4 months post microfracture...has it failed?

[jt10]

Hello,

I am just over 4 months post op from microfracture to a load bearing area of the med. femoral condyle. I have been having a hard time lately with pain, swelling and a snapping/clunking when I bend my knee. My OS isn’t very helpful so I thought I’d put my questions out to the mfx community here.

I know it hasn’t been all that long since my surgery but I don’t seem to be able to move forward in my rehab because of this pain and swelling. The physio says that by now I should be able to walk up and down stairs and do the balance board with my knee bent, but when my knee is loaded and I try to bend it I get a very sharp hot pain in the area that was mfx’d. The knee also aches at rest and feels heavy, and I often have night pain that keeps me awake so I am not getting the rest I need. Does this sound familiar to anyone?

I am wondering at what stage a mfx is determined to be a failure and what criteria are used….scope, MRI ? Is it possible to determine at this stage if it has worked or not, or is it too early? I know I have to be patient but this pain is really wearing me down. I have followed the post op rehab protocol to a T so I am feeling really disappointed with how things are going.

I had put so much hope in this surgery. I am trying to remain positive but it’s hard at times. I’d appreciate any advice, support or ideas that anyone has.

Thanks

[Stevie7]

Hi,

Sorry to hear that youre struggling. If its any consolation, Im 3 months post op microfracture to lateral femoral condyle and have the same painful symptoms as yourself. I feel as if Ive got constant toothache in  my knee as well as all of your symptoms. When my knee locks and releases with an audible clunk its very painful and if Im standing on it - Im going down!!

Ive encountered a very dismissive attitude from my surgeon. Hes got his money - who cares? Ive been at physio since the op doing exactly as they tell me but am not moving forward, still need to use crutches intermittently to move around, its just too sore to walk on at times. Stairs are one at a time. Whether Im walking or sitting the knee justs throbs away around the area that the work was done. If I put my foot down in the wrong place Im in orbit.

Im very doubtful now about the success of the op and would only like to know what the future holds. Maybe its too early to tell?? I hope I havent disheartened you but just wanted you to know that youre not on your own with this one.

Please keep me posted with your progress.

Anybody else got any info or advice???

[jt10]

Hi Stevie7,

Thanks for your reply and no, you haven't disheartened me. While I wouldn't wish this on anyone it's good to know I'm not going through it alone. Sometimes it can feel very lonely....

BTW, your description of the pain as a toothache is spot on. I was struggling to find a good way to describe it but couldn't think of the right word. Thanks!!

Good luck...keep me posted and I will do the same!

[caroline889]

Hi JT

I'm 7 wks post op microfracture both knees and still have the same pain under the knee cap which I had before the op. When are you due to see your OS again? From what I've read on here, recovery times can vary with some people taking up to a year before the pain goes away so there is still a chance that yours will work. Good luck

[madel23]

I'm 3.5 months out from mfx and still feeling pain.  Although mine was to the trochlear groove, so I didn't have a non-weight bearing phase.  I'm hoping I'm just a slow healer as opposed to a non-healer, but starting to get worried...hang in there everyone!

[ghost]

Hi,
I'm 6 months post op for a mfx of the trochlear groove.  I still can't walk long distances, it aches if I leave the knee bent for too long and I can sort of go up stairs, but not down.  My os told me that the mfx failed and there are still areas with no cartilage fill.  So on 7/21 I'm off for the 4th surgery in 19 months and will be doing a patellofemoral resurfacing.  I concede, give me shiny new parts and let me get on with my life.

Hope everyone starts to see some improvement.  The one thing we all know is that this surgery is as much of a mental challenge as a physical one with random pains and aches that come out of no where and for no reason.  FYI, I'm with you, if I put my foot down the wrong way it's a one way ticket to mars.

Ghost

[caroline889]

Good luck Ghost with your surgery - hope it works out for you this time. I feel sorry for you.  Hope everyone else's microfractures are successful! At least with other  procedures you more or less know if it has worked or not. I find this microfracture business torture! Just waiting and waiting. I had  2 knees done. My left has very little pain  but my right is very painful. I'm only 7 wks  yet but can't help thinking my right has failed. Waking up every morning and asking yourself  how is it today  it does your head in!

