TruFit OBI recovery...please help

[DJK]

I have the MRI on Monday.  Things are going just OK at this point.  I am able to walk without pain in a straight line, but if a twist the knee or put weight on the joint from an angle (like trying to get out of the back of a cab), then it is extremely painful.  Feels like I hit a raw nerve.  Strong knees and full hearts....

I feel your pain...same symptom I have when I try to move like that...glad to hear its not just me

[EMANN]

You guys sound like your getting discouraged wiht the OBI plugs.....I hope that isnt the case. i hope they work out well for both of you.....I think its only been a few months for you guys, so maybe it will take abother 3-6 months to really heal.

[shade]

Hey guys,

Maybe my situation is different since I was immobilized for 6 weeks & I'm now about 71/2 months post-op.   Like Emann suggested you just might need more healing time - know you don't want to hear this, but that's probably what's necessary.   Steve - the straight walking sounds like it's going well.  I've just recently been able to walk downhill in a normal manner with the OBI/TTT leg without any pain, so hang in there - it should improve with more time....... Patients!! Patients!! Patients!!  Know it's not easy.   ~shade

[DJK]

Oh without a doubt I need more healing time...just thought I'd let Steve know he's not alone with pain doing those movements...my straight line walking is great...day to day I am better than I was prior to OBI...I am far from discouraged...I used to pop pain meds like tic-tac's...now I am on Motrin and somedays am down to 800-1600mgs rather than the 2400+ I was taking.
I will easily give it another 6months or so before any real judgement is done as far as long term effects go.--DJK

[EMANN]

FYI:  The surgeon I met with the other day seemed very optimistic that these plugs will work well on the patella. 

He has had great success with them elsewhere in the knee but said he has never used them on the patella but feels they will work. 

[knee deep in Goo]

 How long is the rehab on this???  Feels they will work is different than..  this will do it for ya.    Just remember doctors call it a practice.  .. If this doesnt work.. What is your next  option?   Here I am 11 months after they scoped my knee and found all horrible things.

[EMANN]

I had the TruFit OBI procedure to address a chondral defect 8 days ago.  I am a 38 yo male that is(was) reasonably athletic.  This was the second procedure to attempt to address a grade-IV chondral defect on my femoral condyle.  20 months ago, the OS performed a microfracture.  At that time the defect was 2mm across.  I was on crutches PWB for 6 weeks.  The area would continually become sore if I biked too much on it.  I had a series of Synvisc injections and then a series of Orthovisc injections.  For some reason, the microfracture was not successful.  I am wondering whether I put too much weight on the leg too soon or pushed the rehab too hard too fast. 

We decided to address the site of the defect using the OBI plug.  The same defect was now 7mm across.  The OS commented that there was minimal regrowth of new cartilage around the site of the original microfracture.  The OS removed the damaged cartilage and used a TruFit OBI plug to fit the hole.   I am currently on crutches PWB (toe touch) for 6 weeks and my OS wants me to begin rehab on the exercise bike (with no resistance) for 10 minutes on this Monday, which will be 11 days after the procedure.  His thinking is to gradually increase the time and then steadily add resistance over the next 8 weeks.  We will also do a series of 3 Othrovisc injections starting 6 weeks after the procedure (one per week).  I am taking 2000 mg of Cosamin DS daily (2 capsules in the morning and 2 at night).   

I have read in other postings that there is a variety of approaches to recovery from this procedure.  I am hoping that I can get some input on whether it is better to do PWB or NBW on the crutches during the 6 week healing period and whether it is better to start on the exercise bike so soon after the procedure.  Any other tips or advice on raising the probability of a successful recovery would be very much appreciated.

Thanks in advance,

Steve

Steve-- Do you only have a chondral defect or do you have bad cartilage elsewhere in the knee?  Also, was this the only procedure done on your knee besides microfracture or have you had previous work done in the past?

[steve439]

Update....

I had the MRI tonight.  The results are very encouraging according to my OS.  He rated the progress a 10 on a 10 scale.  I was able to see consistent regrowth of the cartilage across the location where the plug was inserted.  OS feels that the area is about 60% of the strength of what it will be in another 12 weeks.  He wants me back on the exercise bike, albeit at a reduced level until I build up some progress (I tend to push it a bit hard).  I know that this is aggressive, but he feels that I could be back to running in another 3 - 4 months.  He said that the pain will decrease over the next few weeks of "loading the joint on an angle." 

EMANN - I only had a 2mm chondral defect initially, which turned into a 7mm OBI plug after a failed microfracture.  I would be hesitant to get a microfracture done, as my OS told me that the success rate on WB areas is lower than generally believed.  The microfracture was the first procedure that I had on the knee. 

