KNEE ARTHRITIS - Cartilage plug transfer :
back to work after oats - - Posted by kathleenj (kathleenj), 8 September 2004
Today was a good day!!! I am 12 weeks post my second Oats and I went back to work today! I truly think the surgery was a success this time around.
I have been having some problems with my plica but I had a cortisone shot on friday and it finally kicked in yesterday. I hope that it lasts because it feels really nice to be able to walk across the room without pain and my OS said that if the shot doesnt work then he will need to take it out. I really dont want to see the inside of an operating room for a long long time.
Keep your fingers crossed for me.
Posted by JG (JG), 9 September 2004
That's great. You're very smart. I went back to work PT after week 2 and full time after another week. I should have taken a minimum of 4 weeks. Being on crutches at work was not good. I had about 4 weeks of it (8 in total). So how is everything feeling?
My knee is still bothering me (medial joint, 5 grafts). Although the grafts looked good during my last scope (April), the MRI showing the underlying bone didn't look so good. My OS and PT have been really pushing me to be NWB for some time. I've pushed back saying it's the summer, etc. Well I was resigned that the best thing to do is go on crutches. It really bothered me last week during PT as well as during my own workouts. I was suppose to discuss this with my OS on Tuesday (9/7). Well, last Saturday (9/4) I tripped, breaking a toe on my right foot (right is good leg, left is bad). Turns out to be a really bad break. My OS laughed until he realized it was my right foot. He thought it was a clever way to get out of being NWB. It looks like I might have to have my toe surgically fixed. We are waiting a couple weeks to determine if it will heal correctly on it's own. It has a oblique fracture, rotated, and displaced.
All I can do is shake my head. My left knee is bad and I am having to rely on it since the toe is bad on my right side.
Let me know how you are doing...Janice
Posted by kathleenj (kathleenj), 10 September 2004
What did you do to yourself? I am so sorry about the toe. Even more for the knee that needs to pick up the extra load. How is it feeling with all the extra work it needs to do? You really need to take it easy. I know how hard it is to sit still but you really need to let things get better before going ahead and breaking something else
I'm doing ok. Its been 3 days of work now and the knee is holding up ok. I am on my feet the entire time and I really cant complain. A little soreness from muscles waking up but other than that, its going good. I do have to say...if it wasnt for that cortisone shot last week, there would have been no way on earth that I could be back at work. It has worked miracles and I am hoping it will last a very long time. At least enough to get this plica inflamation under control.
As far as the graft site...its GREAT! No pain what so ever there so it leaves me to believe that it has healed ok. My OS is pleased with that aspect of the knee and has given the ok to start doing what ever I want, just as long as I dont ever, ever, ever, run or take up tennis or any other twisting sports. We dont want to make my tibial lesion any worse. So basically I can do whatever I want as long as it is low impact. I can deal with that.
Again, I am really sorry to hear about your situation. I hope your toe heals ok and you dont need to have surgery. Try to take things easier and please keep me posted.
Posted by jackpowell (jackpowell), 11 September 2004
Great to hear you are back to work and that the OATs appears to be a success. I hope the scar tissue resolves itself and you don't need surgery. I go under the knive on Monday!
Your poor toe!!! My God, that must have hurt. I got a small crack in my toe once and the pain was pretty strong. Let's hope you don't need surgery on it.
Posted by JG (JG), 11 September 2004
That's great. It sounds like all is healing well. I guess you know when you body feels right. So does the graft site feel better after this surgery compared to your last surgery? I didn't have problems until about 8 months. So how bad is the tibia lesion? I have a grade IV on my lateral tib plateau. My biggest problem with this defect is bone pain. BTW, what do you do for work? I sit at a computer all day and I can work from home. I would have been miserable on my feet all day at week 8 (when I got off crutches).
Jack, congratulations on the surgery. So please give us the update. Did you find a new surgeon? Are you having OATS or ACI? How was everything resolved with your insurance company? Refresh my memory with the details.
As far as my toe goes, I think it will be okay. It really didn't hurt, but it didn't look good. It feels pretty good and seems to be healing well. I'm going to try putting on a shoe today...we'll see.
Posted by jackpowell (jackpowell), 12 September 2004
I am going to have OATs surgery on Monday. I had to find another doctor and he immediately scheduled. There is no insurance issue. Federal Blue Cross does not "exclude" OATs surgery so prior approval is not required and will not be granted. You just have the surgery, submit the claim and they pay it. The other doctor refused to do the surgery without prior approval so I was forced to get another doctor.
Posted by kathleenj (kathleenj), 13 September 2004
Hows the toe doing? Were you able to get the shoe on it? I'm glad that it is looking better. Hopefully it will heal well.
It really is amazing how you just know when things are going ok. Like you said...it just felt good. The first graft felt like something wasnt right from the beginning. It is really hard to explain, it just felt like it wasnt right. This time around it felt different. From day one I didnt have the clunking I had after the 1st graft. Everything was totally smooth when I moved the knee. After the 1st graft I had some sort of clunk that was catching and rubbing deep in the joint as I bent and extended the knee. I guess that is the only real difference that I noticed.
As far as the tibial lesion goes...I'm not sure the grade or anything. When I had my first surgery in Dec the cartilage was thinning. By the time I had the second surgery in June it was crabmeat. All shredded but not down to the bone yet. So far I havent noticed any significant pain with it.
