KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: Scooby on December 21, 2004, 06:39:15 PM

Title: Articular surface loss and microfracture
Post by: Scooby on December 21, 2004, 06:39:15 PM

I had an arthroscopy yesterday and they found I had 1.5 cm full thickness loss of articular surface on medial condyle and performed microfracture.

I was given crutches and told to use them for a couple of days and do a few exercises.  I am a keen hockey player and my OS advised me to give up.

Obviously, I am keen not to have to give up and started to search this site for info on microfracture and return to sport.  I was very concerned to read that after microfracture, it is advised that there should be no weight bearing for approx 6 weeks - I have been told 2 days!

I am very keen to get back to playing hockey and don't want to jeaopardise my chances by weight bearing too soon.  Can anyone help/advise?
Title: Re: Articular surface loss and microfracture
Post by: Heather M. on December 21, 2004, 09:09:50 PM
Scooby,

It does sound distinctly suspect that your doctor did the procedure, gave you instructions for 'a few days' and mentioned you should give up sport.  Was the surgeon in question a Sports Medicine Specialist?  A Knee specialist?  Or a generalist Orthopedic Surgeon (OS) who does all joint and bone surgery?

I'm going to post a link to my surgeon's web page.  He developed the microfracture procedure.  Unfortunately, at least at the pro level, results have been mixed for returning to impact sports.  Terrell Davis was the last high-profile athlete to try that I know of, and he gave up after a year.  The problem is that once the articular cartilage is gone, it's gone forever.  Anything that is done to restore the cartilage (or try) is never as strong as the original stuff, which you apparently chewed up quite prematurely.  And once the cartilage is gone, the pain goes up and function often goes down dramatically.  So most people are strongly encouraged to do whatever they can to preserve the restored cartilage.  

Read about people who have severe chondromalacia and/or chondral defects and osteoarthritis.  There are so many limitations on a person with significant cartilage loss, and the pain is so relentless...many people decide it's just not worth it.  The goal of these procedures that restore cartilage (or try to) is to 'salvage' the knee and attempt to restore as much quality of life as possible.  The goals are simply different than those of an athlete returning to sport.

That's not to say certain people haven't done it--look at Yzerman from the NHL.  He came back after a career ending surgery...but who knows the price he will pay in the next few years?  It is almost certain he will need to have a knee replacement before his time--before he's fifty.

Anyway, that all is a decision for you and the sports medicine surgeon you choose to help you--if both of you want to go for a return to sport, that's great.  Go for it.  It sounds like your current surgeon has punched out, which leaves you rather in the lurch.  I would get back in touch with him and get better instructions for rehab.  The amount of time spent on crutches/non-weight-bearing depends on the location of the microfracture--only your doctor can tell you for sure.

Since you've had the procedure done already, go ahead and give it every chance of succeeding.  Be compliant with the protocol and see where that gets you.  It's not a quick fix--it's a prolonged rehab.  And microfracture hast the *shortest* recovery of any of the cartilage restoration procedures...scary thought, huh?

Here's the link to Dr. Steadman's microfracture page--go through all the different steps to get the information that might help you better understand your condition and the procedure you had.
http://www.steadman-hawkins.com/knee_microfracture/overview.asp

Here is a link about chondral defects--basically, focal areas of deep cartilage damage, which is what you have.  Your options are discussed as well--these are usually limited by the location of the problems.  You're lucky you don't have defects on the back of you kneecap!  That is a death sentence, it seems, for active sporty lifestyles.
http://www.steadman-hawkins.com/knee_chondral/overview.asp

Hope this information helps.  Try the arthritis section at the bottom of the page, as there is a whole group of threads dealing with microfracture.  You can also get to posts of people who have had the other techniques done as well.

Heather

PS Where do you live?  Are you willing to travel to get the best treatment available?  You may not have to, depending on what part of the country you are in, but it's always good to keep your options open.  I traveled 1000 miles to see Dr. Steadman for my last procedure, and am going more than twice that to see my next surgeon....
Title: Re: Articular surface loss and microfracture
Post by: Scooby on December 29, 2004, 05:00:28 PM
Thanks Heather for the reply.

