KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: Beauzer on September 30, 2005, 08:51:13 PM

Title: Major disaster
Post by: Beauzer on September 30, 2005, 08:51:13 PM
I'm now 5 months out from OATS to the MFC.  Everything has been perfect, with no pain or disability at all.  I've been very good at babying my knee.  Today, just walking around, I felt a big pop and suddenly couldn't bend or stand on my knee.  I saw my OS, and the films look like I pulled one of my plugs partway out.  Worse still, it looks like my OCD is spreading (likely why the plug suddenly shot out).  So...

MRI tomorrow AM, scope Monday to at least take out the plug and then try to figure out what to do next.  My OS is thinking maybe TKR a bit sooner than we had planned.

SH*@.

Danielle
Title: Re: Major disaster
Post by: blackbeltgirl on September 30, 2005, 09:03:47 PM
Danielle -

I'm so sorry.   :-\  I can only imagine how you're feeling right now.  If I remember correctly, I think you used to practice martial arts of some sort.  What I miss most about martial arts is the ability to go hit things, and even people, after a day like this.  All without anyone calling the cops and carting me off to jail.  I hope your OS can find a solution for the OCD, so that he can replace the cartilage and it will last.

Good luck!
Jess
Title: Re: Major disaster
Post by: Nettan on September 30, 2005, 09:22:46 PM
Ahhh, Danielle, so terribly sorry !! You have come this far and now this going back. Hope the doc when he scope you can figure out a way to help you. Don't give up, I'm sure there must be some solution.

HUGS NETTAN  8)
Title: Re: Major disaster
Post by: Beauzer on September 30, 2005, 09:44:59 PM
Thanks.

TKD Jess, 2nd degree blackbelt.  I know EXACTLY what you mean.  Somebody asked me what I wanted to do today.  I said "do you mean other than bashing through the wall with my crutches right now?"  Oh well.  I just keep repeating what my instructor taught me, "you can't change what has happened, but you have complete control over how you react and what you do from this moment forward" , so, no use worrying about what I can't change.  We'll just have to see what we can do.

Knees suck (well, at least my right one, that is).
Title: Re: Major disaster
Post by: kathleenj on September 30, 2005, 09:51:04 PM
Oh Danielle,

That totally sucks!!!  I am so sorry to hear that the plug popped out.  I went thru the same thing only my pain was gradual, I didnt have the popping feeling you had.  I had mine re-done at 6 months.  I know you must feel totally devastated right now.  Those feelings of 'I cant believe I went thru all of this for nothing' can be very overwhelming.  Try not to jump to any crazy conclusions yet, a TKR may not be absolutley necessary...you may still have other options.
Having gone thru the exact thing myself, I understand how you feel so if you have any questions please feel free to contact me.  

Good luck with the scope and let us know how it turns out.  

I'll be thinking about you!
Kathy
Title: Re: Major disaster
Post by: shadehawk on September 30, 2005, 09:53:29 PM
Danielle,

OMG - sorry to hear this has happened. 

Let us know how everything goes.

Good luck,

Shade
Title: Re: Major disaster
Post by: SallyW on October 01, 2005, 01:10:06 AM
Ugh. I'm sorry.

What causes OCD to spread?
Title: Re: Major disaster
Post by: Beauzer on October 01, 2005, 01:17:07 AM
Don't know.  OCD is necrosis (death) of bone, caused by loss of blood supply, but no one is sure exactly what causes it.  Whatever started it in me obviously wasn't finished at the time of the OATS.
Title: Re: Major disaster
Post by: scooter5 on October 01, 2005, 01:43:36 AM
Danielle,

Sorry to hear about your bad news.  I also recieved the same info this week.  I found out Wednesday that one of the plugs popped loose.  I had the OATS on the Patella.  I had an MRI today and will see the OS on 10/5.  I also scheduled a second opinion for 10/5.  It looks like I may be heading for TKR as well.

Hope you feel better soon.

Scooter
Title: Re: Major disaster
Post by: blackbeltgirl on October 01, 2005, 04:51:27 AM
Danielle -

Isn't someone else on the board having a plug "pinned down" sometime in the next week or 2?  Similar issue I think, minus the OCD.

