Microfracture concerns

[mhsflute07]

Hi all,

I am currently 3 months post-op from microfracture to the back of my patella. I'm concerned because I still haven't seen any improvement. In fact, the pain is actually worse now than it was pre-op. I did have less grinding for a while post-op, but now the grinding is getting worse again. Is this normal? My OS told me that my knee should be feeling noticeably better by 4-6 months post-op, but so far it's just getting worse. I am still going to physical therapy twice a week. I feel that my quads are getting stronger, but my knee is just not getting any better. My therapist seems to be perplexed and feels that I should at least being seeing some, even if slight, improvement.

How do I know if the microfracture has failed? What are my options if my microfracture does, indeed, fail?

~Erin~

[Jo-knee]

Erin,

I don't know anything about microfracture on the patella; mine were on the med femroal condlye.  I can say the pain was awful the first 3-4 months, then gradually lessened.  At 6 months, I would even have days with no pain.  Still, though I do have pain, and my knee definitely lets me know if I've overdone it.  I'm not sure really how you could tell if it failed at the 3 month point; I know I had a considerable amount of pain until the end of 4 months.
Good luck!

Joanie

[knee deep in Goo]

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=23594.0

This is what I experienced.

[Natalie.D]

Erin,

I'm in pretty much the same situation as yourself.  I am also 3 months out from microfracture to the LFC and the back of the patella.  I am having major problems with patella pain, like you, I had some decreased grinding for the first few weeks but then I had a car crash and hit both patellas off the dashboard, since then I have the crunching and grinding back along with major patella pain when I try to do ANYTHING, I've also developed a click to the right side of the patella (no idea what that is!), the LFC is also giving me some pain but not as much as the patella.  I see my OS again on Thursday but the last appointment I had he said that there wasn't much that could be done to the patella since it was such a large area (grade IV on the majority of the patella), and since I'm in the UK I am limited to what my insurance will cover (ACI and the like are still classed as "experimental" over here  )  I imagine that since you're in the States you may have more options available to you.

My PT has discharged me because I can't do anything other than SLR and has referred me to try some hydrotherapy to see if that helps.

I'll let you know what my OS says on Thursday.

Natalie.

[mhsflute07]

Thanks everyone!

Natalie--sorry you haven't gotten any pain relief either. I hope your OS has some options for you. I would definitely be interested in what he has to say. I'm still going to PT, but everything except SLRs hurt. I tend to just push through it the best I can. I don't know if that's the right thing to do, but I figure I might as well try to get my quads as strong as possible. Last Friday my PT said we will test my strength sometime soon and he's sure that my quads are stronger...the only problem is, the pain and grinding are no better, if not worse. I see my OS in 3 weeks.

Good luck on Thursday! Let me know what he has to say.

~Erin~

[Natalie.D]

Erin,

I asked my PT about pushing through the pain because, like you, I thought I have to if I'm going to get anywhere with this but she said that pushing through very minor pain is okay but if its really painful then its not a good idea because its the body's way of telling you to stop, she also said that once you're in a lot of pain your muscles shut down anyway and won't work properly so you won't be able to improve them much if they're in that state - I don't know if she's right or not but I figures she should know more about these things than I do so I've taken her advice and not pushed through the pain when its really bad.  I hope your rehab goes better than mine and you do start to see some results soon.  Good luck with your OS appointment, hope he has good news for you.

Natalie.

[crumblingknee]

Hi Erin,

I am very sorry to hear of your troubles with your microfracture. I just had a "microfx" myself on my trochlea & reading your posting made my hair stand up on end. I did some research in a library at a local medical school on knee procedures prior to opting for a microfx procedure & saw that the procedure has according to most studies, a 92 % success rate, meaning 8 % of us end up in knee never never land, unsure if we should just give up & settle for being disabled or end the agony demand a knee replacement (reputedly very painful to have done with at least 6 months of rehabilitation).

Here are some thoughts:
1) go to a local medical school (if you are mobile) & read up on anything you can find that is written in laymen's language,
2) make sure you are seeing the best possible specialist in your locale; don't rely on a therapist to make medical decisions;
3) look into a procedure called Carticel (I think it is also known as autologuous chondrocyte implantation or something like that). basically a surgeon can either implant cartilage from a cadaver or harvest some cartilage from your knee, grow it in a lab, and then implant it to fill your holes. I do not know if you can use that after a microfx goes bad. Be sure such a procedure is done by an EXPERT. You will definitely want to research success & failure rates here so you are comfortable with the risks, because they exist.

Anyhow, I hope that helps. Please email me back if you have questions.
Best wishes,
Neil.

Hi all,

I am currently 3 months post-op from microfracture to the back of my patella. I'm concerned because I still haven't seen any improvement. In fact, the pain is actually worse now than it was pre-op. I did have less grinding for a while post-op, but now the grinding is getting worse again. Is this normal? My OS told me that my knee should be feeling noticeably better by 4-6 months post-op, but so far it's just getting worse. I am still going to physical therapy twice a week. I feel that my quads are getting stronger, but my knee is just not getting any better. My therapist seems to be perplexed and feels that I should at least being seeing some, even if slight, improvement.

How do I know if the microfracture has failed? What are my options if my microfracture does, indeed, fail?

