Bone breaks around the knee :

TIB PLAT FRACTURE - - Posted by Connecticut_Jets (Connecticut_Jets), 20 October 2004

Hi to all...where do I start...June 5th 2004. Until then I was a 27 year old football player, active athlete, personal trainer..very active until a blow to my knee in a soccer game and I limp away with a swollen knee. X-Rays reveal type I tib plat fracture - clean break, towards the lateral end of the bone, with no chips or major displacements. Surgery...2 screws in no plates. Do said this was a clean break. But tib plat and femur condule on the outside made contact and I lost a piece of articular cartilage and about 20% of meniscus. He said 20% of meniscus was no big deal at all. But the articualr cartilage..we will se he said...anyhow...I started an aggressive workout schedule 10 days post op. In a mateer of 8 weeks my ROM went back to 145 degrees and after 10 weeks to minus 2. I was non weight bearing for 14 weeks and I started walking after that until now Oct 20...next week I am in for screws removal..yes very early huh? Well..the doc said I have a great bone recovery and thanks to my workouts including 2 times a day bicycle rides at the gym, 5 times a week of swimming...he is taking them out. Even as I am cheating right now walking around here and there...knee feels great. There is some clicking on the full extension at zero degrees point - he says it is the articular cartilage void. So next week - OCT 27 screws are going out...and he will determine if I qualify for ACI. He will at that time if it is a yes, take out a piece of cartilage and send it to Boston (GENZYME)...3 weeks later, open knee surgery to put the implant in. I am scared. I am only 28 right now...still want to play sports. What do you folks think of all this? Will ACI help me get back to sports in 12 months? And prevent from TKR or any other problems? Looks like the bone healed nicely..but this ACI is freaking me out. I am ready to do any workouts it takes to recover. But what are the chances for it?  
Posted by millot310 (millot310), 20 October 2004

I wish I could help you out, but I was not even sure what TKR was until it clicked.... ohyeah.... Total Knee Replacement...... so I am unsure what ACI is. But the one thing I can suggest to you is that whatever you do, make sure you go w/ your own instinct and trust your MD. I had no choice but to have surgery, or I would never have walked again, but I was stablized enough at the ER to be able to go home and find my surgeon. I happened to have the "best of the best" in California. He has does a remarkable job w/ my knee.

Good luck to you!
Posted by hmaxwell (Heather M.), 21 October 2004

I'm just curious why you don't try to live without doing the ACI for a while.  I mean, have the surgery to remove hardware and harvest the cartilage, but hold off on the implantation.  Could it be possible that your current pain is being caused by the hardware, or perhaps something like scar tissue or another meniscal tear?  

It just makes sense to me to try to live without the bit of cartilage, unless perhaps it is a huge divot missing from a weight-bearing area.  You see, cartilage damage doesn't necessarily equal pain.  It's the great mystery of arthritis, I'm afraid.  Some people with severe cartilage damage aren't noticeably impacted and don't know they have the damage until something else comes along (like an MRI for another issue).  Still other people have very minor cartilage damage and are incapacitated with pain.  There's no way to tell if someone will have pain from missing cartilage except to do a trial of life.  And if you do have pain that is from another source...the ACI procedure is a massive one, and the recovery is very rigorous and strict while the lesion heals.  It will be 12-18 months before high impact sports are recommended.

Anyway, I'm not a doctor and I'm sure yours is very proficient--ACI is cutting edge stuff.  But I went into my second scope with my very good surgeon convinced my pain was being caused by one thing...turned out to be something completely different!  And if I had gone through a major recovery like ACI and found it wasn't the source of my pain...well, I'd be bitter.

Regardless, it seems like you are the model patient for ACI--active, with focal damage due to an accident (rather than bad mechanics or genetic mal-alignment).  ACI is a newer procedure here, but it's been done since the 80's in Sweden!

A place to go to read journal articles (very detailed and technical) which might give you information on athletes and ACI recovery is http://www.findarticles.com  Just type in your keywords and go.

Good luck.

Heather
Posted by kgrosskurth (Kathy G), 22 October 2004

Hi and welcome to the club noone wants to join!

I think Heather has some great advice - I would get the screws out and wait/see how I did with that before scheduling any other surgery. It should be obvious in a matter of weeks as to whether the ACI procedure would be worth it or a waste of time.

In the meantime, are you taking any supplements? I'm on a daily regimin of Glucosamine, MSM, Chondroitin, Fish Oil, and Calcium supplements. These are supposed to help with pain, joint mobility, and pain management. You may want to try these as they have been helpful to a lot of people - and studies have been done that have shown Gluc/Chon have helped rebuild cartialage.

At any rate, I hope you get some other replies from people in similar situations (my break was worse than yours, but I didn't suffer any cartialage damage or torn ligaments, so I was VERY blessed)

I wish you all the best in your recovery and hope you get the answers you need!  
Posted by Connecticut_Jets (Connecticut_Jets), 28 October 2004

Sorry folks. Just got back from hospital from screw removal and...great news ! The doc says ACI is not needed. Miracle? My body has started to rebuild own cartialge and it looks great so far. Screws are out, bone looks fantastic. I have never felt better in my life...I will stay in touch on the progress to back to sports etc...  
Posted by kgrosskurth (Kathy G), 31 October 2004

Great news, Conneticut_Jets - thanks for the update!!

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