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Author Topic: I took the plunge, Lateral Meniscus Transplant + OATs  (Read 2435 times)

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Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #15 on: December 04, 2017, 04:12:37 PM »
badleftknee, I'm glad things are going well for you.  I enjoyed aspects of the NWB phase since I was at home and could manage my diet and plan my comeback, but you do get to the point when you just want to go up stairs again without a whole procedure.  Hang in there, sounds like you are nearly at the other side.

The little I have made sense of, I believe swelling is moved primarily through knee flexion (either through the activation of lymph nodes, or pressure in the knee capsule expelling excess synovial fluid), so when you become more active I would hope that reduces down for you.  I say that when I still 5 months on have stubborn swelling, I presume the healing environment in my knee requires the swelling environment as it is still raw healing phase, it would be nice for it to not be there, and get back proper knee function (I have read swelling interrupts brain to muscle messages contributing to poor coordination) but I guess that will happen with time.

I'm rooting for you.
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 fro60ol

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #16 on: December 15, 2017, 08:35:13 PM »
thank you for all your posts!

i posted in my own thread that i am looking at OATS as well and seeing how you guys are handling it is giving a good sense of what i have ahead of me. 

Offline badleftknee1

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #17 on: December 27, 2017, 04:29:11 AM »
Hey guys, quick update (also in my thread)- now 8 weeks post microfracture and full WB! Damn, it feels good. Progressively came off crutches over 2 weeks, which was absolutely required given I am still a bit unsteady, having to walk slow to avoid odd pains/sensations that seem to come from some locking of the patella (particularly with initiating gait after standing for some time). I am doing ok getting around, but long walks are definitely slow and cautious. I, thankfully, don't seem to have pain emanating from the microfracture site. I still have some very mild residual swelling when I put my knee into full flexion, you can feel bulging around the soft spots around the patellar tendon (this has drastically gotten better with weight bearing). I will say that some of my stiffness issues I had prior to surgery (I was having a lot of "classic" arthritis symptoms with stiffness after periods of immobility, particularly in the back of the knee) are better even with the residual swelling.

The next biggest step for me is gonna be weighted knee bends, e.g. stairs, squats, cutting motions. If I can't do these, than I really haven't gotten anywhere with the surgery given these were the deficienes that got me into this surgery! So I am trying to stay optimistic that all this wasn't for nothing! I am now good friends with my PT, who I am gonna start seeing 2x per week in addition to daily workouts, somewhat more extended on weekends, though all are somewhat limited still.

Will keep you updated, and look forward to hearing more about your cases.

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #18 on: January 12, 2018, 08:30:05 AM »
Hi all, 6 month update post surgery:

My 6 month anniversary was last week, and I had my first post surgery MRI on that day specifically to mark a kind of milestone.  I saw Tim last night to discuss the scan, it was an anxious night worrying what news he would tell me despite my steady progress.

To my relief, the meniscus is in position and intact, the OATs plug has fully taken and given me a full articular cartilage again, the donor site has a good layer of fibrocartilage, and amazingly, the full thickness fissure in the articular cartilage in my kneecap groove has vanished, I now have a perfect cartilage surface!  I take the latter with a pinch of salt, as despite taking every supplement I have ever heard of to assist with cartilage health, I know it doesn't grow back easily, but the MRI showed a perfectly continuous smooth full thickness articular surface, where as previously it was a plain as day sharp fissure.  Perhaps the defect somehow fell between the thickness of the MRI slices, but given the nature of the defect previously, it was visible on several pictures / slices, its a welcome surprise.

Things have developed significantly over the last month in function.  Still I have persistent low level swelling permanently, which gets worse as I sit at my desk all day, but can be reversed after 20 mins of focused activity to move the fluid back out.  Otherwise I am lifting all manner of weights in the gym, progressing on balance work etc.  For day to day activities, walking on level or gradients, and stairs (up and down) istrivial.  No stiffness first thing in the morning, in fact that is when I feel best, and I have ditched the 20 pillow leg raise over night to my wife's relief.  Needing to go to work, fit in a proper gym session and get at least 6 hours sleep means my family have bore the brunt of it, seeing me perhaps an hour a day.  While my wife has been supportive she has voiced that this can't go on forever, and I am thankful for her tolerance.  The most tricky part of all of this has not been the discipline or enthusiasm to keep on with the process, but this social aspect.  It isn't trivial and while I had her complete buy-in at the beginning, it has been tested to the extreme in reality.  Of course the unexplained aches and pains which can be present for a week at a time are alarming if you have a sensitive disposition (as I do), but so far I have rode them out, with just a few more grey hairs to show for it.

