Walking after microfracture

[over it]

This is my 2nd microfracture procedure and was cleared a week ago to bear weight on it after 6 weeks of NWB; start walking.  I have so much pain when walking.  And the funny thing is... everytime I am off my leg, like sitting down, and get back up to walk... my leg feels like the very first time I have walked on it in the last 6 weeks.  I keep thinking it's going to get better but each day is the same still.  I am going to PT and doing multiple exercises at home.  Also swimming.  I tell myself to be patient.  Give it time.  But I don't remember having this much pain or weakness last time I had this done.  Also, my knee is still very swollen.  I had 3 arthocentesis after my surgery.  Could this impact the results of my microfracture?  Has anyone else had this happen to them?  I am worried because I have to return to work on 8/11 and I am on my feet all day.  I'm not paniced yet.  Thanks for the help.

[celinenj03]

I can only guess that you are still fresh from the surgery even at 6 weeks out which is very early. Some doctors have 12 weeks non weight bearing as protocol. It depends on the size of the lesion and the location too. I didn't have microfracture (though it has been proposed for me), but I did have debridement of a lesion and I can tell you even with that it hurt for a long time weight bearing, I can describe it as very raw feeling inside. But this definitely subsided over time. I'd say it was a good 5 months before I could weight bear without twinges of pain. But just when you think it won't go away it does. I think it just takes TIME, more than we are willing to give, but we have no choice. Are you wearing an unloader brace? You have lost a lot of meniscus too, which I imagine puts more stress directly on your op site. I have to only guess that you should take it really slow and give that cartilage a chance to heal!

Don't panic yet, but Aug. 11th is right around the corner. Can you get your work duties modified for a bit or is that impossible? I think the slower you take it, the better you will be in the long run.

I agree with your frustration. I am young and previously very athletic at 41. I can't hardly believe the procedures that get proposed to us. It seems like it just drags out the whole thing. I wish it could just be fixed for good.

Lastly, please let your OS know that you are in so much pain while weight bearing. He may have you non weight bear again for a little while. As a veteran of 3 surgeries and a traumatic injury I can tell you that it's always best to listen to your knee. I find you really can't ignore it.

[over it]

Thanks for the feedback celinenj03. It's hard not to compare this surgery with my last microfracture, which was alot easier.  Then again, this was a larger area and 2 of them.  I know that there is a limitation as to the size of the defect that a microfracture can be performed on... do you know the dimensions are?  I thought it was 2cm x 2cm... but not sure.  Is osteoarthritis genetic?  I didn't think so.  Thanks again.

CB

[celinenj03]

It depends, some surgeons will do microfracture on a larger lesion. I believe 2cm x 2cm is generally the norm, but a lot depends on that, such as location, weight bearing or not, even the weight of the patient.

Anyhow, I thought I read that you also had a partial meniscectomy of the posterior horn? I can't remember, but if this is the case I can tell you I had that and it takes a while to recover just from that. I couldn't do a straight leg raise either for a long time and also had lots of swelling and had to have my knee drained from fluid. You had more done than just a straight up microfracture I thought and if that's the case you can expect a longer recovery.

I am probably going to have microfracture soon, I just dread the thought of crutches and non weight bearing for so long. That is absolute torture for me.

Hope you continue to improve and I'll check back on your progress. Take it EASY and SLOW for best results!

[over it]

Thanks again for the support.  I did have partial meniscectomy of the posterior horn and a medial body repair with 3 sutures.  This was actually my 8th scope; 4 each knee.  I am or was very active.  Running 2 miles 5 days a week; playing basketball, volleyball, softball, downhill skiing and backpacking.  All gone now!!  I ride my bike on the flat and swim.  Boring to me but at least it's something.  I live in Colorado and love outdoor sports.  I hope you do well with your microfracture.  Keep up the chin.  I had some equipment from my mom like her platform walker with wheels which helped in the kitchen for wheeling around with food.  I also had shower bench.  It is very frustrating depending on others while on crutches at least for me it was.  I am very independent.  I have older children which helped.  I had 16 steps to manuever several times a day. 

Keep me posted on how you are doing.

CB

[celinenj03]

I will keep you posted, thanks. Your recovery sounds totally on point considering what you had done. I had meniscectomy and ACL recon. and the meniscectomy for me was more painful. I also had more swelling with that. I'll follow your recovery as well. I am aiming to have my surgery and "crutch time" right after the kids are back in school in September. I like your advice about getting around. I just hope it goes by fast! Thanks for the encouragement.

[over it]

Hey Celinenj03,

It's been a little over 2 weeks now since I started walking again.  My strength in my quad has dramatically improved, but the pain is about the same as it was before the surgery.  I am still optimistic that the pain will improve also.  It's fairly early in the game.  How are you doing?  Have you made a decision about your surgery?  Just wanted to update you.  Take care.

CB

[celinenj03]

Thanks! I think your pain will decrease too. Just take it slow for best results. My current OS's protocol is very conservative and he has great microfracture results he says because of it. He demands 8 weeks non weight bearing and another 4 weeks of gentle weight bearing after that. So you figure, 12 weeks of really babying the leg.

I am still really struggling with this. The problem I think is my original OS, the one who did my ACL recon discovered my articular cartilage damage during a cleanout procedure. He just debrided it and when I woke up from the surgery you could tell that he was devasted that I had this type of damage.

I feel like he really downplayed it to me. When I went back to get my stitches out he said I was doing great, etc. and over the next several months encouraged me to do more in PT and "get back out there". I was really confused because my knee was not allowing me to "get back out there".

As the months went by, the initial surgery pain (probably what you still feel) did fade away but I still had the bone on bone pain in the area of the damage so I had to avoid certain movements. Luckily my lesion is only in contact with my tibia when I am standing in hyperextension, so naturally I avoid that...

Within 3 months my OS discharged me as being all better now... He never addressed the lesion or what to do to improve it and get me back to sports or close to normal, etc.

I called him several times about pain and limited function, and he made me feel like I was holding myself back, but in reality it was the knee damage. I started to see several cartilage specialists, but when I bring my records, they say they are very vague... From what they can tell only by looking at the scope pictures  (my original OS never told me), the lesion on my LFC is about 2.5 or 3 cm's long and about 1.5 cm's wide with only part of it touching the tibia (when I stand up straight). My OS had it recorded as a grade 3, but the specialists I saw (3 of them) told me it is definitely grade 4.

The OS I am seeing now thinks Microfracture is possible, but of course he will biopsy if he goes in there and finds it is out of his comfort zone (he has a lot of experience with larger lesions).

I just hate the thought that I have to get another procedure and I don't even know what they will find because my original OS didn't document accurately. If he would have put the exact size of the lesion and the exact grade of the damage, I could just go right to ACI or OATS or whatever. But because he didn't document it and he is so vague over the phone as to the damage (he downplays it), I have to subject myself to a "we'll see what we find scope".

So... that is where I am with all of this.

As for you, remember to really take it slow, don't rush back to work if you can help it and if you do get modified work. Take it easy, you have already invested a lot in this and if you take it slow you have a great chance.

I'll keep you posted as I get closer to surgery and of course, thereafter.

[celinenj03]

Hey, how are you doing? I'm 5 weeks out and still SORE from MF. Doing a little rehab and have 3 more weeks NWB. How's it going for you?

[over it]

I am doing great!  I am back to work full time without restrictions.  I can't run, but that would be expecting a miracle. Walking without too much pain.  I am very happy with my results.  Hope you are doing well.  Let me know.