Keep us posted

Caroline

[ghost]

Hi,

I'll keep everyone posted on how it goes.  I completely understand that feeling of did it work.  Microfracture is a mental roller coaster.  Even now at 6 months out I keep hoping there will be some improvement so every day I try to do something that I wasn't able to do 2 days ago.  Sometimes it works but most of the time it doesn't.  I guess that's just my way of dealing with another surgery, just holding out hope that I'll get up one morning and things will have magically improved.  I have to admit that I have seen steady improvement, the problem is that there is one area where no cartilage grew so if I don't baby that area I can go from 0-10 on the pain scale in a heartbeat.

Good Luck!  I hope you start to see some improvements.

Sue

[jt10]

Hi everyone and thanks for sharing your stories and words of encouragement.

Describing mfx as a mental roller coaster was perfect! It's hard to stay positive sometimes when things are so unpredictable....but I'm trying! I'm not seeing the OS again until 22 June so I will just have to keep working hard at rehab until then.

Ghost - at what stage did the OS tell you that the mfx had failed? Did he do an MRI or was it based on your symptoms?

Caroline889 - I cannot even imagine having this done to both knees. You are extremely brave...and strong!

Finding this forum has been a lifesaver. I feel much better now that I have read other people's stories. This recovery process has been difficult so far and there are very few people I feel I can talk to. Friends keep asking me when I'll be up and running again and don't understand my limitations and this whole process has put a great deal of strain on my relationship. My husband thinks I should be able to do all the activities that I used to do by now and it has affected us quite a lot.

I now feel reassured that I am not alone and that my recovery process is not abnormal. I will just try to be patient and take each day as it comes.

thanks and good luck to all of you!

[ghost]

Hi,

I was told about the failure when I went back for my 5 month post op visit on May 11th.  Although I admit that I had a pretty good idea before the appt that things weren't progressing as they should.  I had/have a wonderful PT person who had pretty much sat me down at about the 4 month mark and told me that I should be able to do stairs and squats etc with relative ease.  I obviously couldn't do those things and a couple of weeks before my OS appt he told me he was pretty sure that I would need a partial knee replacement.  As for the os, he asked about what I could and couldn't do and then just moved my leg while pushing down on the patella and you could hear, feel and see the patella taking a nosedive into the area where there was no cartilage fill and he immediately said we need to do another surgery asap before more arthitis and scarring develops.  He recommended either OATS or PFR.  I talked to him about both options and decided after 3 surgeries in 12 months and a failed MFX I was done trying to make the body produce new cartilage, when I combined that with the fact that OATS, if it worked would probably only buy me another 5 years I decided to opt for PRF as it is a more long term solution and should last at least 8 years and possibly for 10 or more years.

I hope that you continue to see some improvement.  It is a slow process with random pains coming out of no where.  You can do something as simple as getting tangled in the blankets at night or catch your foot on the edge of a stair and it sends you into orbit.  That bone stays sore for a long time.  Mine is still getting better, but there are times where I could cheerfully perform my own patellaectomy.

Keep Me posted on how you're doing.

Sue

[jt10]

Hi all,

Well, I haven't had much improvement lately but I'm seeing the OS on Monday which will be my 5 month post op appointment. I hope he can offer some reassurance and/or reasons why I seem to be stuck where I am.

I was just wondering if anyone has advice about questions I should ask the doctor on Monday. I'm trying to get prepared and make a list. The appointments tend to be short and I often feel rushed so it helps if I'm well prepared with questions.

Have a great weekend everybody!

Janet

[ski-bum]

Janet-
How was your appt. with your OS today?  Hopefully good news!!!!!   Is your OS a cartilage specialist? 

What kind of rehab have you been doing lately?  Aggressive of gentle?

I'm about 3 months now and still struggling...

Marc

[jt10]

Hi Marc,

Thanks for checking in. I'm afraid my appointment didn't go too well. The doc said that it is "quite likely" that the mfx has failed given my symptoms and inability to move forward with things like stairs etc.