It has been nice to get back to work. I am a portrait photographer so I am on my feet for hours at a time and I just couldnt possibly had gone back to work any sooner than I did. I just need to really watch how I move, I do alot of pivoting back and forth to the camera so I have to be careful. My OS says pivoting movements are the worse thing for my knee...but hey, I love my job and there is no way of stopping me.
So have you decided to go NWB for a bit to help the knee? I know its hard now with the toe issue but I was wondering what you have decided to do?
Please keep me posted. Take care
Posted by JG (JG), 20 September 2004
The toe is okay. I find out this week whether it is healing right. I go for x-rays and my FU visit on Thursday. I'm really noping I don't need surgery. That's another 6-8 weeks of laying low...just tired of that. I've been laying low for 17 months (since my mosaicplasty). I can't really wear a shoe except my cycling shoes (they have very stiff soles). I started back to "rehabbing" my knee about a week ago. I put my shoe on long enough to get through my hour rehab workout.
That's a great job! I'm jealous, I have not photography skill. I'm sure it feels great to be living life again rather than sitting at home waiting to heal.
In terms of NWB, it will have to wait. My left knee is bad and my right foot. I've got a double limp going sometimes...very funny. I did go out for a 30 mile ride today, toe felt good, knee was a little painful.
Once my toe heals, I'll go back to my OS. I'm really thinking that I will hire a trainer (from my PT office) to work with 2x per month and pretty much going it alone. If the OS says there really is a problem with the grafts and I should continue to PT, go NWB, etc. then I will. Other than that I am ready to break free. Although I'm in great cardiovascular shape, I could lose some weight, maybe 20 pounds...so that can be my next goal.
Keep me posted on your progress....Janice
Posted by JG (JG), 4 October 2004
How is it going? Just wondering how the knee is feeling. My toe is getting better, but slowly. I go back to my knee doctor in a couple weeks. I'm really just ready to to my own thing and when it gets bad, I can have another mosaicplasty either on the tender medial joint or my grade IV lateral fem chondyle.
Let me know how you are doing.
Posted by kathleenj (kathleenj), 5 October 2004
I'm glad to hear that the toe is healing ok. I understand the feeling of wanting to just go ahead and do whatever you want and deal with things later. I'm so sick of this knee hurting and just want to get things back to the way they were before all this knee stuff started. I am more sick of not being able to do all the things I did before with my kids.
Another mosaicplasty? Yikes! Maybe they will come up with something else before that time comes for you. I hope so anyway...you've had alot to deal with already.
As far as my knee goes......hmmm, it goes. The cortisone shot I got helped alot but it didnt last as long as I wanted. I wish my OS could do another one but he said he would only do that one for me and thats it! If the shot wears off and I am still having problems then he will need to scope and remove adhesions and the plica. I can actually feel the bands of tissue under the skin. They hurt like heck when I touch it and they are messing up the way my kneecap moves. I've also been having some medial joint pain, ut oh, thats the first time I actually admitted it. I've been trying to ignore that, like maybe its my imagination, but its not. I'm hoping its just my tibial lesion and not the graft. Its not bad 'ice pic' pain but its still there.
Looks like I will be having that scope soon. I just havent called him yet to tell him I'm still having problems. (a little chicken I guess, at least now I can work a bit so I'm not really looking forward to being laid up again.)
Anyway, let me know how things go at the OS. And I hope that toe is healed up soon.
Posted by JG (JG), 5 October 2004
Interesting that you are having adhesion issues. I had them as well, but really never exhibited symptoms other than my knee feeling full or "thick". I had them cleaned out in April for my 1 post-op scope. I guess they were really bad, but I didn't notice them for the most part. I ended up having a LR, medial gutter release and an anterior interval release. He actually had to use a scalple to cut thru the adhesions. Based on feedback from the scar tissue posters, it was a big surgery. My PT was surprised when she saw the scope picture because I had bad adhesions, but didn't show common symptoms.
I have tibia problems as well. It's really hard to tell if it is tibia or femur sometimes. My medial tibia is good, but my lateral tibia is grade IV to the bone. The only good thing about the scar tissue was that it grew over my old lateral tib defect, just like having microfracture. I find my tibia pain to always been very deep bone pain and the front of my tibia will hurt.
Good luck and keep me posted....Janice
Posted by kathleenj (kathleenj), 29 October 2004
Well the coritsone shot has officially worn off and the pain is back with a vengence. Maybe working was a bit much for the knee but I really needed to get things back on track. Fortunately I only have to make it thru November and then things will slow down with work. I was hoping that it would last longer than the 3-4 weeks because my os said he wont do another shot. Only other option is a scope.
My PT called my OS about 2 weeks ago and said that I should lay low with my activities and see if things calm down....like I'm running marathons Honestly I couldnt take it any easier if I tried!
Anyway, I called him and said nothing has changed and now he will see me on Tuesday. Not that I'm in any rush for the scope, but....why do they always make you wait around? What was he expecting to happen between the last call from my PT? Regardless, I see him on Tuesday and I am certain he will want to schedule the scope. I suppose its for the best. I have been dealing with this for months and it just isnt getting any better, actually worse now.
Thanks for listening and I'll post on Tuesday after my appointment.
Posted by jackpowell (jackpowell), 30 October 2004
Best of luck on your appointment. It it awful that he has to go back in there again. Exactly what is the difference between plica and scar tissue?
