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Author Topic: I took the plunge, Lateral Meniscus Transplant + OATs  (Read 1322 times)

Offline LateralMeniscusIssuesGuy

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I took the plunge, Lateral Meniscus Transplant + OATs
« on: August 09, 2017, 04:26:59 PM »
FYI after much deliberation and then months on a donor list, I went ahead at the beginning of July with a LMT and OATs plug for my lateral compartment of my right knee.  Performed by Tim Spalding at Warwickshire Nuffield, UK.

As a reminder I had a very thin rim of meniscus remaining (part of one horn lost) from two previous surgeries.  I am 34YO male, 5'11", 80KG, always been fit.  Had remaining meniscus removed and replaced with a donor flown across from the US.  Also had a single 8mm diameter plug from my own trochlea, into my femur (the area that taken weight at 20-30deg bend).  It was commented that I had grade II thinning on a 20mm diameter area of both my femur and tibia.  It is hoped that the replacement meniscus better protects those thinned surfaces going forward.

Very early days, rehab has not been pailful but has been very inconvenient. Am gingerly able to walk pain free but not with a full gait.  Am wearing a DonJoy unloader brace that was provided for free with the procedure.  Will likely get something custom in the future.

I'll update when I have significant news to provide.  Hopefully this is helpful to people.  It will be something like a year or even two to see whether I am in a better situation than I was before.  I do have perhaps unrealistic aspirations of returning to competitive sport, its has been done once before on a mid 20s patient of Tim's who with the same procedures returned and still plays professional rugby.

I will persevere and try to do everything right, lifestyle permitting.

Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #1 on: August 31, 2017, 10:40:17 AM »
8 week update:

Seems things are on schedule with respect to swelling, flexion, strength and scar mobility.

Have had several instances of pain in localised areas during the 8 weeks, all have come and gone, I am now relatively pain free.  Nothing was ever excruciating, but as I am a worrier my mind would always go to the worst circumstance and assume I had a major issue.  I will not be having a follow-up MRI until 6months so am hopeful so far that everything is as expected with regards to the meniscus condition and the OATS plug.

I have approx. 100deg action flexion, approaching 115deg passive.  Almost waling with a normal gait, however slower than normal speed and being careful not to pivot.  Can walk up stairs slowly but walking down is not possible without taking much of my weight through my hands on the rails.  Physio work is mainly all done sitting or laying on a physio bench using ankle weights or thera bands, no machine or free weights and no exercises while standing to still reduce the stress on the meniscus.  I am also having fortnightly MLD massage, not sure how effective it is but my swelling seems less than I expected as a result (I am a notorious sweller).  Diet still quite clean too, hope that has helped reduce the atrophy to a minimum, tho has certainly been some (perhaps 25% of VMO lost, possibly more its difficult to say, even more perhaps lost on outer quad).  Am inching the recumbent cycle saddle slightly more forward weekly to increase flexion.

So long long way off knowing whether I am in a better place, but for now I seem to be somewhat on schedule or slightly ahead in some categories.

Will probably post again at the 4 mth phase when I should be starting to embark on regaining muscle bulk.

Hope this is useful to anyone looking at either procedure.

Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #2 on: September 26, 2017, 11:41:38 AM »
A very brief 12 week update:

Several instances of pain around the kneecap while trying to increase range of motion and mobility, most seemingly due to muscle imbalances, most pain has gone now.  My ROM has progressed to approx. 130 degrees.  I am walking without any issue on flat ground, and climbing stairs without much issue.  Decending is still very gingerly.  I think my muscle firing is off as my VMO doesn't seem to be doing anything when walking stairs, so I have lots of training to do.  I am moderately swollen at the end of each day, which goes away over night.

Focus is on ROM and muscle firing, bias towards the former based on the assessment of my PT.

Am now managing to cycle with moderate cadence and some resistance, and I am managing to get on it about every other day.

Scar mobilisation is decent and I continue to work ok it.

So far no major setbacks, next consultant update at 4 months.
Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline akawai

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #3 on: October 04, 2017, 09:28:11 PM »
keep at it. keep us updated.

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #4 on: October 22, 2017, 07:50:18 PM »
Lateralmeniscus guy,

Thanks for sharing your story. Would be interested to see how the progress is going. I am 32 yo M very active in football and skiing with prior menisectomies, 3 months ago while playing football noted swelling in my knee- turns out I have full thickness chondral defects of large area in tibia and femur- life changing findings that I did not expect and its tough to deal with- being recommended OATS (allografts) + meniscal transplant though its scary to think about give mixed outcomes. Another is recommending symptom management as long as possible followed by partial knee replacement. Read my full post if you are interested, would be very curious to have your guidance.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=71161.0

Anyway best of luck, I know how scary it must have been to make the plunge. Best of luck and keep us updated.

