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Author Topic: Having ACL reconstruct, but do I really need the microfracture surgery?  (Read 1872 times)

Offline eastvillageNYC

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Hi-

So I tore my ACL for the 3rd time recently... and looks like I'll be going for surgery again soon.  The first 2 surgery's, which were in 2001 and 2004, my surgeon did not even mention microfracture... but now I was advised since  we have to repair the ACL anyway, it would be "silly" not to.  6 weeks of non-weight bearing on the leg will be a real inconvenience, compared to weight bearing as tolerated with just the ACL reconstruct.  Plus the additional time it will take rehab wise... it's making me have some doubts, for a procedure which "may" help rebuild cartilage.  Also, getting married in June '13... so need to be up and dancing by then!  Any feedback would be greatly appreciated!

Offline Coolcat

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #1 on: September 08, 2012, 03:54:12 AM »
I had microfracture December, 2011, along with an ACL graft, meniscus repair and patellar debridement. I was non-weight bearing for 8 weeks, which, as you mentioned, is MUCH more inconvenient than being weight bearing on crutches. I've spent a lot of time in NYC and the difficulty of being non-weight bearing there is hard to imagine. 7 months after my surgery, despite following surgeon and PT's instructions 100%, my knee continued to swell even with very limited activity. Apparently, this is a hallmark of microfracture. The knee had to be aspirated three different times during that 7 months. Three weeks ago, I had the same knee scoped to remove some broken cartilage (not the tissue created by the microfracture) and the surgeon was horrified to find my natural cartilage totally destroyed and my ACL graft significantly frayed. The cartilage damage is a big concern, and could be due to instability from the failed ACL graft, BUT the surgeon said it could also be caused by the trauma of the initial surgery. Ironically, the tissue created by microfracture is undamaged. Two weeks ago, I got a second ACL graft and am back on crutches. In hindsight, I WISH I'd gotten a second opinion before agreeing to the microfracture. We'll never know, but I wonder if the trauma of microfracture contributed to my cartilage damage. The recovery from microfracture is slow and painful....make sure you really need the procedure. Also, a close friend of mine had microfracture a 18 months ago and the bone remained "irritated" and painful for a year. Her surgeon repeated the microfracture six months ago and her pain is still about the same. So....I am really questioning microfracture in general. FWIW, I'm a very fit and healthy 40 year old female. Good luck with your ACL repair.  I hope you are back to 100% very quickly.

Offline eastvillageNYC

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #2 on: September 08, 2012, 05:40:15 AM »
Thanks for the reply Cat. 

So your initial ACL graft had to be replaced b/c of the fraying?  Did you do allograft or auto?  Sounds bizarre.  Having already had multiple knee surgeries, I am very wary of putting more trauma on my knees that are absolutely necessary. 

Offline silverghost

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #3 on: September 08, 2012, 08:27:58 AM »
Hi east

The only reason your OS will want to perform Microfracture is to stimulate the articular cartilage growth within your knee.  This infers that your cartilage has worn down following your initial ACL tears and recons.  Unfortunately this is a side of ACL that I experienced and nobody is really aware of from the offset.  Any trauma of the knees CAN (the operative word) lead to increased wearing of a joint and degradation within. 

I have known many people who had simple ACL recons and 15 years later are suffering with their joints through increased wear and tear and reduction in cartilage.  Hopefully your OS is experienced and recommending this as a benefit to you.

I hear many people on the forum saying '8 WEEKS' i cant do that i have things to do! like shopping, ironing, putting the cat out!  The downtime in this and the physio is hard but in the long run this could reduce the amount of TKR's you will need to have in your lifetime by half!

Once you have OA this is for good all you can do is slow the process a bit and these sorts of delaying tactics with microfracture etc.. can only be a good thing.. I think you need to accept that a course of action like this is needed now to delay things for the future!

Stay positive!

SG
'96 ACL reconstruction
'09 Arthroscopy/cartilage repair
Diagnosed with Grade 4 OA no medial cartilage and significant varus alignment
'11 fitted with off loading knee brace
'12 HTO, meniscus transplant, acl reconstruction & microfracture all in 1 go!

Offline eastvillageNYC

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #4 on: September 08, 2012, 04:01:42 PM »
Silver-

Appreciate your perspective.  How did your microfracture surgery go... looks like it was recent?

I understand what the procedure it trying to accomplish... but the operative word is that it "may" work, and even if it does, the cartilage that forms is not as strong as the original.  Point being, it seems like a bit of a gamble.  I trust the Ortho, as he was head ortho for the NY Knicks basketball team for 10 years... so he knows what he is doing from the perspective.  BUT, maybe he's working on some research trying to bolster his number of MF patients?  I know, it's a little suspicious of me... but trying to look at all the angles, and the only thing I really have to go by is people with actual experience.

Cheers!

Offline silverghost

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #5 on: September 08, 2012, 06:42:34 PM »
I see where your coming from and i was a bit suspicious as well when my surgeon reeled off a list of procedures they wanted to do.

I don't really know how the microfracture part went as it was kind of a decision made during surgery I was not aware they were going to do microfracture when i went down only the meniscus transplant, acl recon and HTO.  So not really sure whats going on in there at the moment.

I guess we kind of do throw ourselves into the surgeons hands and expect the best from it..  My knee currently feels worse at 3 months than i did post op but if it gives me an extra 15 years without having to go metal and plastic then i guess its a price worth paying.