Anyway - I recommend you pay a visit to your former TKD school if you're still in the area.  Ask for 2 minutes to use the heavy bag, and whack away at it.  It will make you feel betterm, at least temporarily.  Then head home, pour yourself a stiff drink, and deal with this tomorrow.

Good luck.  I'll be looking for a happier sounding post in coming days.
Jess
Title: Re: Major disaster
Post by: brattkids on October 01, 2005, 08:04:05 PM
Hi Guys,

I was supposed to have my OATS pinned down- but I too have OCD. When they got in the there was no salvaging the plug and they had to redo the plug (OATS) so I know exactly how you guys are feeling. I am 4-6 weeks back on the NWB and slowly counting they days again. Hope you all get better news keep me posted!!!!

Paulette
Title: Re: Major disaster
Post by: Beauzer on October 01, 2005, 10:17:10 PM
Well, I've looked at the MRI and talked to the OS, but the OS hasn't had a chance to look at the MRI himself yet.  From talking to the radiologist, my MFC looks really screwed up.  There is a lot of marrow edema.  My OS thinks it might be AVN, or (hopefully) I fractured the plug or my MFC or both.  He's going to call me in the morning, once he's had a chance to see it.  If it's AVN, it's my entire medial condyle, yikes.  Here's hoping for a fracture...

Either way, I'm on for 9AM Monday.  Wish me luck,
Danielle
Title: Re: Major disaster
Post by: Beauzer on October 02, 2005, 01:04:59 AM
Just got off the phone with my OS :P.  It really doesn't look good.  Basically, best case scenerio I fractured the OATS plug and my MFC and we can pin both in place and be NWB for 6 weeks.  Worst case scenerio (and what he thinks is more likely) my entire MFC is dead and I'll need major bone grafting and be NWB for 12 weeks or more and then need TKR.

Barf. 

Gonna go take some more vicodin (or maybe just drink a bottle of bourbon).  I'm just trying not to cry.
Title: Re: Major disaster
Post by: scooter5 on October 02, 2005, 01:10:12 AM
Danielle,

Good luck with the surgery on Monday.  Keep us posted.  I won't have the results of my MRI until Wednesday.  I'm ready to start drinking myself.

Scooter
Title: Re: Major disaster
Post by: JG on October 02, 2005, 02:10:05 AM
Danielle,

Sorry to hear about the knee.  Have you considered seeing Bugbee in San Diego or Gross in Toronto.  They both specialize in large allografts.  Not allograft plugs like what I had done, but either shell allografts or large allografts (hemi-chondyles).  If my MFC every goes south, I'm going to look into the shell allograft (one huge plug rather than another 5 or 6 small plugs).  I met a patient in PT that cracked her MFC, had it repaired (not sure how), it didn't heal (AVN), and Bugbee did a large allograft on her.  It was a really long time on crutches, like months and months, but eventually she did great. 

This board mainly focuses on OATS (auto or allo), but there is lots being done with larger allografts.  Obviously it's used in extreme cases (mainly trauma), like TP fractures, MFC or LFC fractures, but it's being done.  However, very, very few surgeons are experienced at using them.  I really trust my surgeon to perform another mosaicplasty/OATs or microfracture, but not a shell allograft.

If you do a google search for Allan Gross, lots of good stuff comes up about large allografts.  Also, check out www.mtf.org.

The other thing I find interesting about this board, the number of individuals who have had their grafts "pop" out months after their surgery.  It just seems so odd.  I would love to know how often this happens to patients of the top cartilage docs like Bugbee, Cole, Gross, Buckwalter, Farr, etc.  I don't consider my physician in this group, but the next time I talk to him  I'm going to ask him about it.

Good luck,

Janice
Title: Re: Major disaster
Post by: SallyW on October 02, 2005, 04:35:13 AM
What is considered a "large" autograft plug?

Things are going well for me, I guess, although my PT keeps telling me to not push rehab so much. He says I'll do better if I slow down. But hearing about others whose plugs have gone haywire after months of "great" results makes me nervous. Especially since it seems like those of us with OCD are at greatest risk, correct?