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #5 on: October 23, 2017, 10:42:11 AM »
Itís about time for my 4mth update so this is good timing.  Just shy of 4mths, I have finally started descending stairs, however, gingerly.  Key to this seems to be a pain reduction in the knee, meaning I seem to have made progress with my firing of my quad muscles in more movement scenarios, resulting in less end of day swelling and more flexion.  I am about an inch away from passive heel to glute stretch.  I think the pain reduction, upon reflection, was mainly nerve pain around the shin area.  It has improved significantly with the passage of time.

Scars are barely visible, aided by hair regrowth, but also incredibly neat.  The scar mobilisation and patella mobilisation seem to be going terrifically well, so happy for those as have helped knee mechanics further. I still sleep with a raised leg, and wake up most mornings with only the swelling in my capsule to be present.  It does still shock me how stiff my leg feels in the morning after being raised and very straight overnight, but I think it is necessary not only for swelling but to make sure I retain full extension, it does only take around 5 minutes to warm up, but it is still shocking and not something I have experienced in my life before.  As I said in another post, swelling is of real interest to me, the different types of swelling in the various structures of the knee.  At the end of the day I am more swollen but with an hour of dedicated raised stretching and flexion and massage exercises, I can get back to what I imagine to just be capsule swelling.  I am looking forward to my knee swelling being zero occasionally and seeing if that means for a further breakthrough in flexion and also muscle firing (swelling interferes with those messages as far as I have read).  Muscle activation seems to be key for me at the moment in that, I continue to use a TENS machine when doing exercises that should utilise the quad, such as the leg extension (on ultra-low weight) so try and make more of the muscle fibres respond on request.  The more my muscles are doing what they should do, I imagine that will ease strain on the joint surfaces, reduce swelling, make muscle firing better etc. itís an endless cycle, on which I think activation is the easiest to achieve at the start right now.

So far I am not Wolverine, but it would appear, in the absence of a scan, I am healing on schedule in an ideal way, so I couldnít be more satisfied given how apprehensive I was pre surgery.  You certainly need very understanding family and work colleagues to go through this procedure and not get frustrated or do something silly.  The empathy from most has worn off since I ditched the crutches and the limp, and so its those few who remain supportive and appreciate the length of time ahead of me, who have been truly crucial.


Hi Badleftknee1,

Devastating to hear of people given similar news to me.  I was still actively representing my country at 32 in my sport when they saw the issues on the inside of my knee (now 34).  My articular cartilage defect area was much smaller than yours (about 1cm squared area) and was treated with a single plug.  As I have come to terms with the length of the recovery, I am very patient and happily taking my time with minor incremental improvements each week.  Iím happy to just keep plodding away (donít mistake that for being pedestrian about it, I am going full tilt with workouts and physio, in the gym every day, some days before 4am, getting under 6 hours sleep just to fit it all it, despite knowing how important sleep is).  I just canít go any quicker, as long as I know I am going as fast as I can and putting max effort into anti-inflammatory and muscle building diet, and workouts, and rest, its leaving me with a peaceful mind.  So there is potential benefit to having surgery it seems, so far anyway.

For what it is worth, I spent the best part of 6-12 months deciding what to do after I got the news of my knee condition, I was in good condition relative to you and most in that I didnít have pain unless I did some kind of activity that aggravated it (which didnít include normal daily routine or most gym work).  But I want sport again, and to be able to kick a ball or race my son, so I went for it and had the surgery.  All I can recommend is that you speak to surgeons experienced with both procedures, I think I spoke with 6 in the end, which cost me plenty, but I ended up finding a guy who gave me real confidence.  My research was geared towards small defects so I donít know about the success rate of OATS for a large area of defect, or much about the medial side in general.  Itís possible the exploratory arthroscopy reveals things not to be as bad as thought (it was the opposite for me where the MRI didnít indicate full thickness wear, but upon inspection it was).
Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #6 on: October 24, 2017, 01:23:33 AM »
Lateralmeniscusissues,

Thanks for your thoughtful response, very helpful. I am glad everything is going quite well for you, I really hope it continues this way. It very much sounds like you deserve it.

I was curious. I am actually in medicine myself and have a fairly active job. So beyond even the medical questions, I don't know how I would find time for this procedure and its recovery. If you had to take time off from a job (where you are on your feet for much of the day) post-procedure, what do you think is a reasonable time line to get back to work (limping around would be okay, as long as no damage being caused)? I am told 6 weeks NWB post procedure, but am thinking much more time would be needed off. An advice here would be great.