I have since seen my surgeon, who is a knee specialist but not a sports specialist and with regard to the non weight bearing, he suggested that there was no evidence to support the fact that you should nwb for 6 weeks, but did suggest that the more careful you can be the better, therefore, although I am only 1 week into it and being on crutches is already driving me mad (and making my hands sore!), I will try to nwb for 6 weeks!  I was still rather surprised that I have only been given 3 very simple exercises to do at home with no follow up physio.  I have since scoured the internet and found some exercises I can do from home, but have felt let down by the lack of after-care.  I am seeing my surgeon again in 8 weeks.

I know what you are saying with regard to playing sport again - is it worth knackering my knee for a hobby that knackered my knee in the first place?  I have decided to play that one by ear for now.  I will see how the knee feels in a few months time and do some more research.

Thanks for the links - they and others from this website have been very helpful.  I live in the UK and therefore will not be able to see Mr Steadman - don't think the insurance will cover that one! but I will perhaps have a look for similar clinics over here.

THanks again

Scooby
Title: Re: Articular surface loss and microfracture
Post by: jnamoore on December 30, 2004, 06:21:35 AM
Let me know what I am up for!! I have been scheduled for the same thing on the 7th of Jan!?!? I am getting a little nervous. Yeah I know, a former college football player and a wimp at the same time. I am totally conifdent in my doctor (he has done to shoulders jobs on me, 2 on my mom, and a couple of knees on my sister). He jokes that my family should be a partner in his practice. Let me know what to expect, and how long it will be before I can do anything with my 2 year old twins. And in the future if I will be able to golf this year and play hoops next year?
Title: Re: Articular surface loss and microfracture
Post by: Scooby on December 30, 2004, 04:19:15 PM
Don't panic!  

I was very nervous about my arthroscopy because I am a wimp when it comes to pain,  but I was told I was probably having a plica removed.  When I woke up they told me I had had a microfracture due to the full thickness loss of articular surface.

I was amazed to find that there was very little pain and so far there still isn't (10 days post op).  The only time it seems a bit painful is when I knock it or bend it too far.  From other topics I have read on this site, it may be that when you come off the cruthces is when it gets painful!  I'll let you know!  If you haven't already seen it, there is a section on the bulletin board under "Knee Arthritis - bone marrow stimulation" and also a lot of other boards such as Post Op diary, rehab etc.  I have spent a long time trawling through these boards and have found others experiences very useful.

I presume that you will be non weight bearing for at least six weeks as this seems to be the practice in the US (more so than UK).  I too have 2 year old twins (boy and girl) and it is hard work looking after them on my own whilst on crutches - the worst part is not being able to carry anything and not being able to get on the floor to play with them.  My twins will be 3 in March and are quite useful at carrying things for me! I have been told that it will be at least 8 to 10 weeks before I can kneel down, but this may depend on your level of physio (PT).

Fortunately, we are still off work for Christmas and my husband is here to help, but going back to work (next week!) and getting the kids ready to go to nursery is going to be a nightmare on crutches.

As for the sport, I'm not sure - is your articular loss on the medial condyle (weight bearing part) of the femur?  As I said, my surgeon told me to give up hockey as the high impact and twisting would either wear away the newly formed "cartilage" scab or knock it off all together or increase the area of articular loss, so you wonder whether it is worth trying to return to sport at all.  I was considering taking up golf as a  less high impact alternative - all he has suggested so far is cycling or swimming.  I would suggest that you ask your surgeon what the likelihood of return to sport is and hope you get a more favourable answer than I did!

Good luck with your op!
Title: Re: Articular surface loss and microfracture
Post by: jnamoore on December 30, 2004, 06:29:51 PM
Please keep me informed of your progress and how it works with your twins! Mine will be 3 in July.
I doubt, that I wil quit playing basketball. Afterall, I originally injured the knee in October. And thanks to having to deal with workmans comp. and a missread MRI I continued to play basketball and workout for 2 months. The frustrating thing is that I actually played really well after about 3 weeks, it was just the pain the day after that mad it bad. Feel free to e-mail me and let me know how it goes!!!