The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: kathleenj on January 20, 2005, 05:17:00 PM

Title: update after OS visit
Post by: kathleenj on January 20, 2005, 05:17:00 PM
I saw my OS today for a 6 week follow up after my Chondroplasty and plica/scar tissue removal.   I have been having some pretty bad medial pain which has been preventing me from progressing with my rehab.  I get that sharp pain when I try to do things like mini-squats and weight bearing exercises like wall slides...I've also been having pain with terminal extension, just that last few degrees.   He believes that the defects on the MFC as well as the tibia (kissing lesions) are the cause of these problems.  
We discussed many options for me but right now we are just going to ride it out.  My muscles are pretty bad because of the lack of exercises I was able to do but he called in one of the PT's he has on staff and together we came up with a few things that I can do to help with the rehab.  Right now we need to get as much muscle back as possible before we even consider any other options.  Which I'm pretty happy about because I really dont want to do anything surgically right now.  

The funny thing is...when I got there he told me that I have been the topic of many of his conversations recently, well my knee actually.  He said that he consulted with a few collegues at the Cartilage Restoration Center in Boston because he trained there...thats where Dr. Minas is.  They feel that an ACI is completely out of the question because of the kissing lesions but there are other ways to take plugs from the knee.  Right now I have limited amounts of donor sites because of the prior two Oats but he said that they have begun to take donor plugs from the tibia and it is proven to be just as successful.  I never heard of that...just goes to show you that progress is being made every day.  He also said that if need be we can always do an Allograft but people seem to have more success with their own plugs.  

Well thats about it for now.  I'm feeling pretty optimistic after meeting with this new PT.  I was kind of in a rut with the rehab so I think this will help to 'jump start' things.  I'll see the OS in 5 weeks and we will re-evaluate things then.  

Title: Re: update after OS visit
Post by: QBknee on January 21, 2005, 03:59:48 AM

I had an Autograft done by Dr. Minas in Sept 03.  He did take the bone from my tibia to fill my defect which was on my lateral femoral chondyle, partial trochlear.  My defect was 20mm long,15mm wide, and 8mm deep.  Dr. Minas took the bone from the top of my tibia.  The defect that he filled is doing great.  I have severe Arthrofibrosis, which I had prior to the autograft procedure by Dr. Minas that I am still dealing with.  I have surgery set with Dr. Noyes Feb 2 for the scar tissue.

Title: Re: update after OS visit
Post by: kathleenj on January 21, 2005, 04:02:13 PM

Thanks for your post.  I was wondering how and where they take the plugs from the tibia.  OS mentioned something about the 'bridge' area but I cant seem to find any information about it.  All  the research I can find refers to donor sites on the femoral areas of the knee.  

I have heard such great things about Dr. Minas and I was really glad to hear that my OS consulted with his group about my situation.  I was actually considering going down there to see him in the future if need be.
Right now I am just trying hard to rehab the knee.  After 3 procedures in 1 year the muscles has atrophied pretty bad.  At this point I am just looking into my options for down the road.  

Thanks for your input.  It is encouraging to know that you had the tibial grafts and that it seems to be doing great now.  

Good luck on the 2nd with the scar tissue surgery.

Title: Re: update after OS visit
Post by: JG on January 22, 2005, 10:22:22 PM

Boy, it's been 6 weeks already!  It's great that the OS pulled in the PT to discuss exercises that you CAN do.  In terms of the allograft, that's what I had.  It took two hemi-chondyles to fix everything.  Go to to see what they look like.  Please give yourself time to heal as well.  I know you want everything to be better automatically, but it takes time.   It's been 8 weeks since my fall and I am just feeling better (that just a fall not surgery!).

I know it was the first time my OS used two hemi-chondyles for one procedure.  I'm luck since my medial joint is only bad on the femur side not the tibia side.  The funny thing is is that my lateral side has the kissing lesions with my tibia bothering me more.  This side wasn't fixed in the first surgery. He felt that the 13 trochlea grafts and the 5 medial fem chondyle grafts were more than enough for one surgery.   I did talk to my OS about two weeks ago. He suggested that if I'm not significantly better 16 weeks post-injury, we will do another MRI and based on the results either let things continue to heal or regraft the medial fem chondyle AND the lateral fem chondyle.  I hope things keep getting better.  I don't want to essentially "start" again.  