Posted by JG (JG), 3 November 2004
Sorry to hear you are still having problems. Honestly, I think its a good thing that your OS want to take a peek. It's good that he's not waiting 12 months or even 6 months. It's best to catch things early. This is a long post, so I apologize.
After my mosaicplasty 18 months ago, I only had a few visits with my OS. I saw him at 7 days (unscheduled due to potential infection), 4 weeks, 3 months, 6 months and 12 months. At the 1 month visit, my OS said that he "might" want to take a look at the joint at 3 months and then again at 12 months. However, at the 3 month mark I had just come off crutches and he said that we "might" want to take a look at the joint at 6 months. At 6 months, I was really just starting to feel stronger. So at the 6 month visit he said that it was going to take time to heal so be patient. I started to have problems at 8 months with the medial joint pain and lingering ROM problem (I'm still short 5 extention and maybe 20 flexion). Since my OS said it would take a minimum of 1 year for the grafts to fully incorporate, my PT encouraged me to keep rehabbing (knowing my knee and mental state well), and my general belief that I don't have a knee problem (my best coping mechanism), I waited another 4 months to see my OS. By that time, the medial joint pain was worse and ROM was still bad. When I went to the OS at 12 months, he said, we really should have taken a look at the knee at 4 months and 8 months. So by 12 months post-op, my knee was full of scar tissue and although the grafts looked good during the scope, the MRI showed that the grafts were cystic (that's can be good and bad). Partially, it was my fault for not going back to him at 8 months and demanding a scope. Partially it was that very very few OSs (if any) have any experience doing a mosaicplasty of this size, so my OS was "learning". With the scope, my knee was full of adhesions/scar tissue, a new lat tib plateau defect and further damage to my lateral chondyle.
I've read most of your posts and understand that you are very frustrated. Prior to the mosaicplasty, I would get very frustrated. However, I really have learned to manage the knee given my lifestyle. It's took about 4 years get to this point. I do accept that I have a problem and can't do thing as I used to. I'm always in rehab and management mode and this will NEVER change. I've found activities that I CAN do and really have embrassed them. Coming to some sort of "agreement" with yourself (and the knee) is so important.
I took some time off to let me toe heal (about 4 weeks) during which I really didn't do much. This helped out my medial joint pain. I decided to go to PT 2x per week and really push through the minor problems for the remainder of the year. Previously, my PT would really scale things down if I complained. Each session takes about 3 hours. I talked to my OS and said that I would like to "go it alone" for the next year or so...meaning no more surgeries. He liked the idea and said he wasn't going anywhere. My knee and legs feel great. My medial joint pain has been very managable. I do have lot of scar tissue in medical joint area from the patella tendon to the quad tendon. Like you, I can feel the bands of scar tissue (the worst being the medial quad tendon). I have my PT break up as much as he can each session. It has really made my "traditional" medial joint pain feel much better. You should discuss with PT or massage therapist.
Sorry for rambling and having another scope is a good thing...catch the problem quickly so you can get back to life.
Posted by JG (JG), 3 November 2004
How are you? Hope you are well. Do you have an update on your knee for us?
Posted by kathleenj (kathleenj), 3 November 2004
Thank you both for your concern. I have been sulking and feeling sorry for myself since my appointment yesterday. It went exactly as I anticipated and worse.
It seems that the scar tissue/plica is really what is causing all my problems and it definately needs to be cut out. On top of that my OS believes my Q angle of 30 is beginning to 'come into play', causing my kneecap to track laterally which is tearing up the cartilege under my kneecap. And...I have prepatellar bursitis..? Whatever that is...some sort of bursa inflamation which isnt exactly a major problem, just a pain in the butt. He was going to send me for an MRI to check all this out but then said 'why bother, it hurts, so there are problems and we really should just scope'. So our game plan is for a scope...scar tissue removal, plica resection, debridement and check out the condition of the underside of the kneecap. He said it is possible that the scar tissue is causing the problems with the kneecap since I didnt have any problems with tracking before. Many people have high q angles with no problems.
I really dont know what to think right now. I'm frustrated, disappointed and downright angry(not with anyone in particular, just the knee in general)
Janice, I understand what you were saying about the scope probably being the best thing right now. I think I truly feel the same but, I have my doubts. I really dont want to be dealing with this much longer. It seems like the OATS was a success and I just want to get on with things already. If it wasnt for all this soft tissue stuff...I dont know...I guess there is no sense in talking about the what ifs. I need to deal with it now.
Anyway, I'm glad your feeling a bit better. Going it on your own may just be exactly what you need. Sometimes its best to just listen to your body. Thank you so much for all your support...it means alot to me.
Posted by kathleenj (kathleenj), 3 November 2004
I have been wondering how you are doing? Whats going on? Hows the knee?
Posted by JG (JG), 3 November 2004
Here is why you bother with an MRI...he can't see the underlying bone during the scope. When my OS said that he wanted an MRI before my scope, I told him no that's okay. He told me he was a really great surgeon, but he didn't have x-ray vision. I quickly agreed with him. The MRI showed that the bone was messed up (cystic) even though the scope the next day looked good.
In terms of your comment, "I really dont want to be dealing with this much longer." , the longer you wait to have the scope the longer you will be dealing with the problem. Get it done and be on with it. Don't let this be anything but a hiccup.