Thanks again. Wishing you the best in your continued recovery. Keep me updated on it.

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #7 on: October 24, 2017, 08:11:41 AM »
Badleftknee1,

I had 5 weeks off of work, and spent it entirely laying down apart from performing my exercises for portions of time during the day.  I too was NWB for 4 weeks, partial after that but to be honest wasn't really putting much weight through it until 6 weeks, I can't remember when I came off the crutches but was off them by 8.  I would not advise being on your feet much even now (4 months).  The only reason I don't want to be laying down with my leg raised is unless I am on a bike or doing other physio work.  I do not respond well to standing or walking for long periods of time, but I am a notorious sweller from previous surgeries too.  I really can't recommend enough having an extended period off of work, and that if you return that your workspace is adjusted so you can have your leg raised (the ideal is above your waist but that is usually unsociable) and certainly not standing all day.  Your muscles will have wasted and deactivated, so you put too much unmanaged weight through your joint, even now, unless I am really concentrating on having everything fire, nut perhaps I am just not a very present person and that would come back to you more quickly.

I'm really interested in what you decide to do, and of course will help with any knowledge I have accumulated along the way, however since I haven't done any of the research myself, its all just conjecture and what seems reasonable to the layman.  I'm still just praying that I at least get back to my pre surgery position, if I get there, then any more is a bonus and I can reconcile that I am no worse off for the decision.  The conflict you are going through at the moment was the hardest part for me, where I felt I was doing nothing, and had not committed to a life or surgery or no surgery, and my marriage was suffering as a result.  In the end I went with the thing that felt it had a chance of working, but if I am honest I think I went ahead in the end because of a man crush on my surgeon, and irresponsibly because I felt better doing something than seemingly doing nothing.  Not the best reason to go ahead, but I at least got as many bits of information I wanted to hear to make it not be irresponsible for me and my wife.

Sorry for the ramble, but an insight into the mind-set of being in the situation as you touched on before.  For what it is worth, while things seem to be going ok, I haven't felt this positive about life in the last 3 years.

JT
Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #8 on: October 25, 2017, 12:32:05 AM »
JT, thanks again for the advice. Its great to have a true vision on the recovery process. I really do hope it works out for you. I did want to key you in on this paper that came out of Brigham and Women's last year, ACI (not totally applicable to you) + Lateral meniscus transplants- these guys had very good results (75% viability at 5-10 years) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076751/) . One interesting fact I see is that although they had good outcomes patients satisfaction was low; perhaps given expectations. The "6 weeks NWB" that we hear in the office is much different then the great description you just gave of situation that you are currently in. I think we all need to really know what we are getting into before hand. Another point is that nearly 75% of these patients go for a clean up scope, which is no big deal, but likely not explained to folks prior to. My point is, you seem well prepared for the challenges, are positive and optimistic, and you have some good data backing up that it will work. Keep your head up, which it sounds like you already are. Glad things are going well with your wife, I'm sure she has had enough of your deliberating (mine already has).

I will keep you updated on my decision making, scope and stem cells next week. Keeping my fingers crossed.

Offline Catherine88

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #9 on: October 26, 2017, 08:30:42 AM »
May i ask you why they didn't propose to you the ostheotomy procedure? It seems like people can get back to all the sports afterwards, and my believe would be it's more durable/less risky than allograft?

Offline Vickster

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #10 on: October 26, 2017, 10:53:40 AM »
Is osteotomy not only used if the bones are misaligned. It offloads a damaged compartment, doesnít fill in any holes. In case of DFO or HTO, basically doing this hopefully buys time before a replacement is needed, usually a TKR
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #11 on: October 26, 2017, 12:23:02 PM »
Ya I brought up up osteotomy with my surgeon as well and basically the focus of these cartilage repairs is to not only correct the cartilage, but then to correct the deficit that lead to this. For me, that is deficient meniscus. For some, it is being bow leggged, and putting increased stress on the medial joint space, and these patients may benefit from HTO.

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #12 on: November 01, 2017, 02:30:14 PM »
Lateralmeniscus issues, (also posted in thread I created)

Went for my scope yesterday and a few surprises but overall is what they they thought it was. I knew I had extensive medial 1/3 tibial plateau cartilage loss (grade 4) as well as focal grade 4 lesions of my medial femoral chondyle from the MRI- the scope confirmed this but they also found a more acute flap or articular cartilage in my medial femoral chondyle, which they ended up doing a Microfracture (small holes in bone to stimulate regrowth if cartilage thatbisnless stable than our native hyaline cartilage) on as they thought this may be the pain generator that was more acute for me (the thought is that the tibial plateau lesions may be more longstanding)- they also found a decent amount of shredded meniscus that they thought could also be contributing which they removed.