He said to give it another month, be patient and keep working hard at physio ( we've all heard this haven't we). If I am still having the same problems in one month then he said that would indicate failure of the mfx. 

I am feeling a bit low after getting this news.

Interestingly my doctor just came back from a cartilage repair convention in Miami and he said that every doctor who was there believes strongly in their chosen technique ( MFX, OATS, ACI etc) and there is no clinical evidence that one technique is better than the others. Judging from the messages on this board it seems like there are a lot of people with failed mfx's out there so I don't know what to believe!

I have been following your post and I know you are struggling. I'm so sorry that things are not going well for you and I hope I haven't brought you down with me. Every situation is different!

Oh,and to answer your question about my rehab.....I do about 30 minutes of cycling a day plus wall squats, and at physio I do the leg press machine, hamstring machine and various balance board exercises. I don't know how that compares to what other people are doing.

Thanks again for your message. Keep me posted on how you are doing. I hope things will improve and that you will be one of the success stories. Hang in there....
-Janet

[ski-bum]

Janet

I am SOOOO sorry to hear about the news from your OS.  I appreciate the incredible amount of both physical and emotional energy put into this surgery and to have it fail is devastating!!!  You just want to cry, scream "why me?" or sit at home and give up. 

Now that we have put that behind us we must move forward!!!!!!  Grieve for a short while but when we're done we have to step back into the ring and take another stab at it.  This life is not a dress rehearsal, so you've got to make the best of what life has delivered. 

Research, Question, and decided what to do to heal yourself. 

I so feel what you are feeling.  It hurts.  And this little pep talk is what I keep on telling myself as I prepare for a possible failure. 

This has been the most challenging experience I have had to endure.  It has put strains on my marriage (mostly because of my saddness ) and I've been less productive at work.  I have learned a lot about myself and realized that I have some strengthening to do.

Don't give up.  One more month might be all you need!  Keep me in the loop!

Marc

[jt10]

Hi again Marc,

Thanks for your kind words. I won't give up.

 I'm going to keep working hard until they tell me definitively that the mfx is a failure. If it has failed then it's on to plan B ( whatever that turns out to be). My doctor said that if I need a second surgery I should go to the US, but I live in Switzerland and I don't see how that would work financially or logistically . I have read stories on this board where people had pain for nearly a year and then things seem to improve so I remain hopeful that things could still turn around!!!

You said that this has been one of the most challenging things you've been through and that it has affected your marriage and I know exactly what you mean. It's hard not to feel sad when you are in constant pain and not able to do simple daily activities, let alone sports and things you previously enjoyed. That sadness is hard for our spouses to deal with as there is really nothing they can do to cheer us up.

 I think that is why this board is so valuable to me because I know the people on here really understand what this feels like. It's been great for me to have a place to vent and to read about what others are going through. I feel a lot less alone in all this.

Thanks again for your support. It really does help.
-Janet

[ghost]

Hi Janet and Marc,

I know everyone has to make their own decisions about what to do next, but I thought I would share with you something I learned recently.  On the 25th I saw Dr. Tom Minas at the Cartilage Repair Center in Boston, Ma.  He's reputed as one of the world's best in this field. He told me that microfracture changes the cell structure of the underlying bone and makes OATS or ACI less successful.  His stats were that the chances of success for either procedure drop from 92% to 74% post MFX.  He was in agreement with my OS that PFR was then next thing for me.

Everyone is different, but I thought I'd let you know his thoughts on the subject.

Sue

[jt10]

Hi Sue,

Thanks for sharing that information. It certainly gives me something to think about!

I am still trying to deal with the news that this mfx may have failed. Even though I had a feeling that things weren't right, it's something else to hear it from the doc. It's also disappointing for me to know that there is nobody where I live who can help me if it has failed.

I don't know how I will afford to go to the US - I guess I will have to hope and pray that my insurance covers it but it's doubtful! For now I'm just trying to carry on as normal and am keeping some hope alive that things will improve with time. I can't really get my head round having another surgery any time soon.