Posted by kathleenj (kathleenj), 4 November 2004
I think the reason he says skip it is because right now we are dealing with soft tissue things. He was referring to getting an MRI to see what the scar tissue and cartilage on the back of the kneecap looks like. At this point we know where we stand with the OATS and the articular cartilage on the femur and tibia. OATS looks good, plugs look great. Tibia...not so good, but bearable at the moment.
I know what you mean about not having xray vison but its more surface things right now and not the deep bone issues. Although, knowing my luck......nevermind, I wont go there right now.
Anyway, I'm still waiting for the call to schedule the scope. I think you are right and I am going to get it done as soon as possible. Thanks for the advice, it was just what I needed.
Posted by brattkids2 (brattkids2), 9 November 2004
Paulette here again.
Was wondering if when your first OATS didnt work did you have feelings of snapping in your knee. I am getting where when I walk my knee catches and I get a hard snap. It even sounds like a tight rubber band and hurts like a SOB for a few minutes.
I have my scope on Thursday so hopefully I will get some answers!!!
thanks again for your help!!
Posted by kathleenj (kathleenj), 9 November 2004
No, but I definately get that now. It is on the surface, not deep inside the joint. OS says it is classic plica.
With the first Oats I was having alot of 'clunking'. The knee would get to a point and then get sort of stuck...hard to explain...and then 'clunk' it would go again. That hurt like an SOB too. OS said that was the tibia getting stuck on the part of the graft that was sticking out. Sounds gross when you think about it. Maybe that explains why my tibial lesion has gotten worse...
Anyway, its a little weird how we are both having such unbelievably similar issues now. Please...let me know how things go on Thursday. My scope is scheduled for dec 9th.
Posted by brattkids2 (brattkids2), 10 November 2004
thanks for getting back to me!!!
mabey one of the grafts just overgrew wishful thinking huh
I will certainly let you know how it goes. Im getting nervous. But I know all will go well.
Posted by brattkids2 (brattkids2), 10 November 2004
p.s. that just wishful thinking that it would be easily shaved down but Im not sure if thats possible or not
Posted by kathleenj (kathleenj), 10 November 2004
I just wanted to wish you luck tomorrow. I know you are a little nervous but keep in mind that this scope is nothing like the Oats. Hopefully your OS will find the problems and be able to take care of it right away.
Please post as soon as you are up to it.
I'll be thinking of you.
Posted by brattkids2 (brattkids2), 12 November 2004
Well surgery is over. OS had to remove a piece of loose chondyle in the joint. It was the size of a 50 cent piece and thats why I was getting all the catching and pain.
Also my OATS from August had failed on the medial femoral side so I had that redone with my own plug this time not the synthetic material.
Well another 3 to 6 weeks NWB but It could be worse!!
My kids are being great helpers so far and so is hubby. OS told him that I was right and not crazy LOL. There was something floating in the knee and it wasnt in my head.
I will keep ya posted on my progress. Please keep me posted on yours. I know you will behaving a scope in December.
Posted by kathleenj (kathleenj), 12 November 2004
I'm glad to hear that none of this was in your head
but sorry to hear that the Oats failed. I truly know exactly how you feel, to think you have gone thru all that for nothing and knowing you have to do it all over again. I'm sorry you have to go thru that. At least your kids and husband are being wonderful. As guilty as I felt after the 2nd one...I was very grateful to have my kids around to 'help' mom. They were angles (most of the time) and very eager to help poor mom with the big boo boo.
Well, like you said...3-6 more weeks does stink but it could have been worse.
You seem to be in pretty good spirits...or maybe thats the drugs Take care of yourself and keep me posted.
Posted by brattkids2 (brattkids2), 19 November 2004
Went to my first post-op visit today and OS explained the pictures of the surgery to me. I had two thick bands of scar tissue from the femur to the patella (said it was causing some of my extention problems the condyle piece also contributed to that) and some scar tissue on the medial side of the femur- not really bad though.
I asked why would the other graft fail as the lateral side had not failed. He thought that a possible reason was the even though the medial side was a smaller lesion it was much deeper (all the way to the bone. I even had a chunk out of the bone from my injury impact.) At least I got a possible explanation. He is pretty confident that using my own tissue this time it should take. I told him Im not throwing out the t-rom immobilizer just yet LOL.
He had to use 2 9mm plugs to fill the hole.
I did get to take the brace of and am now able to bend which make nwb for 4 more weeks a bit more tolerable. I just hope I dont develop a scar tissue problem. At my OATS on August 3 there was some that he removed due to my previous surgeries. I get to start some leg extentions and things so I hope it will go ok.
Hope your doing ok and not in too much pain. Keep me posted.
Posted by kathleenj (kathleenj), 2 December 2004
Sorry for the delay in responding. We took the kids to Disney for Thanksgiving. It was a very much needed vacation and only returned home yesterday. The knee held up ok. I needed to take things slowly and take alot of breaks, something the kids werent too crazy about, but we had a great time anyways. Right now the knee is swollen, aches and is catching constantly but I couldnt possibly have postponed our trip. Kids have missed out on too much over the past year, I couldnt take Mickey Mouse away from them.
Your post sounds very encouraging. I am keeping my fingers crossed for you that these plugs heal well and that you dont develop scar tissue again.