[EMANN]

Thanks Steve....Great News about the MRI!!! Hopefully this works and you keep getting stronger & stronger!



Thanks-EMANN

[EMANN]

Was your knee in a brace while you were PWB for the first 6 weeks.

[steve439]

EMANN - No, my knee was not in a brace during the PWB 6 weeks.  Just on crutches.  I tend to quantify everything, so that there is less room for error.  My OS defines PWB as not more than 35 lbs of weight on the leg...just enough for balance. 

[EMANN]

Steve-- When you only had the 2mm defect what was the reasoning for doing the microfracture?  The reason I ask is that I've spoke with a few doctors and they all said a 3mm defect is small and they usuallly dont operate on defects that small.

I know I can be made worse be the procedure, but I dont want the rest of the knee to get worse in the meantime.  I am hopeful these OBI plugs produce excellent results and in 1-2 years more doctors will be able to do them and realize they work then I can have mine done......I'd really like to get back to playing softball and being active sports wise, but at the same time right now I am living pain free and walking pain free day to day and don't want to jeopardize that. The two OS in my area who use OBI havent used them on the patella yet.  Both said they have gotten good results in other areas of the knee with them. One OS feels very confident it will work on the patella but I don't want to be his guinea pig either. 

Thanks for all your help Steve and have a good holiday.

[steve439]

When I had the original 2mm defect, it was located in a heavy WB location of the joint.  Also, it was a full-thickness defect, so it went through to the bone.  When I would put a full load of pressure on the joint (e.g., mountain biking), it would cause a sharp pain. 

For what it is worth, I feel that it is important for you to find an OS that you have high confidence in.  I interviewed several and read my OS's medical articles (only understood 80% of it), but was able to get very comfortable that he was the right person to address the situation. 

Brief update....yet again, I inadvertently pushed it a tad too hard on the exercise bike.  The area got sore and I have taken the last 3 days off to let things settle again.  It is feeling good this morning and I'll start back up today.  New self imposed rule....  Do 5 days on the same resistance level while slightly increasing the cycling duration on the bike BEFORE increasing the resistance to the next level while dropping the duration a bit. 

[steve439]

Update....

I have been steadily working on the "cyclic progression" to build up strength in the joint.  I have 16 resistance levels on the exercise bike that I use.  I started on level 9...did 40 minutes at 75rpm, then 45 min, 50, 55 and 60.  Then I moved to level 10 and go back to 40 min, then 45 min, 50, 55 and 60 and repeat the pattern for each level that you move up.  My OS is a huge proponent of the cyclic progression.  So far things are going well...no pain or soreness the next day.  Today is level 10 for 45min.  Of course, I ice for 20 min upon the completion of the biking.  The joint feels relatively stable, but I still catch myself favoring it a bit.  After I do this for another month and get above level 15, I'll consider taking the bike out again. 

Also, I find a huge positive difference with the Cosamin DS.  I take 1500 mg daily in the morning.

Be well,

Steve

[WithMTN]

I had the TruFit OBI procedure to address a chondral defect 8 days ago.  I am a 38 yo male that is(was) reasonably athletic.  This was the second procedure to attempt to address a grade-IV chondral defect on my femoral condyle.  20 months ago, the OS performed a microfracture.  At that time the defect was 2mm across.  I was on crutches PWB for 6 weeks.  The area would continually become sore if I biked too much on it.  I had a series of Synvisc injections and then a series of Orthovisc injections.  For some reason, the microfracture was not successful.  I am wondering whether I put too much weight on the leg too soon or pushed the rehab too hard too fast. 

We decided to address the site of the defect using the OBI plug.  The same defect was now 7mm across.  The OS commented that there was minimal regrowth of new cartilage around the site of the original microfracture.  The OS removed the damaged cartilage and used a TruFit OBI plug to fit the hole.   I am currently on crutches PWB (toe touch) for 6 weeks and my OS wants me to begin rehab on the exercise bike (with no resistance) for 10 minutes on this Monday, which will be 11 days after the procedure.  His thinking is to gradually increase the time and then steadily add resistance over the next 8 weeks.  We will also do a series of 3 Othrovisc injections starting 6 weeks after the procedure (one per week).  I am taking 2000 mg of Cosamin DS daily (2 capsules in the morning and 2 at night).   

I have read in other postings that there is a variety of approaches to recovery from this procedure.  I am hoping that I can get some input on whether it is better to do PWB or NBW on the crutches during the 6 week healing period and whether it is better to start on the exercise bike so soon after the procedure.  Any other tips or advice on raising the probability of a successful recovery would be very much appreciated.

Thanks in advance,

Steve

Steve---why TruFit as opposed to ACI?