The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: deer on September 30, 2005, 12:04:06 AM

Title: New to board and I'm in need of answers
Post by: deer on September 30, 2005, 12:04:06 AM
On June 1st I feel in work.  I thought I just brused my knee so I did nothing.  On the 8th when my knee still hurt I called the doctor and filed a report at work.  My appointment was on the 9th at which time he sent me for xrays.  One week later the doctor said it was nothing and I had artheritis.  I was told to go to an orthopedic specialist.  When I tried to get an appointment with the specialist I was told that this was a workmens comp injury and I needed a case number.  One month later and in agony I was given a claim number but by that time I was in excrushiating pain and I went to the emergency room.  Again exrays were taken and I was check for a blood clot but again I was told there wasn't anything showing up and they put my leg in an immobilizer.  When I finally got my appointment with the orthropedic doctor my leg was starting to feel better.  The doctor told me I probably had a small tear but it was healing on its own.  3 weeks later I had another appointment and I told the doctor I was still in pain.  I was sent for an MRI, 3 weeks later later I had another appointment with the doctor and he told me that I had artheritis and a small tear and a bakers cyst.  He gave me a cortizone shot.  It has been two weeks and I am now in a lot of pain.  I have an appointment with the doctor in 1 week.  If he tells me one more time its artheritis I will flip.  I never had any pain in my knees until I feel.  I might have the beginning stages of artheritis but I can't  believe that I suddenly had pain from artheritis after my fall. I can't sleep at night because of the throbbing and I can't walk for any distance without being in pain.  My right leg on the inside just under my knee is where it hurts the most.  The doctor gave me a cortizone shot on the outer side of my knee which also had pain up and down the calf.  Climbing steps is almost impossible.  Has anyone else had anything similar happen to them?  I am at my wits end.  To top it off I'm afraid that worikman's comp will charge me back for the time lost at work for all my doctor's appointments  because the radiologist had diagnosed my problem as degenerative artheritis.
Title: Re: New to board and I'm in need of answers
Post by: Nettan on September 30, 2005, 06:35:27 AM
You have a meniscus tear and a cyst, are they due to the doc caused by degeneration or by the accident ?
Maybe you should convince your doc to do a scope to check things out if you don't get better.
Even if you have arthritis this accident worsened it for you, thay must at least be able to see that. Amybe it would have taken you years to get worse if you hadn't have this accident. Don't give up fight for yourself even if you need more opinion to get your rights.
Good luck to you !!

Title: Re: New to board and I'm in need of answers
Post by: deer on September 30, 2005, 10:34:51 AM
The implication from the radiologist report is that its from artheritis.  Wouldn't the cortizone shot have helped?  The exrays only show the begining of artheritis would this have cause a tear already?  I am really getting upset. I don't feel like the doctor is listening to me.   All they see is a 58 year old women with artheritis.  But again I didn't have any any pain until I took that hard fall.  If I was 30 and took that fall would they have checked further?????  Its been 4 months and I need answers but the Doctor seems to be unconcerned and changes the subject when I ask any questions he just keep telling me it will feel a lot better after the cortizone shot.  Well it didn't. 

Thaniks for listening to me vent.  Thanks for the hug!

Title: Re: New to board and I'm in need of answers
Post by: Nettan on September 30, 2005, 02:00:32 PM
Dee, maybe you should try get a second opinion or at least find a doc you feel confidence in.
Wish you good luck !! Feel free IM if i can be to any help for you.

Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 02:18:08 PM
I am having the same type of problem only I did not fall at work and I am only 27.  When I was a kid I had my knee hit hard by a football helmet and it hurt like you would beleive.  I went to the doctor and they said there was nothing wrong.  For 4 years I kept going back with nagging pain in my knee, and yes at times it was nearly impossible to walk.  Finally when I was 18 I was diagnosed by a new doctor with (sorry about the spelling) Osteocondritis disican (from my understand it is just like arthritis).  Basically the trauma to my knee has stopped blood flow to that part of my leg killing the bone and cartlidge.  I have had several surgerys to repair and remove Large Loose bodies from my knee.  Well this past year (one year after a really large loose body was removed) my knee gave out.  We thought I had torn 3 ligaments in my knee the ACL, PCL, and MCL based on how my leg was acting.  Took the MRI and the good news was there was no torn ligaments the bad news was I that I now have the knee of an 80 year old (so that is what the first OS told me).  They told me I would never run again and that all my cartlidge was gone and I was bone on bone.  Well I had my MRI sent to my original OS who did my last surgery to have him look at them (he is a sports medicine specialist for my area).  He told me that what the first OS said was not entirely correct.  I have only lost 80 percent and there was a procedure he could do that would defenitly help but it is very painful with long recovery.  It is called OATS (which there is alot of information here on this site) and I am planning on having it done here soon once I get time from work (short term disability just in case I am out for more than 2 weeks).  All this because of some simple arthritis right!  I am not a doctor just someone who has been told it is arthritis so becareful. 

