KNEE ARTHRITIS - General principles of managing Osteoarthritis of the knee :
30 yr old needs help with OA decision - - Posted by JohnL (JohnL), 14 June 2003
Four years ago I tore my ACL and medial meniscus. Both were repaired, started playing soccer about 12 months later. Long story short I had some of the medial meniscus removed (20-25%) about two years ago and have had a lot of pain for the past six months. I went to a very good OS who thought I might be a candidate for mensical transplant. He referred me to another OS who did a whole battery of tests (MRI, Xrays, manipulations, etc.) His conclusion was that I either needed the transplant as the other doctor thought or an osteotomy since I have about 4 degrees of varus deformation. Last week he removed the screw in my tibia from the ACL surgery since it would be in the way no matter what procedure came next. No big deal. He said afterwards that the meniscal transplant won't help because my wear pattern on the articular cartilage is unique and in an area unprotected by the meniscus.
My situation is that my remaining 80% of medial meniscus is still in "surprisingly good" condition but I have this weird groove worn into the articular cartilage more towards the center of my knee than the medial edge as one would expect. My lateral side is just dandy. Not arthritis and no meniscal problems.
So... after a little more recovery time, I am getting fitted for an unloader brace. My doc claims that it will simulate the effects of the osteotomy and if successful will allow me to be pain-free and return to light activities such as golf and maybe tennis. He thinks that realigning my bones will shift the stress back to the right places. I know I am very young to have these problems but I have accepted the fact that 25 years of year-round soccer does take it's toll and there are certainly people in the world with bigger problems than mine. I'd be very happy to never have another surgery and will do whatever necessary to make that happen!
I have two questions. First, does my doctor's approach make sense based on my description of my problems? I have very little interest in going through another major surgery if it won't help. Second, is it possible to permanently, non-surgically correct my varus? Osteotomy sounds pretty scary and I have read lots of horror stories on this board already.
Thanks for your help!
John
Posted by Kolleen (Kolleen), 14 June 2003
John:
One (1) additional thing, a really useful website that gives alot of information on osteotomy's is:
www.cincinattisportsmed.com and click on patient education. I have learned a lot from one of the researchers there and she is actually sending me different articles on this problem. I e-mailed her several questions regarding my knee situation and she was more then happy to answer them for me. I don't know where you live, but I am in the Boston area and if I can be of any help with doctor reccomendations I would be more then happy to.
-Kolleen
Posted by Golfer (Golfer), 15 June 2003
I had two high tibial osteotomies. The first was a total botch and my peroneal nerve was damaged resulting in foot drop palsy for 11 months. I was fortunate that this resolved as many don't.
The problem was I wasn't an advocate for myself and blindly accepted whatever the surgeon said. After going through this and finding that the surgeon used arcane procedures no longer used and wasn't truly experienced in this procedure, I sobered up pretty quickly.
Unfortunately the varus angle was severe and was not corrected, so when the bones healed, they healed at the same incorrect angle.
So I needed to go through this again. This time I went to the Hospital of Special Surgery in NYC and had their top guy do the surgery. I went perfectly. I recovered in one third of the time and had no lingering side effects. This was done about 20 years ago and really helped.
Regards,
Golfer
Updated Sat Nov 21 2009