How have things been coming along the past 2 weeks? You must be getting close to partial weight bearing.
Please let me know how you are doing.
My surgery is scheduled for next Thursday
Posted by brattkids2 (brattkids2), 2 December 2004
Ohhhhh I love Mickey Mouse Land. We went last year at this time it was awsome. My kids loved it. their smiling faces made the knee pain a bit more bearable!!
I am partial weight bearing as of today. OS said about 25 to 35% of weight. He said take it slow. I go back on the 8th and if that small weight was good I will be graduated off the crutches!!
I told him that I still have the horrible pain on extention and he is just hoping that the muscles are weak and making the patella not track correctly. Can strengthening the muscles really pull the patella back to where it should be?? Can scare (no thats not a spelling error just my pun for how I feel LOL) tissue come back that fast??
The joint is really sore today with the added weight but ok. Sorry bout all the questions!!
At least your surgery is fast approaching and you can get some relief (Im praying for you) I know it will go well.
Keep me posted. Its great to have someone to talk with that knows what im feeling.
Best of luck
Posted by brattkids2 (brattkids2), 2 December 2004
p.s. have you ever heard of OATS being done on the hip. Os think I may have cartilage damage in my hip too due to my fall in the hole. I have been searching on the internet and cant find any information.
He doesnt do hips though so after this knee thing is done I will have to find a hip guy. I am going to wait a bit on that though hip isnt unbearable yet.
Posted by JG (JG), 6 December 2004
Was just wondering how you are doing? I know your surgery is upcoming. How is everything feeling?
I've been going to PT twice a week for about 8 weeks now and been feeling really good. Each session consists of 40 minutes cardio and about 2 hours of leg work. I was even allowed to run briefly (3x30 seconds). I was just commenting to my PT last week that my knee hasn't felt this good since before my very first knee surgery (back in 99). I think that jinxed me. I went to step into the jacuzzi last Wednesday and I slipped. My knee got hyperflexed under my body, basically my full weight on a collapsed knee. My normal flexion is maybe 110 and it was at 135 (full flexsion) with all my weight. I went to PT and they are worried about at a torn MCL and maybe PCL. ACL and LCL seem fine. In one step, I went back 3 years in terms of how my knee feels. I am hoping it's just scar tissue breaking up. The whole thing makes me want to laugh. Knee is really swollen and hot again. I was able to cycle about 30 miles yesterday, so I'm hopeful that all is okay and that it was just scar tissue breaking up. I don't do well resting, so I am going to cycle indoors today.
Let me know how you are doing...Janice
Posted by kathleenj (kathleenj), 7 December 2004
Sorry to hear about your mishap. Geez, just when things seemed to be getting better. Try to look at it as just a minor setback. Hopefully it will heal ok and then you can get right back to where you were with rehabbing the knee. It sounds like things were going great. I admire your persistance. You really stick with it even when you are thrown a loop.
Anyway, my surgery it scheduled for thursday afternoon. I'm kind of in a 'whatever' type of mood about it. I dont really have any feelings either way about going in for another surgery. I just want this stupid knee to feel better.
We took the kids to Disney for almost 2 weeks over Thanksgiving and the knee held up ok. We did alot of walking (very slowly) and things were ok when we were there...swelling and pain but nothing abnormal. Since we have gotten home the knee is protesting everything. Sleeping, sitting, walking, stairs and even driving is killing me. I probably did way too much when we were away and now I am paying for it.
I am beginning to worry about the defect on my tibia as I have been having some serious bone pain which radiates down my shin. My VMO hasnt been firing very well either, which I suppose is from the swelling...therefore, my kneecap is jumping all over the place and catching in the scar tissue. Not very pleasant I might add.
Boy, arent you sorry you asked how I was doing?
It's been a tough couple of weeks but luckily surgery is thursday and HOPEFULLY we can take care of all this stuff once and for all.
I'll stop complaining now. I'm really sorry you hurt your knee again. I was actually thinking of you the other day when I dropped a gallon of juice on my toe.
How did all that play out? Toe better now?
Take care of the knee and I will post as soon as I can after surgery on Thursday. Thanks for the concern.
Posted by JG (JG), 10 December 2004
How did everything go? Were you able to speak to your surgeon after? Please update me when you get a chance.
Thanks for your last message. My toe is great and I just have to roll my eyes when it comes to my knee. I am currently in an immobilizer. I'm trying to get the patella pressure off the trochlea. I had 13 fairly large (12-15mm) grafts in that area that are taking their time healing.
I hope you are feeling okay.
Posted by kathleenj (kathleenj), 10 December 2004
Thanks for thinking about me. I did post in the post op section but to make it short...surgery went ok. OS removed lots of scar tissue and a really inflammed plica. He also had to do a Chondroplastly of the MFC because I have some new cartilage defects in that area. The worst one was right next to the Oats graft. The original graft looks great but now there are more problems there. I'm very discourage right now. Os told my husband the Chondroplastly is certainly not going to fix this and that we need to address the cartilage issues soon. Both the defects on the tibia as well as the new ones on the medial femural area. Apparently it is quite extensive. He wants to do whatever he can to avoid a TKR but he says it is something I will probably be dealing with in the future. That comment kind of freaked my husband out a bit! This is all very depressing. I thought all this was going to be behind me after this simple clean up scope. No such luck I suppose.