I hope all goes well for
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 02:49:53 PM
Sorry to disappoint, but it is actually  very common for arthritis to be unsymptomatic until an incident.  And based on your age (I believe you said 57) most of  the innovative new procedures are not recommended.  Here's some basic info that may (or may not) help.

Arthritis is simply the wearing away of articular cartilage.  It can cause bone spurs, as the joint trys to heal itself.  When you have focal lesions, like bridamin51, there are some repair options.  Focal lesions are basically potholes in the cartilage.  An area where the cartilageis worn away, surrounded by healthy cartilage.  If the damage is in all 3 compartments of the knee, or if all of the articular cartilage is showing signs of damage, your treatment options are greatly reduced.  You can be "bone-on-bone" in one area with focal lesions.  If you are bone-on-bone throughout the entire joint, it's much harder to treat.  One thing they have found over the years - the size of the damage has no direct correlation to the amount of pain.  Some people are in agony with focal lesions the size of a tic tac.  These are the patients most easily treated.  If they can measure the lesion in mm, you've got good odds.  Lesions up to 2 square centimeters have the best odds.  On the other hand, there are many patients who have little or no pain for years.  Then something happens that sends them to an orthopedist, who tells the patient they have arthritis or focal lesions.  Many patients have "bald" joints, meaning just about no cartilage left anywhere, and were not in any real pain until... a trip, bump, bad run, etc.  It's almost as if the nerve endings had shut themselves off to protect you, but once you insist on waking them up they want to make up for lost time.  (completely unscientific explanation - for the record.)

To learn more about articular cartilage, I recommend a website:  Here you can learn about articular cartilage, by reading articles in the cartilage management section.  There are 3 treatment options available in the US to treat focal lesions, but I think that none of them are recommended for patients over 40 or 50.  There are articles about the different treatment options, and how to determine the best option for an individual patient.  There are also injections available, called SYnvisc or Hyalgan, which help some patients.

So as I started, sad to say, it is 100% possible, and at your age, not at all unlikely, that you just have plain old arthritis.  It is not uncommon to feel no pain until you fall on the knee or have another incident.  At the same time, it is also very possible that the fall caused the meniscus tear and the baker's cyst.  I don't know how all of that plays into workman's comp.  Cortisone shots don't work for all patients.  The intention is to place the anti-inflammatory in the most swollen, damaged part of the joint.  The direct placement of the medicine generally has a stronger impact on the inflammation.  However, inflammation is not the source of pain.  Your pain may not be a matter of inflammation, in which case the shot may not help.  If you feel that your doctor isn't listening, by all means, go for a 2nd opinion.  And ask a lot of questions.  Articular cartilage shows very poorly on MRIs, so it's difficult to make a diagnosis.  Standing x-rays are good tools for arthritis.  But ask if it's focal lesions or all over?  Ask if it's early stages, or down to bone.  Ask if you'd be considered a candidate for any of the regeneration/replacement options (microfracture, OATS, and ACI).  Ask what part of the knee is affected: lateral, medial, patella, trochlea.  (You mentioned stairs - damage to the back of the patella or the trochlear groove both cause pain on stairs.  This is the back of the knee cap, or the groove it runs through.)  Ask if you could benefit from physical therapy or bracing.  Ask if there are physical activities you should avoid and any you should seek out.  Ask about long-term treatment options, and how they fit into your desired lifestyle.  Are you very physcially active?  Would you consider a knee replacement now, or do you want to put it off for another decade?  Is it even an option for you?  What about a unicompartmental knee replacement?

