Surfer, Failed Trochlear Groove Microfracture -- and a bonus

[Jazmonster]

I have been hoping that I wasn't going to be in this situation - sitting down to type my story to KneeGuru.    I've been reading the forums, and keeping a positive mind... in an effort to fight off disappointment – the mental part is the hard part of microfracture. 

Physical Details:
39 years old – chronologically (I usually feel like I am 17)
6’1”
186 lbs.
Surfer, fitness fanatic, basketball, anything with a score (Connect four? yes)

Like many of you, I never had an obvious injury... just a steady increase in pain when I was doing deeper bends under loads.  When it started to impact my surfing, I decided it was time to see a doctor.  My wife is a performer with Cirque du Soleil, in Las Vegas, and we got referred to their top knee doc.   I will refrain from detailed comments on his service, and just leave it that he was very busy/rushed, and very uninformative.  I only spoke with him for 4 mins in the first visit (he ordered the MRI) and I was left with his non-medical sidekick for the rest of my treatment.  I opted for PT as a first course of therapy, but 2 months of hard work was getting me nowhere… so I went ahead with MFX (after consulting with his sidekick, since Doc was too busy).  I had read enough, and they told me I had a defect – so it seemed cut and dry.

I have since learned that Trochlear defects are a whole ‘nother deal, in re: to MFX.  I had Trochlear groove mfx on August 19, 2009.  Defect was 7x7mm.  OS said surgery was great.  I was released 25 mins after starting surgery – even though I was still totally in a fog.  Was NOT given a CPM and was NOT given a brace.  Ordered to do 6 weeks NWB.  I had been reading Steadman's articles, and was not sure why I didn't get the CPM or the brace.  OS said I could have them if I wanted, but they weren’t required.

I was super careful during NWB, and got 150 degrees of flexion by week 3.  I had the popping, and pain during transitions (to sofa, to bed, etc) that many have reported.  Otherwise, I did what they asked of me – and then some.

Today, I am 5 months post op.  I had an Arthrogram last week, and was given the results (again, not by the doc, but by his non-medical sidekick).  The MFX did not fill in.  The MRI reported that I now have "Fissuring" and the defect size is 9x5mm.  I never got a good answer from the sidekick about the difference between fissure and defect... but needless to say, I am fairly bummed.
Stairs are still my enemy.  I can do them, but down is worse… and either way (up/down) causes that sharp pain and instability.  I am working my butt off at PT.  My workouts are 2 hours long, and intense – I have been working with Cirque’s PT’s and a guy from the NFL – but trying to build VMO is tough.  The exercises that could help… all hurt (extensions, lunges) so i do them limited range, or not at all.  This was the same dynamic that caused me to go for surgery in the beginning, when the PT didn’t work.  I am unsure how to proceed?  ACI?  Nothing?  Ugh… and here is the best part (read: worst)…

THE BEST PART OF THE FAILURE WAS MY PARTING GIFT…
 
The final weekend before the 6 wk post op visit, I went swimming.  I didn’t kick my legs, and used those floaty bar-bells.  I put in some good distance.  Somewhere between the 3 days of swimming, I got what felt like a bad knot in my back.  I was struggling with the crutches, and the knot was getting worse.  I transitioned to one crutch after my 6 week post op visit, but the knot was really burning - and it had been almost a week of pain. 

Turns out the knot was actually my Long Thoracic Nerve dying.  After the “knot” formed, I started resting on my crutches – letting them dig into my armpit a bit more (a minor amount) and the pressure “allegedly” crushed the nerve.  My scapula now “wings” way out, and I’ve lost the ability to lift my right (dominant) arm over my head.  I can’t throw a ball or do bench press.  I am very much impaired, and the general prognosis is 6-24 months of rehab.  The nerve usually re-grows… but at a snail’s pace.  So, my last three months have been not very fun.  Pain, more pain, rehab, lower back pain, upper back pain, and knee pain. 

Now, I am “that guy” that I used to read about…
 

[Silkncardcrafts]

Hi there,

Sorry to hear what you are going through. It sounds like you definitely haven't had the right advice or treatment to date.

I would really encourage you to get another opinion on your knee. That is appauling that your results were not given to you by your doctor. Do they not know what duty of care is ?

There are a lot of things that you can do to strengthen your knees that don't include curls or squats. Curls are a no-no for patella problems. I am surprised no-one has told you that. This is one of the first things I was told by my surgeon and doctors. One of the main things that has helped me is going to a hydrotherapy pool. They are warmer than a normal pool and support your body. Doing a gentle gym program would definitely help too. I find that using an exercise bike really helps to build up the muscles around the knee. A small stepper and elliptical can help too. Clinical pilates is one of the main other forms of exercise that has really helped me. The classes are usually run by a physiotherapist and each person in the class will have their own program depending on what their needs and weaknesses are.

I wonder whether a trochleoplasty would help in your case. That is where they deepen the groove of your knee cap.

In addition to your knee, I would be seeing a separate specialist about your shoulder. I have had shoulder instability too, so know how frustrating it can be. Unfortunately the type of crutches you have been using can cause the problem you have developed.

Hope this helps.

[Jazmonster]

Thanks for the thoughtful reply.  I see the top thorasic nerve specialist, in St. Louis, this Thursday.  Hopefully I will get a better DX than with the knee. 

I am doing leg press, with the foot turned out - no pain, and getting stronger
I do short arc curls, just until I hit the pain part - getting a little stronger
I've also been water running, and getting stronger.

The deepening of the kneecap groove is a new idea!  I will look into that.   First things first...

I need to find the top doctor for Trochlear groove defects, and start investigating the next steps.

[Silkncardcrafts]

Hi there,

I am glad you are seeing a specialist this Thursday. It would not hurt to go and see a top shoulder surgeon to see if anything can be done.

The way you are doing the leg press is fine. Just be careful as often it can aggravate patella problems. I would stop doing curls as they are a definite no-no for patella problems. Water running sounds good. You could get just as good work out doing walking in the pool.

Good luck with your appointment on Thursday. Let me know how it goes.

[Adobec]

Just wondering whatever happened??  I am two months post op from fem. trochlea. micro, not real confident that it will be successful-- and wondering what my next steps might be.  I am also very very active, this is killing me!

[Maverick]

Jazmonsger, I am sorry to hear of your challenges. I am 9 months post MFX and still having pain challenges as well. MFX takes quite awhile to heal so make sure that you don't over do it trying to fix it.  I speak from experience.  I too did not have CPM and as I understand it the research results are mixed as to effectiveness.  You can read my other posts for my info on my MFX.

Right now is am battling patella femoral syndrome and have to strenthen my VMO as well. Here is a guide that I found that might be of help. http://www.permanente.net/homepage/kaiser/pdf/6946.pdf

Make sure that you don't do something to aggravate your healing MFX.

Best of luck!