As far as this procedure goes, I'm feeling ok. Pain is ok and I'm able to move around just fine. Gonna try with one crutch later, just want to wait for the dizziness to subside some more.
Thanks again for the concern, I'm doing ok physically just a bit bummed emotionally. I hope your knee is feeling ok. Keep me posted on that.
Posted by JG (JG), 13 December 2004
This is repeated under the other section.
It will be okay. I was told after my surgery in 2001 (a simple clean-up) that I would definitely need a TKR. I was 33 at the time. After speaking with my OS, he did give me the option of mosaicplasty but said even mosaicplasty was not meant for a such huge defect. Remember when it is really wide spread they can't do autograft plugs, so there is still lots of hope for you. I never had the autograft option since I needed 5 large (12-15mm) allografts just for my MFC and 13 for the trochela. My LFC will need probably 5-8 grafts and I have two huge defects in my lateral tib plateau. Even with all that, I actually do well. Like you, I battle with scar tissue/adhesion and plica problems. They key is rehab, rehab, and patiences. I've been battling this knee problem since late 1999.
And yesterday I got word that when I fell last week (hyperflexed knee), I most likely tore my MCL and may have damaged the PCL in addition to tearing some meniscus and the fibrocartilage that formed on my two lat. tib plateau defects. Also, he is most worried that I have a bone bruise from the patella jamming into my trochlear grafts. Keep in mind my grafts are still healing at 18 months post op. All this after commenting to my PT the day that my knee had not felt this good in 5 years. I don't cry, but I wanted to, more out of frustration than sadness. But, I got on the phone to the person I rehab with. She knows me best. I just told her that I felt like I was taking a huge step back. I spend 8 hours at PT each week. She put it best, if you got back to "normal" once, you can do it again. I am in a brace with limited ROM for the next 10 days and on prednisone for the bad swelling. After that, I will start over...but hopefully not from the beginning.
Listen, I would totally encourage YOU to come up with a plan for your knee. It is in YOUR best interest. Use the OS and PT as sounding boards, not the decision makers. Don't feel afraid to talk to other surgeons, especially ones that specialize in cartilage procedures. My OS made me talk to 4 other OSs before he would undertake the mosaicplasty. None of them had ever tried to repair such huge defects. And two said the procedure was not meant for such a widespread problem and wouldn't do it.
Once I really took control and developed a plan, I did well (I just had an accident that set me back a little). My OS and PT love this attitude and wished more patients were like me. I've done enough research into treatment options and I NEVER read about TKR. It isn't an option. I truely believe that I can manage the problem for the next 20 years at least (with the help of my OS and PT). Give yourself a few weeks just to recup, then come up with a plan. For me and the health of my knee, I MUST exercise 5 days a week and do 2 rehab sessions. But keep in mind, I am very single (and loving it I might add). Even though I have a very busy job, I still find time. If you ever want to talk, please let me know and I will email you my contact information.
Kathy...it WILL be fine.
Posted by kathleenj (kathleenj), 14 December 2004
Thank you for the encouragement. I know you have been thru this and your support means alot to me. I'm really sorry to hear about your MCL and PCL. When are you going to stop hurting your knee I'm keeping my fingers crossed that this will only be a small setback for you. You have seemed to come along so far since your last procedure and I would hate to see you lose so much 'steam' with your recovery. Hang tough!
I've had a couple of days to let all this crap with my knee sink in. I'd like to say that I'm in a better frame of mind but I really cant. I'm still very discouraged by all this. I have so many questions and I cant wait to see the OS on Thursday. I also have another highly recommended knee specialist that I will be making an appointment with after I see my current OS this week. I think its time to get another opinion or 2 or 3. Depending on what they think, I will then go down to Boston for a consult with Dr. Minas. He's the best around here in regard to cartilage stuff so I think that will be my best bet. At least get a feel of what he thinks is happening here and what should be done.
Its really scary to see how much worse my knee is since June. The pics from the scope only showed that one defect in june and now...gosh....its really just amazing!
Not in a good way either. How could I have done so much damage in just a short time? Especially when I have been doing light rehab stuff the past 6 months. Nothing high impact at all! I guess thats where I need to start. I have alot of questions.
As of now, the knee is feeling good. I can walk around pretty good without the crutches. Knee is very stiff and a bit sore but nothing too serious. I stopped taking the heavy narcotics on Saturday and seem to be doing alright with just tylenol when I need it. Sleeping still sucks but I suppose it will be that way for a long time coming.
Anyway, sorry to be such a downer. I'm trying to keep my spirits up....after all, its Christmas time and the kids need mom to be happy!!! Thanks again for the encouragement, I truly do appreciate it. I'll let you know what the OS says on Thursday.
Take care of yourself and try not to have any accidents for a little while...okies?
Posted by JG (JG), 14 December 2004
Minas is good. Although I didn't talk to him directly, my surgeon did. Minas thought my case was extreme and that the current use of mosaicplasty and other cartilage replacement techniques was not meant for such widespread damage. I'm working on proving him wrong. If not Minas, try Brian Cole in Chicago (and easy on the eyes). He was great. Also, Allan Gross in Toronto.
