by Dr. Steadman that someone posted the link to in this forum:

Dr. Steadman on Microfracture procedure and rehab-- the video
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=14652.0

Dr. Steadman was the surgeon that started doing microfracture and seems to be the only one that gives a detailed rehab protocol. It seems like all the published results about microfracture that I've come across were either written by Dr. Steadman or by someone that used Dr. Steadman's rehab protocol. So when I hear that doctors use a different protocol, I don't know what they base it on. I mean before they had much experience doing microfracture, they must have based their rehab protocol on something they read or heard.

It's true that some professional athletes have had microfracture. Most notably, Jason Kidd on July 1, 2004. He returned after 6 months to play in the NBA last season. He could be damaging it again by playing at this level. The point is, he must have had significant pain to have had microfracture done in the first place and he was able to return, so there is hope for us regular folks.

Good luck and ask any questions you have. I'm interested in how your recovery comes along, so please keep us updated.

Thanks,
John 

[charliecoops]

Thanks John,

Have spoken to physios and OS again. Start cycling, 20 mins no resistance today and have got my rehab sessions up a bit  (v. similar to what Steadman suggests. Don't have a brace like Steadman suggests for Patella Femural defects though just told to keep flexion below 20 degrees when walking? Also I have not been given any patella manual stimulation like Steadman suggests - does anyone know about this? I think I have to think seriously if I want to play Rugby at at pro. level when I get back as have already been out of game for 9 mnths with ACL!

[Jakem]

Jason Kidd's microfracture was on a non-weightbearing spot so his chance for success was far greater than the typical knee geek.

[casey2291]

Hey,

Sorry to hear that you had to have microfracture!!!  I am three months post-op for microfracture to the weight bearing portion of the knee.  I am slowly starting to add some low impact activities back into my life such as biking, hiking and rock climbing.   I am able to bike and rock climb pain free however I do pay for it for several days afterwards.  So, there is some hope to returning to some level of sports.   I too have had to think seriously about what sports I want to attempt to return to and which ones are no longer worth it.  And John is right, the time will go by much quicker than you expect.  However, I am learning that the recovery for this surgery is very long and it does require a LOT of patience!!  Hang in there and keep us updated on how you are doing!

Casey 

[John1]

Jason Kidd's microfracture was on a non-weightbearing spot so his chance for success was far greater than the typical knee geek.

Hi Jakem,

How did you find where the location of his cartilage defect was? And where was the location of the defect in his knee and how big was it? It may be a non-weightbearing location when standing, but it seems like every area of cartilage in the knee has compression forces at some degree of flexion.

Also, you say that because of the location "his chance for success was far greater than the typical knee geek." What is this based on? It seems logical, but it also seems logical that someone with a non-weightbearing defect in a lot of pain might have less success than someone with a weightbearing defect but not much pain.

I hope I'm not being to argumentative. I'm just trying to learn more about microfracture.

Thanks,
John

[John1]

Hi Charlie,

Dr. Steadman treats a lot of patients with bad arthrofibrosis (scar tissue filling the joint), so I guess he is big on trying to prevent scar tissue from forming. That's why he suggests the patella mobilization. It seemed like I would hurt my patella tendon by trying to move it around like in the video. This is something that your physical therapist can do. They usually check to see if you patella moves around enough.

John

[charliecoops]

Have just been given some patella mobilixzation today - aparently it is more necessary for patients with bad scar tissue but still important non the less. I know the rehab will go quicker than I think its just I have already been out for 9 moonths with ACL recon. !!!!!!!

Charlie

[Jakem]

Hi John,

No problem with the question at all.  I found out about Jason Kidd by doing a search on him.  I was desperately trying to find a success story on anyone returning to sport after micro.  I ended up reading about 30 articles on him and his recovery.  It was buried in one of the articles that it was a non weightbearning spot.  I was very disappointed when I discovered it was non-weightbearing.  There were no details on size and exactly where it was.  I also did similar searches on about 6 other NBA players.  Kidd was the only success.  Four had the surgery tried to make it back and couldn't and were released by their teams.  One guy is still playing, but in a lot of pain and has missed large parts of 2-3 seasons.  I forget his name but he is a big guy and a near star in the NBA who was once one of the 5 famous freshmen at michigan.  Several NFL guys had microfractures too.   Basically they were all failures in my opinion.  Dan Marino had several and he was always hobbling.  Joe Montana had one but he was already retired.  Terrell Davis was a failure.  Bruce Smith had one came back and had 1 good year then it wore out and he retired.

The official success rate of microfracture is 70%.  The true success rate is really about 15%.  And those lucky 15% can't really play sports, but they can walk around with just minor discomfort.  The marathon runner with the famous microfracture website is an extreme exception.

[blackbeltgirl]

Jakem -

A lot of literature refers to the lateral femoral condoyle as a non-weight bearing portion of the knee.  Not actually true.  It is true that the medial side of the knee bears more weight while walking and running.  But basketball, soccer, volleyball, tennis, (and tae kwon do) all involve lots of sharp pivoting movements.  Each of these transfers the weight to the lateral side of the knee - the "nwb side".  While it's possible that Jason Kidd's surgery was on a true non-weight bearing area (and by that, I mean an area they may actually take cartilage from for an OATS procedure) it is more likely it was on the LFC.

Either way, the success also depends a lot on the size and location of the lesion, and the activities you actually want to pursue.

Jess

[casey2291]

Jakem...Did you have microfracture?  If so, could you please post how far post-op you are and how you are doing? 

Charlie...hang in there.  I was pretty much out from doing anything active for a whole year b/f I had my operation, so I can understand your frustration.  It really will go quicker than you think.  It is hard for me to believe that I am already three months post-op.  Keep plugging away!!

Casey