KNEE ARTHRITIS - Cartilage plug transfer :
update after OS visit - - Posted by kathleenj (kathleenj), 20 January 2005
I saw my OS today for a 6 week follow up after my Chondroplasty and plica/scar tissue removal. I have been having some pretty bad medial pain which has been preventing me from progressing with my rehab. I get that sharp pain when I try to do things like mini-squats and weight bearing exercises like wall slides...I've also been having pain with terminal extension, just that last few degrees. He believes that the defects on the MFC as well as the tibia (kissing lesions) are the cause of these problems.
We discussed many options for me but right now we are just going to ride it out. My muscles are pretty bad because of the lack of exercises I was able to do but he called in one of the PT's he has on staff and together we came up with a few things that I can do to help with the rehab. Right now we need to get as much muscle back as possible before we even consider any other options. Which I'm pretty happy about because I really dont want to do anything surgically right now.
The funny thing is...when I got there he told me that I have been the topic of many of his conversations recently, well my knee actually. He said that he consulted with a few collegues at the Cartilage Restoration Center in Boston because he trained there...thats where Dr. Minas is. They feel that an ACI is completely out of the question because of the kissing lesions but there are other ways to take plugs from the knee. Right now I have limited amounts of donor sites because of the prior two Oats but he said that they have begun to take donor plugs from the tibia and it is proven to be just as successful. I never heard of that...just goes to show you that progress is being made every day. He also said that if need be we can always do an Allograft but people seem to have more success with their own plugs.
Well thats about it for now. I'm feeling pretty optimistic after meeting with this new PT. I was kind of in a rut with the rehab so I think this will help to 'jump start' things. I'll see the OS in 5 weeks and we will re-evaluate things then.
Kathy
Posted by dhalem (QBknee), 21 January 2005
Kathy,
I had an Autograft done by Dr. Minas in Sept 03. He did take the bone from my tibia to fill my defect which was on my lateral femoral chondyle, partial trochlear. My defect was 20mm long,15mm wide, and 8mm deep. Dr. Minas took the bone from the top of my tibia. The defect that he filled is doing great. I have severe Arthrofibrosis, which I had prior to the autograft procedure by Dr. Minas that I am still dealing with. I have surgery set with Dr. Noyes Feb 2 for the scar tissue.
Dan
Posted by kathleenj (kathleenj), 21 January 2005
Dan,
Thanks for your post. I was wondering how and where they take the plugs from the tibia. OS mentioned something about the 'bridge' area but I cant seem to find any information about it. All the research I can find refers to donor sites on the femoral areas of the knee.
I have heard such great things about Dr. Minas and I was really glad to hear that my OS consulted with his group about my situation. I was actually considering going down there to see him in the future if need be.
Right now I am just trying hard to rehab the knee. After 3 procedures in 1 year the muscles has atrophied pretty bad. At this point I am just looking into my options for down the road.
Thanks for your input. It is encouraging to know that you had the tibial grafts and that it seems to be doing great now.
Good luck on the 2nd with the scar tissue surgery.
Posted by JG (JG), 22 January 2005
Kathleen,
Boy, it's been 6 weeks already! It's great that the OS pulled in the PT to discuss exercises that you CAN do. In terms of the allograft, that's what I had. It took two hemi-chondyles to fix everything. Go to www.mtf.org to see what they look like. Please give yourself time to heal as well. I know you want everything to be better automatically, but it takes time. It's been 8 weeks since my fall and I am just feeling better (that just a fall not surgery!).
I know it was the first time my OS used two hemi-chondyles for one procedure. I'm luck since my medial joint is only bad on the femur side not the tibia side. The funny thing is is that my lateral side has the kissing lesions with my tibia bothering me more. This side wasn't fixed in the first surgery. He felt that the 13 trochlea grafts and the 5 medial fem chondyle grafts were more than enough for one surgery. I did talk to my OS about two weeks ago. He suggested that if I'm not significantly better 16 weeks post-injury, we will do another MRI and based on the results either let things continue to heal or regraft the medial fem chondyle AND the lateral fem chondyle. I hope things keep getting better. I don't want to essentially "start" again.
Check out the following website. It's from the a symposium on cartilage restoration. Minas, Cole and Farr give lectures. You will find it interesting.
http://www.slp3d2.com/gen_1061/docs/player2.cfm.
Keep up the exercises you can do and hopefully you can add more.
Janice
Posted by kathleenj (kathleenj), 24 January 2005
Janice,
Thanks for those links. They were very informative and answered a few of my questions about the allografts.
It is good to be prepared and be fully informed of all my options for the future. Right now I am really focusing on the rehab. Since I met with the PT last week I have noticed some significant changes in my knee ( and its only been about 4 days doing these new exercises). First of all on Friday...I woke up sore! Yes, muscle soreness! I havent had that in a really long time. I know it seems strange to be excited about that but it showed me that the new exercises were definately targeting the key areas that I just wasnt able to get before. Secondly, my kneecap is not jumping all over the place anymore and the knee is not buckeling as often as before. I think I have actually woken up the muscles and they are beginning to work a little. I honestly didnt expect to see results this quickly but I am amazed and loving it. I still have a long way to go, very long way to go, but it is promising.
As far as doing anything surgically...I will put that off as long as possible. My OS wants me to get as much function out of the knee as possible...when I get to the point of not progressing anymore we will see where I stand with my activity level. If its something that I can live with then we wont do anything. He says its really a quality of life issue right now. If I can do most of the things I want to do with limited amounts of pain then we will let it be. If it continues to prevent me from doing the things I miss the most, then we will proceed to some sort of surgical intervention. I'm not talking about running marathons or even any sort of running for that matter. I can deal with never ever doing that again...its the simple things like playing catch with my kids or ice skating on the pond or hiking in the woods that I want to be able to do. If I can, than I will leave the knee for now and deal with things later down the road.
I'm glad your knee is beginning to feel better. Hopefully it will continue to improve and you wont need to have the regrafting. Have you been able to get back to your workout routine? You were really kicking butt with it for a while there before your fall. Maybe if you can get back to that things will be ok for a while and you can avoid the surgery for the time being.
I was just wondering...does your OS think you may have injuried the orginal grafts with this fall or is it still that same issue with the grafts as before the fall that would want him to regraft that area?
Kathy
Updated Tue Dec 2 2008