I went probably 13 years after my ACL recon without pain and then the OA set in fast and I mean like grade 0 to grade 4 within i would say 4 years.  If you can keep going with the pain then its obviously your decision and yours alone i guess it just depends on future timescales and getting done in the future. what i mean is when the pain gets worse can you get the microfracture surgery done then pretty quick or will the chance have gone?
'96 ACL reconstruction
'09 Arthroscopy/cartilage repair
Diagnosed with Grade 4 OA no medial cartilage and significant varus alignment
'11 fitted with off loading knee brace
'12 HTO, meniscus transplant, acl reconstruction & microfracture all in 1 go!

Offline eastvillageNYC

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #6 on: September 10, 2012, 03:44:07 AM »
I can always go back to get the microfracture surgery later, but I guess I'm thinking if it's worth the risk of having microfracture surgery at all.  What it boils down to is that you are causing more trauma to the knee, in order to "trick" the body into producing a form of cartilage that is not as good as the original.  And... it doesn't always work. 

When I asked the surgeon, he said since we are already going to have the ACL surgery, it would be "silly" not to as we're already there.  I get his point... but I feel like I'm gambling a bit.  The one thing I've learned through my surgical experiences... is that is you can avoid having any procedure done that will cause trauma to the body, then avoid it.  Tough call.

Offline silverghost

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #7 on: September 10, 2012, 01:19:17 PM »
I see what dilemma you are in...

I suppose it depends how active you are at the moment and your lifestyle...  Luckily i have been married for nearly 10 years so nowhere near as active as I used to be!  ::)

When i had my first ACL I was up and about playing football after about 6 months so i know the acl surgery is much much easier although still painful!!  I saw guys in the hospital built like brick ####houses crying like babies after their ops! guess it can affect everyone!

Hope you make the right decision although guess you won't know for about maybe 10 years!


Sg
'96 ACL reconstruction
'09 Arthroscopy/cartilage repair
Diagnosed with Grade 4 OA no medial cartilage and significant varus alignment
'11 fitted with off loading knee brace
'12 HTO, meniscus transplant, acl reconstruction & microfracture all in 1 go!

Offline Lottiefox

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #8 on: September 10, 2012, 01:57:44 PM »
A couple of questions - how old are you? MFX reduces in effectiveness the older you get.
How big an area is the proposed MFX going to be? I am assuming its a WB section as you will be non weight bearing.
MFX doesn't guarantee no false parts in the future, it can only try and mimic the natural "scar cartilage" we have that develops. Do you have much pain regarding the site of damage?

I rejected MFX 3 years ago. I have a lesion on a WB section of my femur done through sprint turns on a bumpy field and a general wonkiness of leg! Mine has settled down and is perfectly bearable now unless I jump off a high step, which I can happily avoid 99% of my life!

Good luck with your choice

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline rob43

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #9 on: September 10, 2012, 02:01:52 PM »
ive had a micro-fracture to the cartilage also,mine was 1.5cm done 11 months ago although i am up and about doing sport etc it isnt right and never will be as strong as my other knee,i also question why they do micro-fracture when the rehab is so long and i,m guessing half the people its done on it  doesnt work!

Offline eastvillageNYC

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #10 on: September 10, 2012, 03:30:44 PM »
Lottie-

I'm 39.  I have no idea how big an area the MFX is going to be, and neither did the ortho I assume (as we did not have the MRI at the time).  He knew the ACL was torn from manipulating my leg, and I'm guessing its something (MFX) he does to aid in the regeneration of the cartilage... assuming its damaged.  I had some meniscal clean-up work done in 1995 on the right knee... but other than that, it's been fine until 3 weeks ago while playing football (soccer) when it popped.  The left knee has undergone 2 ACL reconstructs, no MFX... but that's really inconsequential.

To make it clear, I'm officially retired from playing any more league football... so I'm not looking to get back on the field.  Add to that I am getting married in June of next year... so not looking to be hobbling around either.  I just want to play with my kids (when I have them). 

Offline eastvillageNYC

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #11 on: September 10, 2012, 03:35:16 PM »
Rob43-

you're never the same after surgery, so I hear you there.  Did they just do the MFX only, or was it in conjunction with something else you were having done?  I'm curious if someone had the MFX in conjunction with ACL reconstruct,
« Last Edit: September 10, 2012, 03:38:53 PM by eastvillageNYC »

Offline Lottiefox

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #12 on: September 11, 2012, 08:42:08 AM »
Thanks for the info, I think at 39 you're classed as young enough! Hurrah! (says she just over 40 !)

There is a poster on here Cosmicsnuffle who had ACLr and then about 12 months after had MFX for a focal lesion that was causing a lot of issues on weight bearing and walking certain ways. I know she's had a pretty decent result from the MFX and the rehab wasn't half as bad as she thought it was going to be, but perhaps she got lucky!

Surgery seems like a game of poker sometimes, which is worrying given the whole premise of medicine!

Good luck with your decision

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline rob43

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Re: Having ACL reconstruct, but do I really need the microfracture surgery?
« Reply #13 on: September 11, 2012, 11:06:01 AM »
i was told i needed it because it had torn while playing football, and after the op i was told i had a microfracture+a lateral release
i am back playing football but as i said its not right i can twist turn run jump etc but it feels weak and i wont be able to return to the same level i was before hand!