So the big surprise is that I now am partial weight bearing for 6 weeks, and recovery to sports (if it works out) looking like 6-8 months. The doc thinks it went well and is hopeful for me to get back into sports, with some pain of course but to a lesser degree. For now, Iím in absolutely no pain and already flexing 90 degrees so the hardest part of this is gonna be mobility around work and the house! I will def keep updating on my recovery and let you know if I can get back to some more high impact activity as I go along. This is, fingers crossed, a good enough bridge to get me another decade without a PKR. If it doesnít work, I will need to consider the allograft procedures.

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #13 on: December 01, 2017, 12:56:07 PM »
Hi all, short 5 month update:

I took a two week holiday from work at the beginning of October, spending approx. 5 hrs/day in the gym, split between flexion work, strength work and balance work.  The 100 hours had a profound mental impact on me, and I felt more connected with my leg, however the improvements did still feel only slightly incremental, no vast improvements.  Since then I have continued with my usual gym routine around work.

As of right now I have no issues walking on flats or upstairs.  Down stairs isn't painful, but my knee capsule still feels full, and has constant swelling present (seemingly low levels, but still there regardless).  If I have a rather swollen knee from being sat at my desk the day, it takes about 30 minutes of focused stretching and flexion work to squeeze the swelling down to the minimal level again, and restore the flexion.  It still takes me 15 minutes of persuasion to have my heel touch my glute, but I can do it almost every day now.

My strength and control when bending my knee is better.  I have progressed to being able to single leg legpress half my body weight (40kg), hack squat machine my body weight (80kg) and leg extension 15kg, all manageable 10+ reps for multiple sets.  I'm not trying to test my 1 rep max :) its great to get DOMS occasionally.  I don't feel my leg muscle looks like it has responded to the training in appearance yet, but there is certainly more confidence or control there now.  I can generate approx. 210Watts on a stationary bike for over an hour which feels like something of an achievement, or climb stairs at 200Watts/hr for the same duration.

I don't have much pain in my lateral compartment that I am aware of, an occasional dull ache, but it is rare.  I am aware of the meniscus being there funnily enough, it feels like I have a wedge on that side of the knee, thicker than I am used to.  I'm still terribly grateful to the donor and their family.  My main pain and discomfort comes from different areas around and (I think) under my kneecap.  That around my kneecap has been hypothesised to be the ligaments exhibiting scar tissue from the surgery and prolonged disuse, and the swelling in the knee stretching them perhaps.  The pain behind my kneecap I think is due to the full thickness articular cartilage fissure I have behind there, which plays up in certain movements (like being on the bike and leaning back).  At the time of my surgery the surgeon was aware of the MRI showing the condition of the back of my knee cap, and I think did some trimming of loose material there, I hope that the sensitivity dissipates over time.

The plan is to have an MRI just after new year to assess the 6 month state of the allograft and the OATs.  Fingers crossed it all looks fine, just giving me the reassurance to continue on and to interpret any discomfort as normal to the healing process.  As mentioned in a post on the articular cartilage injection page, my surgeon has thought lipogems might be a worthwhile experiment to see if that can further assist with healing inside the capsule, and perhaps reduce the residual swelling I have, calming things down.  I've had some helpful replies on that and will keep researching seeing if I can have something suitable done for less than the GBP4k I have been quoted here, as that is probably too much of a monetary outlay for something that even my surgeon acknowledged may have no effect.

Hope that's clear and helpful to anyone in a similar situation!  Next reply will have the MRI results!!
Partial Lateral Meniscectomy (2/3 removed), pristine articular cartilage...2013
Return to impact sport, continual responsive swelling ever since
Mild pain onset..2016
Arthroscopy reveals grade 2/3 articular cartilage damage lateral compartment behind kneecap
What now? Allograft / brace / nothing?

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #14 on: December 04, 2017, 03:08:07 AM »
Lateralmeniscusissues, Iím glad itís going well for you! I canít imagine the MRI would show anything but good given your abilities at the gym and otherwise. Keep up the motivation, your giving me some. I feel like a slacker comparatively..

Thigh just under 5 weeks out and NWB for atleast another week, I also have this low grade inflammation that I canít seem to get rid of after the microfracture, Ebs and flows with acitivity level though never completely abates. I also have some burning in the same compartment, and occasional sharp pains with the wrong movement. From what Iíve read from others microfracture stories this is quite common even 4-6 months out or sometimes longer so Iím sure with your more invasive procedure this would be within the norm.

Keep us updated.

 















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