~Erin~

[Natalie.D]

Hi Erin,

Just got back from seeing the OS, he wasn't too happy with things so is referring me to another OS who does mosaicplasty & OATS etc, he thinks I would have a good chance of a successful outcome from the mosaicplasty as the cartilage surrounding the defect is in fairly good shape and the defect is small (11mm), so I've got to wait for an appointment with this new surgeon and see whether they think I should have the mosaicplasty done or not.  I asked him if there was ANYTHING that could be done with the patella, he said that if I have the mosaicplasty done then the OS will debride the kneecap at the same time, other than that the only other option was for a PKR which I really DO NOT want to do just yet in case it all goes wrong, so in the meantime I'm to keep on with the hydrotherapy and physio.  Will let you know how my consultation with new OS goes.

How's your pt going?  Any change in your pain levels?

Natalie.

[shade]

Natalie,

Sorry that the microfracture didn't seem to cure the situation with your knee.  Hopefully the new OS will be able to give you options that will relieve the pressure on your knee.

Good luck and let us know how everything goes.  Take care.  ~shade

[Natalie.D]

Thanks Shade,  I think the microfracture would have had more of a chance to work if I hadn't had the car crash, however, these things happen (oddly enough always to me  ), but I've not given up yet, hopefully the mosaicplasty will be an option and one that can solve at least some of my problems.

Natalie.

[shade]

Natalie,

I've read up on this mosaiplasty procedure and it sounds really interesting.  Hopefully this will be the answer.  It's so unfortunate that the car accident happened, but that's the way things go.  RATS!!

http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/mo76_mosaicplasty/index.shtml

~Erin~, hopefully you'll be given some of these options like Natalie.  Think the OATs would be the next step and there is lots of info about that procedure. 

It's a shame that you've both had such bad results after your microfracture procedures & have to start again to find some pain relief.

Let us know how everything goes.  ~shade

[mhsflute07]

Hi Natalie,

Thanks for letting me know what your OS said. I'm sorry he didn't have better news for you. Hopefully the new OS will be able to do the mosaicplasty and maybe even be able to do something with the patella. PT is about the same. After PT yesterday, my pain is a little worse today. In fact, yesterday when I got to PT, my therapist goes "I'm not even going to ask about your knee today because I know what you're going to say" lol...at least we're on the same page. Please do let me know what the new OS has to say.

Hi Shade,

Thanks for psting. I'll have to read up on OATS. I wonder if I could get away with reading about OATS instead of doing my chemistry homework? lol

I'm glad you're doing so well after your TTT/OBI procedure. I hope your left leg feels better soon!

Hi Neil,

Thanks for the great information/suggestions. I'll have to look into to the Carticel stuff too. Thanks again!

By the way...don't base your potential outcome on mine. I'm pretty sure it's not the norm. Best of luck for your recovery!

~Erin~

[crumblingknee]

Hi Erin, You are very welcome. I am sorry you are having such problems.

I am getting worried on my end that my "good" knee (which did not have the operation) has been injured while doing "double duty" to fill in for the bad (operated on) leg. My achilles tendon on the good leg has been irritated badly by my compromised gait caused by my bad knee (this started a month before I got operated on). Do you or other list members have any suggestions on how to protect the good leg while rehabilitating the bad knee?
Best wishes,
Neil.


Hi Neil,

Thanks for the great information/suggestions. I'll have to look into to the Carticel stuff too. Thanks again!

By the way...don't base your potential outcome on mine. I'm pretty sure it's not the norm. Best of luck for your recovery!

~Erin~

[Kris]

I'm struggling after microfracture surgery as well.  I can't actually tell you where I had the microfracture surgery.  I never really asked where he drilled the holes.  I'm coming up on 4 months right now and I'm at the point where I'm using my hands on the floor to help me climb stairs or not wanting to move at all when I get done with my job.  At my last appointment he told me to walk at a brisk pace, use the elliptical, and SLR nonstop.  I don't think he realizes that I can barely with either of my legs.  It's now starting to affect my sleep.  If I turn in my sleep and hit the kneecaps I'm waking up in pain.  I see him tomorrow.  I'll try to express my problems, but he's really hard to get the point across.  I may have to put it in football terms so that he can relate. 
 
Kris

[reggieandabears]

   I have had microfracture, on the right femoral condyl.
   It was in the middle of April so I am 5 months out.
   I was getting frustrated as well, wondering if it had failed because it didn't seem to get any better. I quit PTabout two weeks ago because the therapist and I agreed that there was no more for them to do. I still can't do stairs without pain, no squating or weight bearing lunges at all. Walking in the house is all I am able to do. My poor dogs haven't had a decent stroll for nearly a year.Ani I have been out of work that long as well.
   I regained most of my ROM and can walk with a limp. The limp and the pain get progressively worse the more I am on the leg, any more than 10 min or so at a time. The OS doesn't seem worried at the progress, or lack therof.
   I did have some issues with the "good" leg being compromised by the surgery, I was on crutches, NWB for 12 weeks, and the opposite knee, which had never given me problems, swelled up and low an behold I have arthritis in it. The only way it resolved was to get off the crutches. I did the PT for both legs when I was able to pitch the sticks. Slowly(you can say glaciers moved faster) it got better and now only whimpers when I am on it to long. The original injury...sigh...