It's amazing how much damage can happen quickly. When I had surgery in 1999, I had no articular cartilage damage, but in 2001, I had enough for a TKR. It was 18 months between the two. I've always thought that I had a low grade infection...my OS is thinking maybe that is a contributing factor. Even the time between my big surgery and my recheck (12 months) I develped a second large lat tibial plateau defect. And I have no alignment issues. I'm still lucky, not joint space narrowing and I have 100% of my medial meniscus and 70% of my lateral meniscus.
I find it helpful to just have a "knee" routine. That's what is killing me right now. I'm basically doing nothing but trying to get all the swelling down. I'm normally at PT M and F and have my other 4 workouts I do each week. I'm just really mad that I was feeling awesome and I slip in the jacuzzi. Ridiculous! I skipped the depression phase and I'm in the permanent pissed off phase. I'm thinking if this is a 6 or 8 week recovery just to get the swelling under control that I might just have my lateral femoral chondyle grafted now. I had planned on re-evaluating at the end of next year. It probably needs 8 grafts. It is actually worse than my MFC. It was a surgery day decision to do the MFC and trochlea rather than the LFC and trochlea the first round. I think he was worried that the area between the lateral edge of the trochlea and LFC would fall apart and he would really left trying to graft most of the lateral joint.
Let me know how you are doing...Janice
Posted by brattkids2 (brattkids2), 18 December 2004
I was wondering how you were doing and how your OS visit went. Did you make an appointment with another OS yet? I hope your spirits are better!!!
I am going to a new OS. I am gong to see Dr. Wojtys here in Ann Arbor in January. I have that ice pick pain and pain that wakes me up again. Its as bad as it was before the first surgery. Im really depressed. I think I need a new and fresh approach to treatment too. My current OS is great but I think he is frustrated with how to treat me as I am such a difficult case. I am trying like you to stay positive for the holidays. I have an 8 1/2 yr old and a 6 yr old so excited for Santa.
Hope your doing well
Posted by kathleenj (kathleenj), 22 December 2004
Sorry I havent posted in a while. Things have been pretty hectic. Between the stupid knee and holidays and family issues...you know that saying 'when it rains, it pours'...its a monsoon here.
Anyway, I did see the OS on the 9th for my follow up. And to be honest, it was kind of worthless. He couldnt really give me much info other than we need to wait and see how the knee plays out. What the heck? Basically he said that there are more defects in there, nothing is down to the bone like my original one so its basically a wait and see. He said I will be the one to determine if something should be done about it. Depending on how it starts to feel as time goes by. He said many people have defects that have absolutley no symptoms and that the chondroplasty may be all that was needed. Time will tell he said. He wants me to work hard to rehab the knee because the atrophy is pretty bad. Once the knee is rehabbed and I start using the knee to its full potential we will be able to determine if something should be done and if so, what.
So thats the story...pretty much wait and see. I am going to make that appointment for the 2nd opinion though. I dont really like just sitting back and letting this ride. My OS is great...has been great, but I think I would like to have another persons feel on it. I will make an appointment after the holidays.
I hope you are feeling better. Hows the knee feeling?
I really admire your perserverance. You seem so optimistic even when you are royally pissed off
Let me know what have decided....are you going to go ahead with more grafting or are you still holding off?
Sorry to hear that you are still having problems. I am glad that you are going to see a new OS. Like me, you need to get a new perspective on things. Another set of eyes might see something the original one didnt. At least that is what I am hoping. Hang in there and please keep me informed.
Happy Holidays to you both!!!!
Posted by JG (JG), 23 December 2004
Kathy, I certainly understand the hectic life. I don't have kids, but I have two high-energy, demanding dogs and a crazy job. I hate to say this but he is right on two fronts - time will tell and some individuals have huge defect but are asymptomatic. I have two large defects (one LFC and one (really two) on my lateral tib plateau). Both are down to the bone, but don't really bother me that much. Since my fall, the tib is very tender, but okay.
Again, I cannot stress enough that it up to you for the rehab. Use your OS and PT has a sounding board, but you need to figure out what is going to make you better. There are days that are going to be difficult, but take it in stride. Even if my knee feels bad, I start my rehab and modify it as necessary. In terms of a second opinion, don't mess around with that. Go see one of the big names. I would highly recommend either Brian Cole, William Bugbee, Tom Minas, or Allan Gross (U of Toronto). Gross is the "grandfather" of allografting procedures, but, according to a recent lecture he gave (2004), he is no longer doing grafting on patients with bipolar defects ("kissing" lesions"). Bugbee is into allografting as well.
Trust me I really like my OS and he is extremely gifted. The technique he uses is not really used by anybody else. He actually does almost as many grafting procedures as Bugbee, but it's not the forefront of his practice. Having said that, I plan on seeing either Gross, Bugbee, or Cole for a second opinion. Each of them is somewhat familiar with my case. For me, I'm just curious as to what they think. Small price to pay for great advice.
I haven't responded to many of your posts lately. I certainly have some advice/opinions for you. First, let me tell you that I'm not the "supportive" poster type. I think that stems from not seeking emotional support from this site. I'm much better with someone kicking me in the butt than telling me it will be okay. I'm looking for something entirely different from this site. You have been a great support and your words have been kind to many. So here it goes....
From what I understand your latest procedure was on 11/11. So doing the math you are 6 weeks post-op. You should be on crutches. No if ands or buts. You should be on crutches for 8 weeks with 4 more PWB. Read any of the articles or view any of the conference presentations from the top guys, from Steadman (grandfather of microfracture) to Gross to Bugbee to Cole. 6 weeks is minimum and 8 preferrable. This is key to graft healing during the first 2-3 months. Given that you have two failed procedures - one microfracture in April/May and then a synthetic graft in August/September. Why would you not be conservative and safe given your history?