I'm still not at pre surgery levels in terms of comfort because of the residual swelling, my only idea to relieve some of that is wear a pair of compression socks while I am at my desk to assist with blood and lymph flow around my legs, but it feels like a long shot.  I think it is mainly synovial pooling rather than lymph which would mean needing to compress the capsule rather than the calf tissues, but will try and see how it goes.

All in all, Tim wants me back to sport in the summer.  It still seems like a pipe dream but he wants me focused on that, not that I need a timeline to continue to be motivated, I don't think I can find much more time to rehab in my schedule, or push much harder. He inferred he speaks to other patients of his about me and my progress, so think he is partially keen for me to return to sport to report back what is possible, not that he wants me back irresponsibly early, I think in his mind wanting to wait longer isn't necessary, where I would be willing to wait as long as necessary if it meant long term, worry free sport participation.  Maybe too he has an eye on statistical lifetimes of transplants, and if i spend too long rehabbing, statistically I won't have as much time with it before predicted failure :( that is just conjecture on my part, I remain positive for the future.

Anyway, enough for now, nothing is certain for the future, I still want this knee to last me for the rest of my life which based on statistics still seems like a pipe dream too, yet that is my goal, so i will give it the 5 star treatment every day and take it a step at a time.
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 #19 on: January 16, 2018, 02:15:21 AM »
Amazing news! I can only imagine how excited you are....after all the effort, the weekly ups and downs....good news is so vital. I really think you are going through this process well, and now to know that you made the right decision!

The swelling is going to have to pass eventually, right? I can't imagine it would stick around too much longer. I am curious if it is some sort of warning sign that you still need to ease into things, no matter how stable and pain free you are. Perhaps, or possibly even more movement will help it further recede? Either way, small potatoes. I am curious, are you able to walk for extended periods of time at this point or does fatigue and discomfort kick in?

Please do take it slow though, you can't let your cartilage reach where mines at or it gets a lot worse, quickly, and that meniscus is your last resort. Just food for thought, coming from someone who wishes he had caught his pathology as early as you did....when I got my second opinion at Brigham and Womens and was recommended for meniscal transplant, I was told specifically no pivoting sports following; this seems to be the consensus amongst the majority of cartilage restoration specialists and it has to be for good reason. I absolutely want you to reach your goals, but would be crushed for you if something traumatic happened too early in the process. I have read a few stories out there going for second rounds of meniscal transplants after the first one goes!

I still go back and forth on whether I should go through with a meniscal transplant, even while waiting to see how things work out following my microfracture. This, despite my poor cartilage status (given that all major academic articles except those by Stone Clinic seem to predict failure for me with meniscal transplant). I dream (basically, just unrealistic expectations) that even over the last few years surgical techniques have improved, and literature hasn't yet had time to catch up. I will update my thread in a few weeks at the 12 week mark with my progress, but I can promise you lots of ups and downs. I find it difficult to take a step back and grade progress on tiny biweekly and monthly increments, when just months ago I had zero limitations.

One last thing (in attempts to not completely overwhelm your thread), definately agree with the social impact of this process. I am finally able to walk the dog and do household chores with somewhat more comfort, so my wife is pleased (who has been so helpful through this).  But, I have had to avoid so many get togethers, ski/hiking trips, etc in just the last 3 months that it really puts a perspective on the ability to be mobile. I know there are younger patients than I with worse knees, and I envy their will power and strength. And then to realize that we are talking about knees, when in fact there are those out there fighting much worse. Its an eye opening and humbling experience, to say the least, something that I likely needed. 

Keep the updates coming. After perusing this website and others, I feel like long term outcomes are so hard to find and so many people will benefit from hearing your story for years to come. Thanks again for the insight.



Offline Mr. Potato Head

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #20 on: January 26, 2018, 02:17:03 AM »
Lateral meniscus Guy thanks for your updated report. For all of us thinking about MT its great to follow your progress.  Bad left knee and I are in the same boat. Haha .  Went snowboarding a month ago and it totally swelled my lateral compartment. Knee inflamtion consistent but finally get better.   Got HA injection last week and thats felt great.  Oh knees!!!

Offline Tai-pan

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #21 on: February 04, 2018, 10:04:17 AM »
 LateralMeniscusIssuesGuy

This LOG is a great read. It goes without saying, I really hope everything works out for you.
I will keep following and look forward to hearing the day you are back doing sports...pain-free!
 

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #22 on: February 12, 2018, 01:48:02 PM »
Hi all, approx. 7 month update.

It doesn't feel like there have been many gains since my last update, but a few new developments.

