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Author Topic: I took the plunge, Lateral Meniscus Transplant + OATs  (Read 4233 times)

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Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #30 on: July 04, 2018, 05:22:22 PM »
Finally the 1 year update!

1 year is reported by many rehab protocols as the time required for a meniscus transplant recovery, so I have been curious this entire time how I would feel on that 1 year anniversary of surgery date.  Would my leg feel pre surgery still, or more like a normal leg.  Would I regret the year of work and money invested as it didn’t yield a knee I felt I could live with?  So many questions swirl when you are thinking of going ahead with a serious surgery.

My current response to all of that is satisfaction and relief.  I am largely ache and pain free, zero ‘visible’ swelling, and getting stronger and more athletic month to month. I don’t have discomfort in the mornings, I can get full flexion at any time on demand without easing into it, in honesty it’s been more successful than I had hoped!

I remarked on pains in and around my knee recently, and in fact throughout the rehab process, all of which have resolved. I suspect the majority if not all of which were brought on by waking up muscle patterns, over training / under training, essentially me not coordinating properly leading to imbalances and so muscles tugging on ligaments and structures to the point when they become painful.  Spending lots of time following the guidance of a man named Trevor Bachmeyer (youtube channel “Smashwerx”), spending upwards of 30 mins a day essentially massaging my muscles, peeling facia layers, gaining ROM in my hips and other joints…and it seems to resolve all onsets of pain.  I’m still trying to shift what I think is some plantar fasciitis, but it’s much better than a fortnight ago.  I think this work may be a vital component of rehab that isn’t addressed by any physios I had access to, I do really recommend his channel.

The unloader brace came in, and it is a great piece of kit.  When wearing it I feel very supported, and have already been pushing myself skating with it, performing skating strides which would have been agony before my surgery without issue.  I think this brace will be excellent for any kind of sport outside of the gym, and won’t be visible under my equipment.  I will report back more on it after more use, but after 10 hours in it, I think its vital for me to responsibly engage in impact, twisting and valgus loaded movements, and so thankfully not £700 wasted.

The scaredy cat in me is concerned that I may just be pain free due to the OATS and actually slowly working through that new articular protection…but that wearing away was previously accompanied by massive swelling which there is zero sign of now, so I’m slowly permissioning myself to not think in such a conservative way. 

The physio sessions have stopped now, I won’t get access to more care, just a final MRI follow up with the surgeon next month to confirm everything looks ok inside my knee.  The end stages of the physio which focused on movement patterns in things like quick squats, hops and quick feet was interesting, challenging, and valuable.  I didn’t realise in so many movements how much I was attempting to protect my lateral compartment, such as walking up stairs my stride was very different on one leg to the other as I climbed and descended (twisting my hips, less knee bend, foot placement not under body…), being made aware of these things seems to have left me more balanced and again addressed some pains I would develop.

Whilst this all sounds good, I must stress I’m still not at the activity level that “fully recovered” probably implies in the mind of most persons when they have hopes of what this surgery can do for them.  I have perhaps been more conservative than most with my progression through to impact activities.  I need to apply myself more with a return to running and jumping, but since those activities aren’t core to my sport I have avoided them.  When I have ran for a train recently, I have been pleasantly surprised by the lack of pain or swelling and the spring in my step.  So someone else might instead be able to report flawless running at my stage of recovery, but while I have probably been guilty of overtraining in some ways, I have been cautious with impact. 

Also, I still get pains, but again, I really do think these are muscular / nervous system related due to improper movement or inadequate body maintenance.  They all resolve with time though sometimes reappear.  I can only assume as my movements become more trained that the maintenance time required will reduce, as I obviously have never had to do this amount of stretching and massage before to keep pain free, and still do very little for my good side.

I’ll update after my MRI, which will be approx a 13.5 month update, by which time I should have progressed my attempts at a return to sport, have more time in the brace, and perhaps even some moderate impact work.

So, again, so far so good, pleased I went ahead, if I could turn back time to my initial injury I would have sought out Tim Spalding to attempt my first meniscus repair, and regardless of whether he managed a repair or had to do a partial removal (as happened with the surgeon I went with), I would have committed to this custom OA unloader brace to participate in sport.  Ah, sweet hindsight!

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 AndrewC

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #31 on: July 07, 2018, 05:14:04 PM »
Thanks for the detailed reply. It is great to hear of a success story from this treatment. Im a 42 year old fit male who has always been very active, well until recently. I have a post in the general forum about my current situation but basically, my medial meniscus is torn and extruded from the joint, no articular damage yet according to MRI but it is still very limiting in what I can do at present. Partly through fear, the other part through pain.

NHS said 'cant help' so I will be seeing Tim Spalding and Nick Black and maybe one other opinion depending on choices to see if they can repair it as an attempt to would be the case in America going on my very extensive research. I already had my lateral meniscus repaired in the same knee years ago.... bucket handle tear, and that side is ok thankfully.

I'm a realist though, I know I won't get back to serious running or twisting sports but I served my time doing these, I will be happy to be able to jog after my son and not be in pain so often.

Will see what the consultants say and report back. Please keep the updates coming, it fills me with hope in case this is a route I am offered!! Maybe it won't be and if so, I will have to deal with that.
Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,

Offline Mr. Potato Head

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #32 on: August 20, 2018, 04:10:35 AM »
Lateral Meniscus Guy,

Thanks for all your updated posts will enjoy to continue hearing how your return is to sport and what you decide you can and can't do.  For all of us thinking about this surgery its great information.

Great updates and best wishes for return to active lifestyle!