Check out the following website.  It's from the a symposium on cartilage restoration.   Minas, Cole and Farr give lectures.  You will find it interesting.

Keep up the exercises you can do and hopefully you can add more.  

Title: Re: update after OS visit
Post by: kathleenj on January 24, 2005, 04:23:34 PM

Thanks for those links. They were very informative and answered a few of my questions about the allografts.
It is good to be prepared and be fully informed of all my options for the future.  Right now I am really focusing on the rehab.  Since I met with the PT last week I have noticed some significant changes in my knee ( and its only been about 4 days doing these new exercises).  First of all on Friday...I woke up sore!   Yes, muscle soreness!  I havent had that in a really long time.  I know it seems strange to be excited about that but it showed me that the new exercises were definately targeting the key areas that I just wasnt able to get before.  Secondly, my kneecap is not jumping all over the place anymore and the knee is not buckeling as often as before.  I think I have actually woken up the muscles and they are beginning to work a little.  I honestly didnt expect to see results this quickly but I am amazed and loving it.  I still have a long way to go, very long way to go, but it is promising.  
As far as doing anything surgically...I will put that off as long as possible.  My OS wants me to get as much function out of the knee as possible...when I get to the point of not progressing anymore we will see where I stand with my activity level.  If its something that I can live with then we wont do anything.  He says its really a quality of life issue right now.  If I can do most of the things I want to do with limited amounts of pain then we will let it be.  If it continues to prevent me from doing the things I miss the most, then we will proceed to some sort of surgical intervention.  I'm not talking about running marathons or even any sort of running for that matter. I can deal with never ever doing that again...its the simple things like playing catch with my kids or ice skating on the pond or hiking in the woods that I want to be able to do.  If I can, than I will leave the knee for now and deal with things later down the road.  

I'm glad your knee is beginning to feel better.  Hopefully it will continue to improve and you wont need to have the regrafting.  Have you been able to get back to your workout routine?  You were really kicking butt with it for a while there before your fall.  Maybe if you can get back to that things will be ok for a while and you can avoid the surgery for the time being.  

I was just wondering...does your OS think you may have injuried the orginal grafts with this fall or is it still that same issue with the grafts as before the fall that would want him to regraft that area?

Title: Re: update after OS visit
Post by: brattkids2 on February 04, 2005, 02:53:55 PM

Just thought I would touch base and see how you are doing!!

I have been doing alot of PT also with muscle soreness it was great!!

My new OS thinks that the plug from my recent OATS isnt sitting correctly.(I am getting lots of catching and sharp pains) I had an MRI on the 31st. It showed marked irregularities in both the donor site and the plug site. I go back to see the OS on the 8th to get his interpretation of what marked irregularities are. I am not going to have anything done till at least May though. I am taking three online classes and I go one day a week to campus for labs and I really need to build up the leg strength before anything is done.

I hope your continuing well with your PT and you are getting along good.


Title: Re: update after OS visit
Post by: kathleenj on February 04, 2005, 04:16:11 PM

I havent been around the boards for a while.  I've been trying to put my knee in the back of my mind for a while except when I am exercising of course.  Anyway, its going ok.  I have really been making alot of progress with rehab and can actually see some results.  Of course, I am continually hitting obstacles and roadblocks but I've been managing ok.  Strength is increasing everyday so that is definately a good sign.  I am scheduled to go back to work in March and I think I might actually be ready.  I have learned lots of ways to avoid the things that irritate the knee so I think I will be ok.  Twisting movements send me to the moon with pain so I've been very diligent with avoiding that...its amazing how you can adapt to your bodies limitations.  Unfortunately twisting is the one thing that I cant avoid with work...photographer, pivoting back and forth to the camera.  It will be challenging but I'm certain I'll manage. I'll only need to work for 3 months and then off all summer so I'll re-evaluate how things go with knee at that time.   
I understand what you mean about the catching and sharp pains.  That was pretty much what happened to me when my original plug wasnt sitting right.  I'm hoping your OS will have some good news for you when you see him.  You never know right? 
Sounds like you have your hands full with school.  I'm sure it helps with keeping your mind off the knee.  I think thats why I'm looking forward to heading back to work. 
Thanks for the update.  Keep up the hard work with rehab and let me know what the OS says.

Title: Re: update after OS visit
Post by: kathleenj on February 24, 2005, 06:37:48 PM
Hi all.