It must have been good to get some reassurance from Dr. Minas as he is a specialist in this area. I guess everything is on track for your PFR next month! It must be a relief after all you've been through with your knees. Let's hope this is the last surgery you'll need!

Are you going to keep a post-op diary on this board? I'd love to follow your progress.
-Janet

[ski-bum]

Hi Janet,
Thanks for your information.  Dr. M is one of the best and I would have faith in his recommendations.   There is something that feels good about having a plan to move forward...GOOD LUCK!

Would you remind me, where was your lesion?  How big was it?  What surgeries have you has in the past? 

Hope you are having a great Sunday....

Marc

[jt10]

Hi Marc,

My lesion is on the medial femoral condyle between 20-30 degrees of flexion ( bending) and it's 2cmx1cm. The location means that when I'm weight bearing and try to bend my knee even a little bit it engages the lesion site. I guess that's why I can't do stairs etc.

Is yours in a similar location?

Microfracture was the first surgery I've had for the knee, but I tried physio and synvisc injections before opting to go the surgical route. It was nearly 2 years from the date of my injury to the surgery! Maybe I would have had better success if I'd done the surgery earlier on. Who knows.....

I'm having a good Sunday..the weather is great...hope you're having a good one too!
-Janet

[ghost]

Marc,

My lesion is a grade 4 o the trochlear groove and is 1 1/2 cm by 1 1/2 cm.  Like Janet, my lesion is at the bottom of the femur so anytime bend the knee to 30 degrees it is bone on bone.  I can bend it painfree as long as it is non weight bearing, but if I bend it with weight on it the pain goes from 0 to 10 in a heartbeat, but subsides as soon as I take the weight off it.


Janet,  I hope you are able to find someone who can help you improve the situation.  I am lucky the US has a multitude of specialists in this area along the east coast so I only have to travel about an hour and a half to see my OS.  Where did you say you live?  There has to be someone closer that specializes in this field?  Even if you could find someone within a days drive it would be doable and certainly less strain on the pocketbook.

Yes, I will have a post op diary running after the surgery.  I also have one running now.  You can find it in the member list my user name is Ghost and the subject is Trochlear groove microfracture.

From a surgery standpoint this will be my sixth knee surgery.  I had two surgeries on my right knee for meniscal tears in 1983 and 2001.  The past three have been on my left knee.  12/07 I had a torn meniscus, 6/08 I retore the meniscus and had a partial tear of the quad tendon attachment, December of 2008 I had microfracture of the Tg and 7/09 will be a partial knee replacement.  Four surgeries in 19 months.  I've had enough now and am hanging out the white flag.

2 1/2 weeks.  The count down is on and the nerves are starting to kick in.  No surprise there I guess.

Sue

[investor54]

Hello JT10,

I'm 6.5 months into my MFX. Pain and swelling improving ... but very slowly. I'm still feeling like a cripple.
My OS did a post-op MRI after less than 5 months and told me the surgery was both a success and a failure ... .
He suggested 3 shots of Orthovisc, a repeat MFX or a total knee replacement.
I've seen two additional OS, one shot me up with cortizone and the other said to give the MFX another month healing time and also talked about a total knee replacement. Both these guys have Hip and Knee replacement practices.
My advice ... get a 2nd and 3rd opinion from a Sports Medicine Doctor as well as a Cartiladge specialist.
Good luck.

 

[Frazer]

Hi all, well i am 6weeks post MFX on patella on the 31st august and have to see my doctor then, so i will know more and beable to post up then, but after reading what some have experienced on here, i wait with baited breath....... feel positive i do but have that doubt in the back of my mind what if...... after being active all my life the last thing i dont want to hear is you cant or wont be able to do this and that what makes it worse is that im 265lbs and 38 years old, after 22 years running, rugby,squash, BJJ and MMA am my days numbered?.... best of luck to everyone on here and ill keep you posted.

 

[dm]

I'm in the same boat as most of y'all - found out 7 months postop via mri that my mfx failed - can see the intrustion into my femur on the side views where the lesion hasn't healed, big time. I've got a shirtbutton size hole in my femur, which has probably gotten bigger by now. I'm in pain with every step I take, just putting weight on it straight legged is painful, and bending it with full weight sends me into orbit! I live in an unloader brace which helps a bit, but I have to take it off some of the time to give my skin a break, else I eventually get skin sores because it can't breathe from 14-18 hrs a day in the thing.

