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Author Topic: Third surgery November 6, 2012- possible microfracture or OATS  (Read 980 times)

Offline CrankyShortBus

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Third surgery November 6, 2012- possible microfracture or OATS
« on: October 20, 2012, 09:01:21 PM »
Why hello there fellow knee geeks, how's it going.  I ran across this site researching what microfracture surgery and have some questions about my upcoming knee surgery.  First off though some history of my knee journey...

I started having problems when I was ten or twelve from an injury I sustained playing basketball and have had problems since with only about a year or two respite total.  I went about my business despite all the pain in my knee until I had my first surgery in 2004. In that surgery, the doctor removed a piece of cartilage on my medial femoral condyle that had partially sloughed off and shredded the outer edge of my meniscus causing a tear all the way across (did not break out though), removed three pieces of cartilage had broken off completely and were floating around my joint, did chondralplasty, and debridement. Six months later though, in 2005, I was back under the knife for scar tissue removal on the back on my patellar tendon pushing my kneecap up and to correct the tracking of my patella and have additional chondralplasty and debridement. This second surgery lasted one, maybe two years before I started having knee pain again.  At this point I vowed I would not go back o the doctor until I could no longer walk and they had to replace the knee. Which now brings me to the point I am at today...

About the event, I really don't know what happened but I think it was from lighting weights (squats and Romanian dead lifts) since that was the only thing different I did that day. I went to see a surgeon down here in Seattle as my previous two surgeries were in Dallas, TX and he ordered an arthrogram MRI which showed a piece of cartilage that had fully broken off and settled on top of my ACL. As far as damage to my cartilage, he said that he did not know really how much damage was there and wouldn't be able to tell until he got in there. All that said, he is definitely going to be removing the piece of cartilage and doing chondralplasty/debridement, but will also possibly be doing a microfracture as well.

Finally to my questions- what can I expect from the microfracture results wise, success wise, and pain wise? Through research I know it is a long recovery but there is not much online about the other aspects post-op. Would OATS be better or could he end up doing it over the microfracture if it is called for?
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2004 - partial menisectomy, debridement, loose cartalige removal, chondralplasty
2005 - scar tissue removal, debridement, chondralplasty
2012 - debridement, loose cartalige removal

Offline NickCat11

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Re: Third surgery November 6, 2012- possible microfracture or OATS
« Reply #1 on: October 21, 2012, 02:21:26 AM »
My personal opinion would be to stay away from microfracture. It's an outdated procedure with poor results. If possible, try to see a cartilage specialist and ask about Denovo NT. Depending on your financial situation, stem cell injections is also a great option. You can read in depth about both of these options on Google :)
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Offline CrankyShortBus

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Re: Third surgery November 6, 2012- possible microfracture or OATS
« Reply #2 on: October 21, 2012, 08:50:48 AM »
Thanks for your reply, and i hear you on your comment and that is what I am afraid as far as the microfracture but doctor did say possible OATS once he gets in there- basically one or the other is likely given my history but he said he cannot make a definitive decision until he is actually in there. He did say he scheduled enough time to do what was needed (about 45 minutes is what i was told so is this even enough timemfor OATS) but again did not say what he was thinking. He did however say that I am possibly a candidate for a transplant when he evaluated me prior to the MRI, but not really much more. I want to simply trust his best judgement but am leery given my history. I did tell him that I would prefer it if he did what would give the best results despite a longer downtown as I have been living with these issues for most of my life and it would be nice to get back into sports I love (hockey, bicycle racing, etc.). As to what his specialties are, he is a sports medicine surgeon and does lots of cartilage work on professional athletes. I just made a call and ended up getting an appointment with him.....
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2004 - partial menisectomy, debridement, loose cartalige removal, chondralplasty
2005 - scar tissue removal, debridement, chondralplasty
2012 - debridement, loose cartalige removal

Offline NickCat11

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Re: Third surgery November 6, 2012- possible microfracture or OATS
« Reply #3 on: October 21, 2012, 09:41:59 PM »
If he's a cartilage specialist then ask him about Denovo NT. For isolated cartilage lesions, that's the way to go.
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Offline Teacher2Many

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Re: Third surgery November 6, 2012- possible microfracture or OATS
« Reply #4 on: October 21, 2012, 10:32:38 PM »
I agree in trying to stay away from the microfracture...success results simply aren't that great anymore.  I had bilateral ACI done 3 yrs. ago with possible revision using an allograft but that ended up not being needed.  Not sure if he was going to do OATS with an allograft or an autograft but with an allograft, it's a lengthy process to try to find the right donor for you and is not something that is available 'off the shelf'. 