Offline LateralMeniscusIssuesGuy

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Re: I took the plunge, Lateral Meniscus Transplant + OATs
« Reply #33 on: August 21, 2018, 10:11:04 AM »
I'm glad it's even a little useful, even if just an interesting read.

Had my 13 mth MRI performed yesterday, have the report and 'final' meeting with Tim Spalding on Thursday.  I have encountered lots of issues with the knee as I have tried to ramp up the activity level, all seem to have resolved again, but it's a really confusing, worrying, and frustrating time.  I hope that the MRI reveals that everything looks fine internally, and I plan to hire a movement coach, as despite my best efforts, I'm obviously not aware of the haphazard way I move, sit, lay etc.

I have had /still have:

- shin splints
- plantar fasciitis
- IT band syndrome
- foot pain
- hip internal and external rotation issues

Literally my whole architecture has gone through an enormous reset, and its all jumbled up.  I honestly was a very high level amateur athlete, very present, very body aware (compared to the layman), this has been an enormous shock, especially since things were going on schedule, and none of the rehab schedules remarked on these kind of issues, and I literally had them all together.

I hope that things still turn out fine, I am doing really well despite all these complaints that last for a fortnight or more at a time, but I obviously want to be perfect, and far better than my pre-surgery condition.  Maybe in 6 months I will be somewhere I dreamt I would be after surgery, so far I still have a way to go.  What a mountain of a rehab!

Proper update the end of the week
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 #34 on: August 24, 2018, 08:50:28 AM »
I had my "final" catchup with Tim Spalding at the 13th month post surgery mark, and learnt a bit more about the surgery and the condition of my knee.

First and foremost, I seem to have good thickness articular cartilage everywhere.  The site of he OATS has healed well and has essentially filled the 1cm pothole I had on the posterior lateral head of the femur.  The meniscus transplant is fully infact, no rips or tears, which is as I would hope since I have full range of motion.  He did explain in more detail that of course the rest of the surface of the bone which was not operated on didn't have pristine articular cartilage at the time of surgery, and again went through the pictures to show an almost fluffy texture when it should look like smooth marble, but the thickness is essentially full thickness despite this wear.

I did also have a defect in the posterior lateral tibia head, however he elected to simply place the meniscus over this rather than any kind of oats pug, and it seems I have some kind of full thickness fibrocartilage over that.

The OATS donor site has completely healed with bone, and again seems to have full thickness fibrocartilage.  I remarked that I has a full thickness fissure (essentially a small crack) behind my patella, and that seemed to have disappeared on my last set of MRI, but it is back this time, haha, essentially it was missed in the thickness of the MRI scan slices last time.  It has not developed and as far as he is concerned, is zero issue and the underlying bone is fine.  He doesn't anticipate it progressing and thinks much of the population probably have something similar without ever knowing.

He explained better to me that the reason I have a more pronounced bump in the surgical site is due to the suture technique for the transplant, where he retains a 1mm rim of the meniscus, and then uses sutures to attach the donor to this, then tying the horns down using bone tunnels.  I have been a little anxious that my knees don't look the same, and I keep getting remarks from PTs that my right knee looks puffy, but I think it is this protrusion.

He anticipates the low level swelling I occasionally get is probably due to the OATs donor site continuing to mature, that is a nice mindset for me, and while it was robbing peter to pay paul, it doesn't give me any pain, and means I will be less anxious that I should anticipate swelling as an issue with my lateral compartment.

I will try and upload some pictures of my knee to this post to show some of the progress and where I am at the moment.

So essentially from when I met Tim 18 months ago, I dreamed I would be at this stage.  I have had 3 sessions back at ice hockey, taking it very slowly, without issue so far.  I am performing well at the gym, but want to take things to the next level.  I am hiring a PT, likely for the next year, who I think will really assist with my quality of movement.  I have been doing some work recently on my hip mobility, and that has been a huge step up for my knee function and comfort during exercise and all times really.  So I want to sent that into overdrive, as while I can do that myself slowly using YouTube, I suspect it will take some time to become self aware to the point I will realise all the compensatory habits I have.  His website and YouTube content is really good, have met him, and start training tomorrow, I think it will be a great investment https://movementfirst.co.uk/.  Together with the Smashwerx youtube channel, and movement videos from Dr Spina, I think I am doing things the wrong way around, and that quality of movement should have been sought pre surgery and much earlier in the rehab.  As much as Isokinetic was a good rehab practice, there is a whole other world of quality of movement out there, which would have probably help avoid injury in the first place.

So essentially I am pain and swelling free 95% of the time. I would say a couple of days a week, I have a swelling sensation at some point during the day when I have been sat down for a long period of time, but I can flush it out with a bit of bike work or even just low compression while going through active ROM. The crepitus is reducing, though still that knee is more audible than my other.  I am really excited what I can achieve in the next 6 months.

For all the success, Tim was careful to say that this was still salvage from his perspective, I don't have a new knee, just a new to me knee.  That said, I can't believe the typical meniscus transplant patient will be taking all the supplements and dietary considerations I have, and will be working out in the balanced way I have tried, and this new approach to proprioception and movement quality, and no plans to run (which almost everyone else does), so I'm optimistic this salvage will be a very long term fix / project.  He said the hope would be this gives me 5 more years of international level sport, then reduce down to something like cycling, and it should keep going until my 60's (currently 35YO).  So lets see, but I will put all my chips in to get a little bit more out of my prime.

Thanks all for reading.  Tim has also released a website called meniscaltransplant.com which has some other patient stories and information, is a work in progress, but a good resource, which I will contribute to soon.

I'm very open to advice or support or questions and will be as honest as I can.

Warmest regards
JT

« Last Edit: August 24, 2018, 09:01:17 AM by LateralMeniscusIssuesGuy »
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?