I'm on mid-level narcotics, trying to not take more than I have to, but I've gone way past the point where hydrocodone does much. Only the strongest of that helps anymore because it's bone pain. On the bad days my knee hurts so bad even my ankle hurts just because it's on the other end of the same bones. Even now I'm tethered to my Polar Care, because I overdid it again today stuffing myself into a machine at work. Almost time to replace the ice, in fact. Good thing is, once set up, I'm good for the night and can actually get some sleep between my ice machine and the meds when I hurt this bad.

My OS wants to do OATS allografting, and is talking 3mos nwb, but I just changed jobs 4 mos ago and don't have job protections under US laws. If I had to take the time off now, I'd lose my job, so that means I can't even consider doing the surgery until next summer, because it's not life-threatening. In reality, they ought to just quit playing and do a TKR, this'd be my 7th surgery in 10 years, my knee's been patched and repatched, I'm in line for it within 5 years anyway with the damage it's got, so it's my opinion that I'm almost better off if they'd quit mucking and just replace the thing.

I've found another OS also on my new insurance who's special interest is cartilage injuries and is a sports med OS, he's one of the orthopods for the Tampa Bay Lightning Hockey team, in fact. So, I'm thinking of pulling a CD of my last MRI and report, and getting a copy of my last surgical report, I've already got the pics, and going to see him for a second opinion on what to do next. I figure at this stage it can't hurt to get another eyeball at the situation and see if perhaps I'm better off going another route besides OATS allograft. Goodness knows I'm crippled up enough now, and its not gonna get any better, and the likelihood is that by the time I can have surgery, and allograft isn't gonna be an option because the damage will be too far gone for that - the hole will be too big.

You'd think that with me being 40 in less than 2 months, they'd at least consider whether it's worth putting me through the massive recovery of an OATS type procedure with the decreased probability it'll heal, given that the mfx failed. that's where I figure things stand when an mfx fails and they want to do oats - there's an increased risk it too will fail, especially when the first failed from non-healing.

[surfbum]

Hello JT10,

I'm 6.5 months into my MFX. Pain and swelling improving ... but very slowly. I'm still feeling like a cripple.
My OS did a post-op MRI after less than 5 months and told me the surgery was both a success and a failure ... .
He suggested 3 shots of Orthovisc, a repeat MFX or a total knee replacement.
I've seen two additional OS, one shot me up with cortizone and the other said to give the MFX another month healing time and also talked about a total knee replacement. Both these guys have Hip and Knee replacement practices.
My advice ... get a 2nd and 3rd opinion from a Sports Medicine Doctor as well as a Cartiladge specialist.
Good luck.

 

You'd be foolish to even reconsider a repeat MFX and if that is what your OS is recommending, he obviously does not specialize in cartilage restoration. Has anyone ever talked to you about Denovo NT or ACI?

[surgery2011]

Hi everyone! 

I have the same question.  I had surgery back in Oct 2011.  I feel that I should be doing better than I am.  I cannot do leg lifts or sitting leg raises unless I am in water.  There is terrible pressure under my knee cap when I try to do this.  The muscles are doing ok (even though you can tell they are weakened) but, I just don't understand why I don't have that range of motion yet.  I also cannot go up stairs yet, I either do one step at a time or I have to hold on to a rail to help with the weight bearing.  I am not sure if any of this is normal?  I have been reading your stories and it sounds like the answer is no.  I see where alot of you have range of motion or are talking about stationary bikes and such.  There is no way I can do any kind of bike at this point.  So how long do you wait to know if the Microfracturing worked or what you are supposed to do next?  Any advice at all would be appreciated!

Any of you who are going through recovery from this surgery, I hope you all are doing better than when you posted previously.