I hope everyone is doing ok with the knees.  I just thought I would drop a line to give an update. 
I saw the OS today for a follow up.  I have been working very hard with rehab the past month or so and the doc said that things are lookin good!!!  I still have a ways to go with muscle strength but it is definately coming along.  Its hard to say right now what exactly is happening with the cartilage but at this point I really dont need to know.  My knee feels pretty good most days, a bit achey at times, but for the most part it is ok.  I really need to avoid twisting and I'm still having some problems with uneven ground (or snow) but I can manage ok on a daily basis.  Stairs are still difficult but thats not uncommon at this point, going down moreso than up.
OS gave me a Donjoy brace to help with stabilization as that seems to be a problem for me since the muscles are still a bit weak.  After all its been over a year since the 1st surgery and its going to take some time to recondition my brain to feel comfortable with the knee.  I need to try to not think about each and every step so much.  (very hard I might add)  Anyway, the brace should help with that and help with getting back to a somewhat active lifestyle.  He said it is ok to do what I want.  I guess I cant cause any more damage than whats already there and in the meantime, I should try to get as much as I can back to normal.  I'm willing to go with it...test it...that is.  Having said that...I"M HITTING THE SLOPES!!  Well, the bunny slope.  Kids arent ready for the big hills yet.  I'm not sure how it will pan out.  I may just put the skis on and then say 'are you crazy'  but I'm at least gonna try.  Who knows...if I can at least go up and down the tow rope with the kids I will be very happy.  Wish me luck, but please, not to break a leg. 

Well, thats about it for now.  I really hope everyone is doing ok.  I'll update again soon
Title: Re: update after OS visit
Post by: JG on March 06, 2005, 12:02:20 AM

Please let me know about how you do with the skiing. It's been about 14 weeks since I hyperflexed my knee.  It started to feel pretty good about 2 weeks ago and I'm about 90% of where I was pre-injury.  I started running on the treadmill (let me define "running", basically 3 to 5, 15 to 30 second runs where I support 50% of my body weight with my arms).  I really want to do some skiing on maybe green and blue runs.  I'm no longer in formal PT, but arranged a deal with my PT to use their facility.  It's great.  I have access to one of their trainers (she's awesome and bascially when i was in formal PT, she is the one I really looked to for guidance) and if I want to touch base with my PT, I have that too.

Good luck with the new PT...Janice
Title: Re: update after OS visit
Post by: kathleenj on March 08, 2005, 05:43:38 PM

Glad to hear that you are starting to feel better.  Running is a big step, even if only for 30 seconds at a time...hooray for you!!!

Skiing went ok.  Actually it went surprisingly better than I had anticipated.  It was actually a bit funny at first.  At first I couldnt even get my foot in the boot.  The hardest part was being able to jiggle and twist to get my foot in...a bit painful for the knee as twisting causes the most of my pain.  Walking in the ski boots was weird too, a little painful.  I wear a size 7 1/2 shoe but I had to get a size 9 just be able to get my foot in.  That took a while.  Once I did we headed over to the j-bar and I think I stood there for about 10 minutes before I had the courage to test this out.  Finally got to the top (of the bunny hill)  and again stood there for about 10 minutes believing that I couldnt do this.  My kids went up and down 3 times before I had a go at it.  As long as I kept in complete control, nice and easy, things seemed to feel ok.  We stayed on the little hill until I felt confidant to hit the lifts.  After that we headed to the green trails, again staying in complete control and going nice and easy. 

I would have to say that overall it went well.  I lasted for about 3 hours and finally decided that I had tortured my knee enough and headed to the fireplace to warm up.  I honestly think the brace is the only reason I was able to do this.  Even with it, the knee was a bit unstable, but couldnt have imagined being without it.  My entire leg hurt really bad the next three days.  But that was just muscles aches...really bad muscles aches.  Gosh, it made me feel really old :P

So thats pretty much the skiing experience.  I think we are going to head up again this weekend.  I'm only 30 minutes from a few ski resorts up here in NH and I think we are going to try to make up for some lost skiing this March...spring skiing is lots of fun up here. 

You should try it out.  The worst that will happen is that you cant do it.  Thats how I went into it.  I was just so tired of letting this knee dictate what I can and cant do.  I feel great that I tried it and was pleasantly surprised when it wasnt as bad as I thought. 

Good luck and happy skiing!!!!!!!!