I have subjected myself to more open chain exercises (leg extension and ham curl) than over the rest of my rehab.  Specifically my physio (Isokinetic, Harley Street, London) had me on their machine which is a combined extension and curl device, which you strap into and it limits the time it takes to move in the arc, irrespective of the force applied, and so can gauge leg power generated and compare hams to quads.  Seems from those tests (which I suffered no ill effect from pushing as hard as I could!! a mini milestone for me) indicate understrength quads.  I guess I know this as I am squatting and deadlifting what my able bodied peers are, but then can't do other more quad dominant exercises anything like as comfortably.  So I am reducing the frequency of the big compound exercises to focus on more functional movements (such as single leg straight leg box squats) trying to activate my quads more.  They look flexed but I'm not convinced they are doing what they should in some movements.

I have put on 5-7kg since my lowest point post surgery, I imagine lots of that is fat, but went with a clean high calorie + protein diet trying to be an anabolic as possible, not sure how effective that has been but it might have fast forwarded me a bit, as least my mind is clear that from a fuel perspective I shouldn't have lost out on any gains in the gym from not eating enough, trying to watch my weight.

I am still low level swollen, I would say where it was reducing month to month, that it has remained constant this month.  That said my flexion has increased minutely again, and I've had improvement again with how quickly at the end of the day I can get full passive end of range movement (down to about 20 seconds now).  I would like swelling to go down as surely that is indicative of the joint being unhappy, but no one has really shouted out about needing to take any action on it yet, so I suppose wait and see.  I would perhaps consider an injection in the joint, maybe removing the fluid in my knee and replacing it with fresh HA, in case something about the fluid in there is preventing it's dissipation.

In terms of problems, I really do have a complaint about the medial edge of my kneecap.  It is near an entry point to the surgery, and when my quad is under load and bending, it is painful, it feels like I have an thickened or scar tissue structure there (perhaps MCL or the ligament type material to the medial side of the kneecap) and that can get irritated with too much stimulation, to the point where flexing past the limit of active ROM is painful.  I've been exploring the pain with my box one legged squats and it wasn't as bad today as last time, so perhaps it is scar tissue breaking up, or its irritation where I have inadequate muscle control for some movements meaning some structures are interacting when they shouldn't. 

Overall I am progressing slowly, but to be honest the introduction of a deadline from my surgeon has introduced a bit of panic into my rehab, and anxiety that I might not be moving at the rate required to meet that goal.  SO I think to enjoy the process more, and stay sane, I will ditch the timeline mentally and focus on the small goals letting them happen when they do, just giving the best effort and attention I can spare.

For all my complaining I am very mobile now, I think I could stand or walk for hours without any real negative effects, joint isn't too noisy (silent after a gym session curiously, make crackly sounds when 'cold', what's that about?  muscle activation? reduced fluid in capsule?), and pain free in the lateral compartment 99% of the time.  I think I get a mild ache one a week for about an hour, something like 99% issue free in my limited but fairly rewarding current level of activity.

Thanks for all the advice and support everyone, I am still aiming for sport return, however reckless, but feel strangely strong and robust, more so than I imagined I would after the surgery, it is almost feeling like my leg now, I often forget that I have had a transplant.

Please all keep updating with your own progress and decision making, as this site was invaluable to me getting this far, I plan to donate in the very near future.
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 #23 on: February 23, 2018, 03:27:16 AM »
Keep up the hard work. It sounds like things are continuing to move in the right direction. I'm hoping that swelling goes away for you completely over the next several months- no rush though, as you are now very functional and nearly uninhibited by most activity it would seem. Next up is agility movements, perhaps some running? Looking forward to hearing your continued updates. I still find it hard to find documented success stories despite the growing number of procedures being performed (and knowing that there are many success stories out there).

My microfracture rehab has been a bit shorter than yours from a post-surgical standpoint, but does not obviously offer the degree of benefit that a transplant will. As an example, swelling was nearly completely gone by 3 months, and I don't really have "risk" of tearing an implant (meaning I can start more aggressive rehab earlier). I have started some light agility training at this point, light jogging but mainly only the length of a gym floor. I still have "twinges" often in my medial compartment- isolated knee bends at 30 degrees (hiking, etc) or cutting motions are the worst, and the running isn't great. At 4 months I am trying to determine what success is- and I tend to think its based on 1) progression and 2) my expectations. Currently, my progression has slowed but not completely plateuad, and my expectations are not completely met despite being better off. Gonna repeat an MRI (suggested by the OS) to look and see if the microfracture healed in and see if there is continued bone marrow edema (if so, would suggest continued lack of protection of bone). OATs/MTS remains in the back of my mind....


Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #24 on: March 12, 2018, 10:05:07 AM »
Hey all, brief 8 month update.

