Feeling Anxious and Confused.. Help? :(

[minor_discrepancy]

Hi everyone,

I am a long time lurker here.. only posted once before back in 2009 when I was to be getting a lateral release.  Well, things have definitely changed since then a LOT and I could sure use your help if you are willing to give it..

After two years of increasing pain and limping, I finally went back into the doctor who performed my lateral release and was told that I have Adult onset Osteochondritis Dissecans due to the fall I had.  I've had arthroscopic debridement and microfractures drilled into the bone since then (in February).  I was told that my potential for recovery was about 70% and I was really happy about that.  I was on crutches for about two weeks before my doc told me to stop using them and proceed as normal.  I was given the instructions "If it hurts, don't do it."  Well.. I followed those instructions to a T.  About two months ago I was walking to get coffee and felt something pinch.  Hard.  Since then, I have noticed a steady deterioration in my pain levels and general physical ability. I called up my doc who told me to take 1800mg of ibuprofen a day and come in in a month.  That appointment is for next week.

It's been really hard for me to get my doctor to tell me what's actually going on with my leg.  His description of Adult Osteochondritis Dissecans was perfunctory and the only real stuff I can really find online is on Juvenile OCD. Not only that, but he seems to have a hard time believing my symptoms and it makes me feel really self conscious.. sometimes anxious even.  He's straight up implied that I was going too easy on myself before.  It makes me feel like a hypochondriac almost.  The thing is, I don't think my symptoms are normal, or even part of a normal recovery for the microfracture procedure I had..  I can't bear full weight on my leg and bend it past about ten degrees without it forcefully giving out, can't jump because of the same problem (I've toppled over before), when I cross my legs I often feel pain lance all the way up to my hip, when it's cold out I limp, it wakes me up on occasion from a deep sleep, and I've had to cut out most forms of real exercise from my life such as trail biking and impact based aerobics.  My knee has full range of motion but there are many instances where I can feel it "lock" like something has gotten in the way of it bending.  It's always when I am extending the knee though, not flexing it.  Also, when I bend it I can feel/hear a sort of grinding like gravel..  I have noticed that if I don't exercise for about three days and ice it each night, the symptoms diminish quite noticeably.  However, an example would be this week, I went on a short bicycle ride (which my doctor says I should be able to do by now) on a flat residential street, and my leg woke me up hurting two nights in a row after. 

I just don't know what to do.  Do I just stop exercising and hope that in a year the symptoms go away? Am I a total spaz and making a huge deal out of nothing? Do these symptoms sound normal from any of you who have been through similar procedures/experiences? I know how my doctor feels about it, but the last time he told me my knee would "just hurt sometimes" I ended up coming back with Adult onset OCD which is no picnic.. I'm kinda scared to be honest.

Thanks for your help everyone...

[Forevergimpy]

I think this is the most frustrating part of knee issues - and the reason that this great board exists. I am so glad you stopped just lurking and are willing to ask for some help. I too have often wished I had bones obviously broken just so that the doctors would believe that I am in pain and that this is serious.
Are you somehow required to continue with this doctor? I have found that finding the right doctor/PT is absolutely critical (and feels nearly impossible too). If you area having to make significant changes to your lifestyle then that indicates that there is a problem. No exception. The goal of you and your doctors should be to get you back to life again (and avoid any future damage).
I do not have any advice on OCD, or microfracture but it does sound to me like a second opinion may be the way to go.
Good luck and keep us posted!

[aaa]

Hi

I'm sorry I can't say what is going on with your knee.

I also had an LR which failed.  My OS basically said it was nothing and I basically had to live with it.  I got a second opinion and diagnosed medial patella instability as a result of the LR.

I then had to have the LR 'reversed' by rebuilding the LPFL with an allograft, and corrected the real problem which was a deficient MPFL.

[minor_discrepancy]

I think this is the most frustrating part of knee issues - and the reason that this great board exists. I am so glad you stopped just lurking and are willing to ask for some help. I too have often wished I had bones obviously broken just so that the doctors would believe that I am in pain and that this is serious.
Are you somehow required to continue with this doctor? I have found that finding the right doctor/PT is absolutely critical (and feels nearly impossible too). If you area having to make significant changes to your lifestyle then that indicates that there is a problem. No exception. The goal of you and your doctors should be to get you back to life again (and avoid any future damage).
I do not have any advice on OCD, or microfracture but it does sound to me like a second opinion may be the way to go.
Good luck and keep us posted!

 Thank so much for the reply.   I definitely worry that I'm blowing things out of proportion.  I hear people talk about playing soccer or going on 80 mile bike rides a couple months after their debridement/ micro fractures and it makes me wonder how they do it!  Do they have similar symptoms to me and just tough it out? I have a really skewed idea on what's normal since my current doctor seems to think I should be running marathons.

I do like my doctor as he is quite competent.  I am sort of locked into continuing to go to him for various reasons though it seems he is leaning towards allograft surgery to remove the lesion and I think I will definitely get a 2nd opinion on that one..

[Maverick]

Hi, you are not making things up and I know that your pain is real.  Please see my post by Maverick "Lateral femoral condyle (LFC) Microfracture recovery".  My microfracture was in Sept 2011 and I was non-weight bearing for 3 months and on crutches for 5.  I still have serious pain periodically and can only do day-to-day activities without much pain.  When I do my strengthing at the gym or spinning, my knee flairs up and can keep me up all night! 