I've written quite a bit, so I'll stop here.  But I hope this helps.  Let us know if you have any more questions.
Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 04:14:20 PM
I have a question about my case.  I have lost 80 percent of cartlidge and the area affected in my knee is 1.8 cm.  Now I have been told by my Ortho that he wants to try a different procedure called OATS (first time i had Microfracture).  I have already asked this once but I guess this will be my second opinion.  Do I have to have this procedure?  I am 27 and I have heard about TKR come up and was told if I dont do this OATS procedure I will have to have TKR sooner than later.  Is this true?  My knee is not in constant pain just more of a nuissance and at times yes it hurts a good bit. 
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 04:56:28 PM
Bridamin -

Of course you don't HAVE TO have surgery.  I have had microfracture, and am considering ACI.  But I don't feel like I'm in enough pain to warrant the surgery.  It's a difficult decision - to have surgery as a *preventive* measure, or to wait until the pain gets worse and hope you're still eligible for the surgery.  I'm 31, so I totally understand.  I'm going for a 2nd opinion to an out-of-state specialist myself.

Good luck-
Title: Re: New to board and I'm in need of answers
Post by: deer on September 30, 2005, 06:51:50 PM
Thanks to all of you for your answers and suggestions.  I am going for a second opinion.  I still have a hard time believing that artheritis can be this debilitating.  But at least now I know it can show up suddenly after a major fall. The doctor suggested that I have a scope done but then he cautioned me that it can make it worst.  Has anyone had this done and was the pain worst after this minor sugery..
Thanks again to all for listening and your suggestions...

Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 07:05:17 PM
See I have been told by several (including 2 OS) that in my situation that surgery is necessary because of the disease and that it will continue to get worse.  I was told if I dont do it I will have to undergo TKR in my not to distant future.  I just dont see it as the pain is not always really really bad just a normal pain I deal with.  I dont want to have surgery but I really really dont want a TKR anytime soon either. 
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 07:07:16 PM
Dee -

Being worse after surgery depends on what they do.  If all they do is look around (very rare) you won't end up worse most likely.  If you have a debridement & lavage- where they clean up all the loose edges (kind of like trimming a thread to keep it from unraveling) you may end up worse.  They'd be unlikely to do microfracture at your age, so you don't need to worry about that one too much.

Arthritis can be incredibly debilitating.  And we all react differently to hearing that word.  The first OS I saw (who didn't touch my knee, but only looked at the x-rays) said I had arthritis, too bad.  I was 30 at the time, and found that completely unacceptable.  My current OS calls the damage focal lesions.  It's still, technically, arthritis.  It's still damage to the articular cartilage.  But it doesn't sound nearly as hopeless.  At least to me.  

I guess, the older I get, the more I realize how many "in between" ages there are.  There are the early adolescent years - when you're not quite a teenager, but not really a little kid.  The late teen years, when you're mostly an adult, but not quite.  The mid-twenties, when you're somewhere between a "young adult" and a plain old "adult".  No matter where you are in life, you're a little young for some things, a little old for others.  57 is a little young (but not by much) for a knee replacement, but old for microfracture, OATS, or ACI.  And for most people, it's definitely too young to have to change your life to accomodate arthritis.  But then again, there are a lot of teenagers, 20-somethings, and 30-somethings on this board who've had to change our lives to accomodate arthritis.  Or focal lesions.  

I hope your 2nd opinion discusses all of your treatment options with you.  It's no fund when you need medical care, and it's not good when you have limited options to begin with.  But if you're not even given info on the treatments available, how will you make the best treatment decision for yourself?

Good luck.
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 07:11:48 PM
bridamin -

I don't know all the details of OCD, but I thought you said you already had microfracture.  Did that fail?  Or has it worn out?  Is there still more bone dying?  How will they handle that with OATS?  I'm not a doctor, and don't know too much about OCD.  One of my kneeguru friends has OCD and had microfracture.  Her screen name is Casey2291.  She's got a post-op diary in the microfracture section.  But I don't know why the OCD area would expand without OATS, but will stop expanding with OATS,  From a patient perspective, I'd want to understand that first.  ANd there's nothing wrong with seeing more doctors until you're comfortable with your decision.  I'd try to find someone who does both OATS and ACI, to see which they think best suits your case, and why.

Title: Re: New to board and I'm in need of answers
Post by: shadehawk on September 30, 2005, 07:30:19 PM

It can be tough coming back after surgery sometimes, but doing nothing is not an option if the physio and meds are still not giving you any kind of lifestyle...that is my feeling anyway.

Since surgery in July - it has been tough getting strength back in my knee and balancing that with keeping the OA from flaring up.  You just have to try and stay positive & keep up with the exercises and biking or ellipcal or whatever therapy you are having & following the OS protocol. 