If I were you, I would consider using this surgery as a 'look and see' and then waiting to make a final decision on what type of cartilage repair surgery would be needed based on defect size, etc.  I know when I was going in for my scope to determine if I needed ACI or not, they asked 'could we do microfracture if we find that you are a good fit for it?' and I told them absolutely not.  No way was I going to agree to that time frame and recovery without investigating other options first.  Turns out my defects were too large for microfracture anyway so that option wouldn't have even applied.  Perhaps he can do a scope and clean-out and then you can have a conversation about what option would be best, and then go back in and do that option.  I know it's an additional surgery but it might mean you get the right results without having to repeat a major surgery months-years down the road.
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6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline Room 101

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Re: Third surgery November 6, 2012- possible microfracture or OATS
« Reply #5 on: October 24, 2012, 07:52:10 PM »
Hi, Cranky.  I hope your search for opinions and options is going well.  All of the replies in here are great, by the way.  First and foremost, you want a cartilage specialist to help you determine the proper path.  I had a sports OS initially, but he referred me (even made the initial appointment) to a cartilage specialist.  Here is my short story verision because it is a bit different

winter 2008 I had a left knee AMZ & patella ACI on 3cm x 2.5 cm lesion.  Everything went according to plan and the result was extraordinary.  I was back to sports (not basketball or volleyball though because I broke my wrist playing softball when a guy took me out trying to knock the ball out of my mitt - I'll never forgive him... but I digress) and had so much confidence in my knee.  Worst thing I got was some swelling if I overdid.  I was running up & down stairs though.  I felt 20 years younger, like a teenager again.

Spring 2011.  I was once again training for softball post wrist surgery.  Honestly, I was a beast.  hitting farther, playing outfield again.  It was so awesome, and I am thankful for those memories.  One random day, at home walking across the yard playing with the dogs, I bent over to pick up the Frisbee... and POP.  Something happened to my left knee.  Swelling.  Inability to bear weight.  PAIN.  Crap... I had a scope planned for microfracture or ACI biopsy on my right knee a couple of months later.  I went to see the surgeon, moved up the scope date to become bi-lateral.  He didn't like what he saw, but didn't commit.  Of course, I thought I destroyed the ACI somehow... I didn't.  When I awoke, I immediately felt my right leg for a brace.  Nothing... that meant ACI biopsy, but I figured that much... then I moved my left leg and dang was it HEAVY.  Turns out my ACI graft was "pristine" and looked perfect.  When I hurt my knee, I tore trochlea cartilage.  A very small and deep tear with very distinct and clean edges.  So they did a semi-surprise microfracture on my left trochlea. 

5 1/2 weeks post mfx on my left trochlea, we went to Sicily with friends on the vacation we had planned.  I had pt to go and got along just great.  I healed just great.  I was pain free and exercising and had no pain.  So, I have had a recent great result from microfracture, but my situation fit the bill, and my surgeon will always pick the best option for me.  I am confident in him.    I never did return to sport as my right knee gave out before I could attempt it.  We did xc ski thru the winter.. 7 months post mfx.

September 5, 2012 - I had a right knee AMZ patella ACI.  I am 7 weeks post op today and doing ok.  Pretty standard so far i think.  I lost the brace at 6 weeks and am meandering about on 1 crutch.  Lots of stiffness and swelling still, but I was limited in ROM until 6 weeks.  No pain.  Just discomfort.  Plugging away every day like most who have had similar issues.

I wish you the best in your search, surgery and recovery.  This is a pretty great support group. 

Room 101
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February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella
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