KNEE ARTHRITIS - Cartilage plug transfer :
Battle with the Docs - - Posted by mtnbikcowboy (mtnbikcowboy), 7 April 2004
Hi, six days out from allograft. 15mm fresh graft medial femoral condyle. Reasons: continued worsening pain after 10mm autograft one year ago. It turns out the new allograft is 50% bigger than the area replaced a year ago. Are there reasons this wasnt done prior? When asked directly the os stated, with the allograft we didnt need a donor and we truly thought we could cover your area of questionable cartilage with the 1cm graft. I have a couple of questions for some of you "experienced" people. Why do the docs continually battle you with pain? They either think it is not there or think it is not as severe as indicated. It seems to be relatively common with surgeons. I wound up having to get the medications needed to cope before and after the procedure from the sports med guy that referred me to the os. I thought there were laws in the US about treating pain. Ok, number two, does anyone know or have reference to info concerning the use of creatine and protein to speed recovery and build muscle and bone faster? And of course, number three, is there anyone that knows if continued cpm, ice, and elevation while on six weeks no weight bearing helps total recovery time? and if so, any documentation?
Thanks, have read here for a long time, decided I should get involved, I know there is great advice and help here.
Posted by JG (JG), 7 April 2004
Hi,
Here is the best insight that I can give you. The reason they most likely did not do an allograft to begin with is that there is limited supply and a wait. For a focal defects such as your original 10mm graft, autograft will almost always be the first choice. Some people wait 12 months or more to get the donor material.
As for the pain issue, ask you OS for a referral to a pain specialists or use your primary care physician for this. See what the reaction is. My OS is great, but I felt he wouldn't be as concerned about pain management long term. I have really bad defects in three compartments so my battle is very long term, plus I have migraines. I don't want to harm my liver since most pain medication are metabolized in the liver. I actually see a rheumatologist for this who checks my liver enzymes about every 6 months.. She is in the same office as my OS.
As for question 3, the purpose of the CPM machine is not to speed total recovery time. The CPM allows for 1) the graft to be molded to the structure of the existing bone, 2) help with range of motion, and 3) provide nutrition to the graft via synovial fluid.
Good luck....Janice
My best advise is to let the graft heal, so be patient.
Posted by mtnbikcowboy (mtnbikcowboy), 10 April 2004
Janice, thanks for the info. I am now at 9 days and if I am still the pain is under control. If I am up forget it. I do remember this part from my autograft. Another week or so and it should be manageable. So if I understand it right, the synovial fluid gives the cartilage the nutrients and it is not dispersed or moved around except for knee movement 
Then if on crutches it is probably good to use the cpm everyday... Still wondering about using creatine and protein. I also wonder about how things turn out in the long run. I thought everything was fine with the autograft, but never seemed to get pain free and after about six months the real pain came into play. Usually activity related. Used to be 9% bf and participated in adventure racing and mountain bike racing throughout the midwest and east. Am now 19% and cardio threshhold has got to be nothing. Three to four hour cardio trainings seemed to happen once or twice a week. Seemed to go from the best fitness ever to this. Works on you a bit. But, we'll see how it goes. Hope to get back to at least the bike in a couple of months...fingers crossed.
Again, thanks, A. 
Updated Sat Nov 21 2009