What are you doing for PT? 

You have to have trust in your Dr. and if not you need a second opinion.  Unfortunately, there are great Dr.s and some not-so-great and many in between.  Find one that you are comfortable with.

[minor_discrepancy]

Hi, you are not making things up and I know that your pain is real.  Please see my post by Maverick "Lateral femoral condyle (LFC) Microfracture recovery".  My microfracture was in Sept 2011 and I was non-weight bearing for 3 months and on crutches for 5.  I still have serious pain periodically and can only do day-to-day activities without much pain.  When I do my strengthing at the gym or spinning, my knee flairs up and can keep me up all night! 

What are you doing for PT? 

You have to have trust in your Dr. and if not you need a second opinion.  Unfortunately, there are great Dr.s and some not-so-great and many in between.  Find one that you are comfortable with.

After about two weeks I was getting pretty good at being weight bearing without any pain so my doctor said I didn't need any PT and didn't give me a scrip.  I continued to do my home regimen which eventually included things like the elliptical and lifting weights once I started feeling better.  About a month after I got to the point of going back to the gym was when I got the weird pinching/tearing sensation and my doc told me to take it easy until my next appointment.

The OCD I have causes a spot on my femur to essentially shatter off in tiny pieces over time.  I have a lesion there too, since the bone is dead cartilage can no longer grow.  I am worried because I am feeling many of the same symptoms now that I did when they pulled that big hunk of bone out of my leg but at the same time I don't want to be a huge worry wart.. 

I'm starting to wonder if maybe he was trying to be optimistic with me because the particular form of OCD I have is extremely rare and (according to Google at least..) very hard to treat.  Do you think a doctor would do that?

[Maverick]

I think Dr.'s in general try to be optimistic.  I think that the key is whether he/she is listening to you or not.  If not, then you need to do some research on OCD and try to find a specialist.  If he/she is listening then and is willing to work with you on options, PT, etc. then I would stick with them.  Remember, no one know your situation better than you so be your own advocate!

[minor_discrepancy]

I think Dr.'s in general try to be optimistic.  I think that the key is whether he/she is listening to you or not.  If not, then you need to do some research on OCD and try to find a specialist.  If he/she is listening then and is willing to work with you on options, PT, etc. then I would stick with them.  Remember, no one know your situation better than you so be your own advocate!

That's a good point.  I think I will make a list of the things that I am unsure about to make sure and ask him.  I don't think he's a bad doctor, but getting information out of him is like interrogating a brick wall sometimes. Perhaps i should be much more forward...or bring my boyfriend and he can be the one my Dr. doesn't like, heh.

[Maverick]

Great approach!  I take notes in my iPhone and walk through them with my PT or Doc during my visit.  Somehow it makes the converstation easier since I wrote everything down.  Best of luck!

[minor_discrepancy]

Well.. I thought I'd write up some of my questions here and see what you guys think.

1. Is it common to know so quickly if drilling the micro-holes was a failure or not?
2.  Is the pain and the limp I'm experiencing every time I exercise a normal part of the healing or is it a sign of something more sinister?
3. Are there any successful methods of treating OCD and if so, what are the typical pain levels after having the procedures done?  Does it ever actually go away?
4.  What does the grade 3 chondromalasia under my patella mean for that area in the near future? (I've asked this before and he told me I'd be fine.. I'm inclined to think that my continuing pain means probably not, but he is the expert so I will ask again in another way and see if I can get a more clear answer. )

Those are the ones I've thought of so far at least!

[minor_discrepancy]

Hello there, I am writing with the results of my Doctors appointment.

It all turned out much better than I was hoping.  He took my descriptions of my symptoms very seriously.  He really seemed to listen and I am happy with his responses about my concerns. 

It turns out my OCD lesion is pretty severe and requires an OATS procedure.  They are going to core out the dead/rotten bone and replace it with healthy bone and cartilage from another part of my knee.  Hopefully all goes well.. has anyone here had an OATS?  What was the minimum amount of time you'd say it took you to feel comfortable going back to work?  I could potentially risk losing my job by becoming "obsolete" if I stay away for too long.. one worry on a list of many.

Thanks!

[kneepaincure]

Sorry to hear that you have to undergo such a major procedure. Hope it turns out well for you in the end!!

If you check the post-op diaries section, you may find someone who has had an OATS procedure, or just search the whole site to get all posts about it..

[KneeZilla]

I can totally understand why this situation makes you worried but there is a sunny side! I hear oats can have some pretty decent outcomes. I have also heard that it has a lower success rate after undergoing micro fracture in the same area. I wish I could find the study I read on it, I may even be wrong but I think this is a good thing to bring up with your OS before you go in for another surgery. Either way I hope things look up for you!

[Vickster]

OATS isn't done terribly often compared to other repair techniques such as ACI (if this forum is anything to go by), but there are some posts and experiences here

http://www.kneeguru.co.uk/KNEEtalk/index.php?board=32.0

Good luck

[minor_discrepancy]

Hey everyone thanks so much for the support.   I have been a little down in the dumps about it.  I don't know why I guess I was hoping for a quick and easy fix, but nothing in life is quick or easy!!  At least I am 26 so I have a good chance of healing at a steady rate.

Vickster, thanks for the link to that thread.  It was really helpful and gave me a lot to think about as far as how much time I will end up taking off.  More than I'd like, but I'd hate to have issues with the graft like some people seem to have!!