[Rupert]

Hi Caroline 889

 As a potential mfx patient also in Wales- and also with  problems in both knees, I'd be really pleased to share thoughts with you

 If youwant to e-mail me then I 'd be more than happy to exchange details See my details for e-mail contact
regards
Rupert

 

[toakoak]

what happen to jt10, its been a while. i have same problem to a tee. my os said give it 6 more months

[Amy29]

Hi;

I am 5 weeks post-op, have been partial weight bearing from the start (am hoping to go full weight bearing next week as that's the 6 week mark).

I don't really have much pain and can manage it with Ibuprofen - I also don't really have any swelling anymore.  I was never in a brace so have always been able to bend it and my flexion is really good.  My only problem is that I cannot straighten it - I am lacking 30 degrees and have been for the past 3 weeks.  I don't know why I cannot straighten it and it just seems to be different to what everyone else has said.

Anyone else had this problem?

 

[Stelfox]

Hi to everyone on here!

I'm not a specialist so the only thing I can share is my experiences so far.

On 14th of September 2011 I had microfracture surgery on the later femoral condyle at a bend angle of 15 -20 degrees. The damage was 2cm sqaure and my surgeon (David Elliot) used the microfracture 'steadman' technique and made 6 holes. I was told I could have weight bearing straight away.

This is my 3rd operation to my left knee:
2007 - ACL repair using my hamstring
2009 - medial meniscus damaged and removed and 0.5cm micro fracture repair in same area

Someone in this chat mentioned it is a roller-coaster and that is definitely what its been like for me. I had swelling quite significantly until 4months post op and the swelling went down with icing it every day. I cycled after 3 months and started exercising after 4 months With leg curls, balance ball exercises, one leg press and calf raises. Ive been having strength tests and my left leg was weaker by 30% and is now at about 15% weaker than my right knee and i just cant seem to get it stronger.

At this time May 2012  it's been 8months and I still have slight swelling after a day of just walking and would have a dull pain which is more discomforting than pain. If I have my leg bent more than 90 degrees for a long period of time( 20mins) that would be really uncomfortable. I can't really improve my strength by increasing the weight at the gym as this causes a bit of pain in my knee where the repair was taken place.

I hope this info may help people and I'm happy to of found this sight. I wish everyone the best of luck and it's has been hard for me but I hope to see a positive future.

I'm 24 years old and I would apreciate any comments regarding if these symptoms that I am experiencing now is normal and if it has failed or not from some people experiences. And if it has what would be the next step to take.

If you have read this thank you! 

[Adobec]

I am two months out from a surprise microfracture on my femoral condyle.  I went in to the operation planning for a 3 week rehab for a partial meniscectomy.  This has certainly been a roller coaster.  It seems like most of us on this board have a dificult time staynig still!  I have spent the past two weeks mostly swimming -- and doing yoga for the past two weeks.  I am frustrated, though, with my ability to just get through my day without planning/counting my steps due to the pain.  I  have four young children who I was previously very active with.  Now we just sit arouind and stare at each other   Not really, but it has been very difficult for us all. 

I had my third ACL reconstruction a year ago -- at the time, my medial and lateral meniscus were repaired.  Lateral healed better than a teenager, medial was really messed up.  ACL is intact and strong. 
My right knee is 10 and 20 years out from ACL repairs and medial/lateral meniscectomies, so the pain in that joint is pretty severe. 

Trying to keep my chin up, but it's hard!!!

[Frazer]

Late i know but now 15 months post MFX patella, was back in gym after 8 months MFX has done wonders for me no pain, no giving way, only issue is when i am tired it ACHES !!!!   unfortuantly i now has issues with left knee, and terrible pain in left hip, that first started day one after getting on crutches.  Doc says its arthritis...... not a day goes by when it does not hurt.  Lately tho ive been waking up middle of night and hip has locked, i am shouting out in pain !! untill i can straighten my leg out ...... referred to hospital lets see whats the next plan of action is.......

[Adobec]

Wow... If it's not one thing, it's another....

I am actually about to have TTT surgery to take the load off of my patellofemoral joint and help realign the patella.  I have gotten progressively worse . Every step hurts.  I hope they can do something for your hip!

[Adobec]

I felt horrible, but it was discovered during my surgery that the microfracture had healed perfectly.