Also, give your knee a break! You've had 4 procedures since April. Any cartilage repair procedure requires a very long time to heal. You should still be healing from the microfracutre. I will admit that I don't know how it was determined that it didn't work in the first 4 weeks. Read info about microfracture....18 months to feel normal. And contrary to a recent post, there are top athletes that had this procedure recently and have returned to top form. Heck it takes 8 weeks for the fibrocartilage to start filling in. Yours was deemed failed before it had a chance to heal.
When I got my second opinions before my mosaicplasty, all said it would take 18 to 24 months for full graft healing/incorporation. I would also start feeling better at this time. Unless the graft fails to incorporate or the graft has poor congruence (sugeon fault), these take time to heal. When I initially went PWB, I thought for sure my grafts failed. I was positive. It hurt every step. But what do you know...18 month later, my knee felt awesome. They were all right! Okay, so I had a little fall recently, but that's only a minor set back. The best advice I got from both my OS and PT was, doing nothing the first 8 weeks is far far better than doing something. Other than 8 weeks of CPM and icing, I didn't do anything. Nothing. I checked in with my PT every couple weeks.
Also, don't mess around with some guy in Ann Arbor. Drive down to Brian Cole in Chicago. He is on the forefront of this. And don't look for a quick fix. There is nothing quick about these procedures. Like I told Kathy, YOU need to come up with a plan. If I were you, I would be back on crutches and fast. Also, look into getting an unloader brace. My medial compartment has alway been the problem. The unloader brace really helped keep the pressure off the joint from 12 months to about 15 months. I wore it full time. I still wear it to rehab.
I hope you take this as friendly advice. Both of you need to come up with a knee plan and be very patient. After falling recently, I was thinking, "what the heck". I'll just have my LFC grafted...just get it over with. It was that immediate emotional reaction that we all get. I was really, really mad that I worked so hard, followed good advice, had a fantastic plan...and I fall. The knee isn't great but better. However, after a good kick in the butt from my OS, PT and trainer (from PT), I've readjusted my plan for my knee. I need to wait and see with how the knee responds. So we are all in the same boat. Please give it time.
Posted by kathleenj (kathleenj), 27 December 2004
Thanks for the big kick in the butt!! I must say though, I was kind of getting there myself. Although, kicking yourself is a bit difficult with a bad knee.
I was thinking about what you said about making a plan for myself and I've been doing that. I have totally reversed directions for myself. I think what you said about looking for a quick fix is pretty accurate. I understand now and I have come to grips with the fact that this WILL be a long haul and I really need to be patient. (which really isnt one of my strenghts) I have come up with a plan...its basically taking one day at a time. I have begun rehabbing and the knee is beginning to feel a bit better. So are my spirits, I'm finally taking a proactive attitute here. I am determined to get as much strength from this knee as possible. I will see my OS the end of January for a follow up and then that will be it for a while. I think I need to just give it time to see how it plays out.
In the summer I think I will re-evaluate how the knee is doing and if need be I will go see DR. Minas. I absolutely will not have another procedure until my knee is as strong as it can get and only then if it will drastically change the way I live my life. I think 3 procedures in 1 year is a bit much and like you said...my knee needs a break!
So how are you doing? Last you wrote the knee was feeling a little better but you were struggling with the swelling. Any changes? Are you able to get back to your routine yet?
Keep me updated.
Posted by JG (JG), 28 December 2004
Good to hear you have a plan! Stay on top of rehab. My knee is okay. The swelling is finally gone. I took prednisone for a week. That's the best drug. Everything feels better. Now that the swelling is down, I can really tell what is bothering me. Of coarse my medial joint as well as my tibia. The medial joint is something that bothered me from about February to September. It finally started feeling better in October and November. I decided it was best to start wearing my unloader brace and limit my exercise to swimming, deep water running, and maybe cycling. The knee might need another month to settle down. I plan on calling my OS today to get his thoughts. I still have to shake my head at the thought that my knee was awesome for 2 months and then I slip and fall. My trainer at PT is trying to help me not lose all the strength I gained while balancing what loads my knee can tolerate.
Good luck and keep in touch...Janice
Posted by brattkids2 (brattkids2), 28 December 2004
Thank you so much for the post and I take the advice as friendly advice!!! Thank you
I dont know if I can go to Dr. Cole with my stupid insurance. I have Blue Care Network and they are horrible about out of newtork but believe me I will surely look into it.
I plan on giving my knee a long rest before I do anything else. I really need to build my strength back up and allow the joint to heal. I need to let all the inflamation and irritation go away.
I guess my OS was just not a stickler with how much time to be on the crutches. His thing was always 4 weeks and then progress off. Could you please let me know where I can read some information on the proceedures and those conferences?
I am definately making a knee plan!! I have nothing but time and I will be patient that is for sure!!
I knew my microfractures had failed (at least that is what I was told) when I had the scope in may to clear out the debris. I had absolutely no healing and the lesions were larger and causing me lots more pain!!
Thanks Again for the help. Please feel free to give advice anytime
Hope your Christmas went well!!
Happy New Year
Updated Thu Apr 29 2010