has my micro-fracture failed?

[dm]

the indentation in the top bone (femur) is where the mfx failed. you can see that there's a distortion of the articular surface, instead of being a smooth curve, it's got that dent in it. the dark horizontally in the joint is the narrowed joint space where it's basically a void because I've no meniscus there.

[rob43]

right went to see the surgeon, and surprise surprise he wasnt there,so had to see some other doc!!
who said that the micro fracture hasnt healed yet and was still healing!
not sure at 6 and a half months this is the correct imformation, or if he was just trying to get me out the office double quick!

[rob43]

been for a second surgeon too look at my knee today! weds
told me i still have cartilage damage even though i have had the micro-fracture reapir 6months ago
he has offered me a cartilage graft, does this op work or will i just end up worse than i alrdy am?

[Vickster]

It can certainly work, but it's a very long and tough rehab, probably nothing approaching impact sport for 12-18 months

Have a read of this as well as threads in the section on  for MACI/OATS etc

http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

Assuming it's MACI, it's 2 operations - one scope and one open with a biggish incision, brace, weeks of nwb etc

You'll need to weigh up what you can do now, pain levels etc and decide whether you can dedicate to the rehab and long lay off

Did you go to Stanmore?

[rob43]

yes i went to stanmore
ive spend most the night with this on my mind!!
i really need to get back to work and dont have another year i can waste sitting on my back side!!!
ive improved a lot  in the last few months walking up down stairs is ok now pain free
doing the weights only seems to hurt at the start then i,m pretty much pain free
cycling is fine on my exercise bike, ive even been out riding my mountain bike and standing up riding and that doesn,t bother the knee at all
feels a little tight in the knee to start but after a few mins its ok!
ive started jogging roughly a mile at a time and that is pain free ,plus doesnt upset the knee after!!!
only thing i cant do really is squat down on the bad leg with the knee over the foot!
hurts,but also feels unstable so not sure if thats down to muscle weakness?

[Vickster]

Personally, with that level of function, jogging and cycling, I'd leave well alone, and work on strength with a physio.  I don't squat if I can help it, works for me

[rob43]

but i want to play sports, dont think i can go through the rest of my life without playing football

[Vickster]

Then you need to discuss with a surgeon and also ask in the MACI section - someone will have been there.  How old are you?  Normally the chance of success after 45 or so is lower (stats typically around 70% for condyle defects).  Did you read the link?

[rob43]

I,M 43
yes i did look at the link thankyou!!
apart from the microfracture or the cart graft
isnt there anything that can be done that doesnt take a yr of your life away
if this was 100% going to fix the problem then id do it, but i might end up just the same or worse?

[Vickster]

Tthis is true.  There is a procedure call OATS where they take cartilage from a nwb part of the knee and implant it in the defect but it's still a big op with a long rehab.  Unfortunately, once the articular cartilage is damaged, it's normally very hard to fix as it has no blood supply, it's quite new science with big operations and tough rehab.  I would do some serious conditioning for 3 months and then see again.  You may not get back to playing football at the same level, maybe kick around the park.  And yes, you could end up worse

You could try a hyaluronic acid injection and see if it calms everything down - sometimes available on NHS.  Normally for generalised arthritis, but it worked for me for the last year.  My defect is tender again, not to affect function really but it's sore when prodded

[rob43]

i would of thought at 6months mine would also be sore to touch or prod,but it isnt at all
ive been trying to do one leg lunge for a cpl of days now, a few of em are ok then every other one or so sharp pain than makes me feel like i,m going to fall over!
but the leg is still like a chickens leg very small in muscle which i am wondering is the reason?
i would of thought that if the pain was due to the knee all the time why once the muscles are warm does the pain go off?
surely warm or cold the knee would hurt the same wouldnt it?

[Vickster]

Mine has always been tender - 2.5 years on - there is damage to the bone even though the defect is filled with fibrocartilage (like with mfx).  I have grade 2 all over the tibia below as well, I expect that isn't totally asymptomatic either

I am no physio - I do think you need to find the cash and see someone to set you up a programme.  Often people say on here you need to go back to basics, with really simple PT before you can even think about weights and running.  Post for advice in the rehab section, someone will have been through the same

If you have no pain, I wouldn't go down the transplant route.  My Stanmore OS wouldn't even consider it due to my function even though was sore and stiff until I insisted.  Then he couldn't do it due to the kissing defects, hey ho...I am really glad as I am averse to big open incisions (after a big back op 20 years ago)

[rob43]

dont even get me started on the back ops lol
ive had 3of them last one being a spinal fusion and bone graft 10 yrs ago i have a 8inch scar at the base of my spine
having a troubled knee isnt helping my back either as i feel unbalanced

[Vickster]

I am not sure my scar is 8", certainly a good 6"

Hope you get some feedback on your other threads.  Do you have full flexion and extension and good gait?  Is it squatting and stairs that are an issue - so maybe more strength than some sort of block in the knee?

[rob43]

stairs are kinda ok doesnt hurt just feels weak
its one leg squats or lunge that i find difficult as it feels weak and unstable
everything else is pretty much ok
i was jogging about of the football pitch this morn and kicking the ball
wasnt using my bad leg but didnt seem to do it any harm