Things have progressed positively on all fronts over the last month, however in tiny bitesize bits.

The negatives first, I still have residual low swelling.  I bought a set of very light compression knee sleeves, not wanting to cause any patella irritation, but hoping the light compression could do something for the pooling of fluid that can happen during my 10 hours sat at the desk each day.  The initial response is positive as my selling has halved and occasionally has been near zero (near zero visible from sweep tests anyway).  So will continue wearing while at my desk to see if I get it flushed more.  I still have some end of range resistance if I donít bend my leg fully at all during the day, can take 5-10 seconds to get entire heel to glute flexion, but if I stretch that a couple of times during the day is is basically always immediate.  Also the joint is noisy when bending past around 110 degrees, I feel what I imagine to be the MCL flicking over part of the knee architecture, and there is a second less extreme noise when getting to 120 deg.  I wonder if some of this is due to the level of swelling still present on the capsule, or whether it is due to thickening of the ligaments and / or scar tissue making their movement during flexion more prominent.  For the avoidance of any doubt, the same clicks are observable in my good knee, but you have to hold the knee to be aware of them (i.e. feel the flick), the noise is so much more subtle.

The good progress:

-   I can comfortably sleep on my front, I spent so many years now sleeping on my back to protect my knee, to sleep on my front is a real treat
-   Fairly impressive increases in functional exercises at the gym (squats, deadlifts, also open kinetic chain exercises are pain free with challenging weight i.e. as hard as I can go)
-   Good balance work
-   No reactive swelling response to any intensity of workout, tho they are all performed carefully with proper form of course
-   Ability to graduate walking down stairs very slowly and carefully and controlled, more so than before surgery
-   My upstairs performance feels identical for both legs, even for double steps
-   95% of the time I forget I have any issues with my knee, and it feels entirely like my knee.

I have not attempted jogging get.  I have tried some jumping and reacted well in a very controlled basic few attempts, but donít plan to no too much until the year is up.  Interestingly the IsoKinetic machine test at my physio (a combined leg extension and hamstring curl) measurement for power had me the weakest male in the gym that day, despite probably looking the most muscular, so I will keep my nutrition to be growth and low-inflammation focused, and work out as often as possible.

I do have one eye on whether a return to sport is possible, I know I would be in a very very small minority who managed to do something like that (just 1 in the c.200 of Tim Spalding went to professional sport and seem still fine, tho he was younger and stronger), but I am obsessed with it.  So to start to build a tolerance to playing I have just started kneeling most days, on my soft sport specific knee pads, just getting comfortable with that.  So far not too many ill effects.  I even got fully kitted yesterday (ice hockey goalie kit) just to explore some of the positions and range of motion.  I was slightly sore in my lateral compartment when I went to bed yesterday evening, which was a setback as hoped it would feel fine, but often through my recovery I have hit movements which have left me sore, even raw pain types, and those have all since resolved, so I hope this is similar to that, rather than indicative of those positions seriously jeopardising my lateral meniscus and repaired articular cartilage.  Iíll do something similar most days and just see how it does, if the discomfort doesnít subside in a few days I will cease until I see Tim again next month for the 9 month follow-up.

I can get into true full squats (ass to grass) but am avoiding doing it too much as my PT has said itís a position of extreme stress on the meniscus so why risk it if not necessary for day to day life or my sport.  I couldnít help but enjoy being in the position as it looks and feels athletic, and want to keep my with my 2 year old who pops down into it no problem, but will hold back.

In summary I am really happy, really relieved, but resisting the urge to step off the gas.  Since I said to people that my surgeon wanted me back in the summer, those I used to compete with have been checking in more often seeing when I am back, which while thoughtful, has added more of that pressure I mentioned previously, and I have to manage their expectations, as unless you have looked into it, no one realises how big a surgery this is or how much of an ask it is to return to sport, but thatís as I have wanted to keep it private so a situation of my own creation.

Iím still NOT at pre surgery capability, I used to run for trains and could be symptom free after (say a 3 minute sprint, most of the time would be fine after, wouldnít make a habit of it), and was leg pressing more in the gym, but the positions of my sport feel mainly pain free, so it feels like the surgery has addressed the lateral compartment issues, and that I still just have more rehab to do to understand my body and truly re-establish the mind muscle connection.  I consider myself a fairly present and thoughtful and dedicated individual, but to be at 8 months post-surgery and still remarking that it feels like my brain still isnít fully in control of my body, is surprising.

Hope thatís a useful update and not too self-indulgent!  My 9 month update will also include a surgeon follow-up.

Cheers all and please feel free to update this post with your own progress and decision making.
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?















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