Everyone heals differently so everyone has different experiences with surgery.  Some people bounce right back and other's take longer to recover.  Some people walk out of surgery from a scope & other people are on crutches for weeks - it all depends on the extent of the work done once inside the knee & maybe how long the damage was left before surgery was performed.....etc, etc,
Trust in your surgeon, I believe is very important.  If you are not sure, then seek more opinions.

Good information in the post from Jess.

Good luck,

Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 07:53:46 PM
The Microfracture did fail after 9 years.  This is the second OS I have seen and He has performed surgery on my knee before so he is familar with my case.  He is also the specialist in my area in this type of procedure.  He did say that we could go do microfracture again but thinks it would fail, He recomended the OATS procedure as he said it would take alot better and be stronger.  I am not sure how it would stop the OCD but he said this would defenetly help and that I may even be able to get back to doing some light activities.  (but he did stress it was a bad idea for me to do any running).  I think I have already made up my decision to have the surgery because everyone I know keeps telling me that I have to do it.  I have friend on my softball team who is a physical therapist and he told me my leg would feel so much better after a few months post op.  He also stated I need to do it now to prevent TKR just like everyone else has.  You are the first one who has actually said try other routes, hold off, look around.  And I apprciate that.
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 08:12:55 PM
I'm not a doctor, and I'm not trying to give medical advice.  I just advocate being an informed patient.  In an earlier post you say your knee is 80% down to bone.  Do you mean 80% of the knee has no cartilage, or that, your focal lesion is 80% of the way down to the bone?  I've never heard of OATS - even with a cadaver donor and significant mosaicplasty work - being done on an entire knee.  You would need healthy cartilage around the knee to serve as a frame.  I've been told that I'm probably not a good candidate, based on the size of my lesions (I've got over 23 sq. cm. of damage), so I'm curious how 80% of the knee can be filled in with cadaver cartilage. 

In the end, if you're confident in your surgeon and in your decision, than it's the right choice for you.  And if you're really having 80% of your knee cartilage replaced, please let me know who you're seeing.  I'd be curious to see what he thinks of my knee.

Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 08:28:43 PM
80 percent has no cartlidge I beleive cause the fist OS I saw said there was no cartlidge and I was bone on bone.  The second OS said that was not a true measurement that I actually had lost 80%.  my measurment I beleive was aproximetly 1.8 cm.  The original OS said something about if it got be greater than 2 they could not perform the surgery and i would have to go to Duke University (i dont know why and forgot to ask my current OS what that was about).  My current OS was also a little concerned about the size also but said I was still in the range.  He was not going to use cadaver cartilege either he was going to use my own from somewhere.  I guess I am a non informed patient.  I am still trying to read up on the procedure and learn more about it. 
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 08:34:16 PM
OK - you have a focal lesion measuring less than 2 sq. cm, that has worn away 80% of the cartilage and is nearly to bone.  The way you wrote that at first, I thought that 80% of your knee had no cartilage whatsoever - which is most of your knee.  2 sq cm is considered large for the purpose of OATS, but not in the grand scheme of things.  I have 3 focal lesions - all of them grade 4, completely down to bone.  One measures 18 sq cm, one is 3 sq cm, and the 3rd is I think 2 or 3 sq cm.  I had microfracture, so there may be some fibrocartilage there, but based on my pain, it's not enough.  Now I understand better why they don't want you to wait - if you can have autograft OATS now, or wait and have allograft OATS, I think I'd prefer to not have to wait for a cadaver donor myself.  Good luck with the surgery.
Title: Re: New to board and I'm in need of answers
Post by: bridaman51 on September 30, 2005, 08:50:42 PM
I apologize I didnt mean to misinform like I said this is all new to me and i am still trying to understand it all.  actually the way you put it helps me alot I understand alot more of what is going on in there.  I see the OS on 26 of October at which time we are supposed to set up the surgery. 
Title: Re: New to board and I'm in need of answers
Post by: blackbeltgirl on September 30, 2005, 08:59:18 PM
No worries about misinformation here.  We're all just figuring things out as we go along.  I'm still holding onto the thought that you got 9 years of relief from your microfracture.  It's been less than a year since I had it done.  The first 5-6 months were really recovery and healing, then I had about 3-4 good months, but it's been acting up lately.  Maybe if I look at my knee, tell it that this has to work for a lot longer, it will listen.  Good luck with your surgery.