The only thing to keep in mind, I guess - aren't people who are having problems more likely to hang around here? The people with successful recoveries usually are all too eager to put their knee problems behind them - not think about stuff like this. So maybe this board doesn't offer an accurate picture of successful operations?
Title: Re: Major disaster
Post by: blackbeltgirl on October 02, 2005, 04:22:11 PM
Danielle -

How was that bottle of bourbon? ;)  Hope you're feeling a little better, mentally speaking.  No matter what happens, remember that your attitude can make a huge difference in how you heal.  Partly because it may be the only thing you have control over, but partly the seratonin level, or whatever that hormone is.  I always call it the happy hormone.  At least you know you're not alone, and have a support system here.  Imagine the patients going through knee trouble, whose family and friends don't quite understand, but they've never found kneeguru.  Here you can vent to your heart's content, cry big sloppy tears if needed, and get comfort, sympathy, and even voices of experience.

I'll keep my fingers crossed that it's just a fracture, and hope that you can get through the next step of healing without any new troubles.
Jess
Title: Re: Major disaster
Post by: JG on October 02, 2005, 05:20:04 PM
Sally,

I'm not sure there is such a thing as a "large" autograft.  I'm talking large allografts, shells and whole hemi chondyles.  Remember where they are taking the autograft from, there is not much donor area to take a large plug.  I'm not sure how large shell allografts are, but if a normal allo or autograft plug is say 6 mm to 12 mm, a shell has to be 2 or 4 times that size and they are not alway round in size but cut to the defect shape.  I've done tons of research on allografts, but don't have the research organized.  If I find it I will post it for everyone.  I did find some results for shell allografts (see below).

Here are some papers reviewed at the AAOS meeting last year regarding the utility of allografts in orthopaedics.  The bottoms one refers to shell allografts.

http://www.medscape.com/viewarticle/491618_2

Here is a picture of a shell allograft, just scan down the page (Figure 1b)

http://radiology.rsnajnls.org/cgi/content/full/219/1/35

I agree about this board being attended by mostly people who have problems, but this "poping" thing just seems strange.  Prior to my surgery I got a second, third and fourth opinions.  Because we knew I would have at least 10 (I had 18) plugs, I was worried about all of the plugs living.  Basically all of them said that if they survived the first 3 months, they would survive.  No one was worried about the plugs moving after three months.  But they all said the recovery would be 18 months to 24 months.  I didn't believe that part, but it was.

Janice
Title: Re: Major disaster
Post by: JG on October 02, 2005, 07:26:06 PM
Here is something I found about grafts coming loose...

"Peripheral containment of the lesion is another factor when subchondral bone is markedly involved. Ideally, the periphery of the defect should be rigid enough to contain the outermost grafts. This is intuitive and important from a mechanical stability standpoint; without adequate press fit, unconstrained grafts may loosen in the early postoperative period when range of motion is started, even without weightbearing."

Janice
Title: Re: Major disaster
Post by: shadehawk on October 03, 2005, 01:54:00 PM
(http://www.eirefirst.com/clipart/thumbs/tn_Shamrock%20-%20Good%20Luck.jpg)

Danielle and Scooter

This is going to be a tough week for both of you.  Danielle with the scope today and Scooter awaiting your news on Wednesday.

Our fingers are X'd,

Shade
Title: Re: Major disaster
Post by: brattkids on October 03, 2005, 04:54:41 PM
Thanks for the info Janice, I find it really weird also that everones grafts are coming loose- what a coincidence.

Danielle, I sure hope things go well for you today!!!!!!

Paulette

Title: Re: Major disaster
Post by: kathleenj on October 03, 2005, 07:21:54 PM
I have to agree that it is strange to hear about plugs popping out.  Last year when I was told that my plug shifted I didnt fully understand how that was possible.  I was told that after the first few months it would be incorporated.  I think I had a false sense of security when I had xrays at 2 months and was told the plug is looking good.  I was never told that it is still possible for it to move.  But there I was, 4 months post op being told that the plug 'shifted' and having to schedule the revision.   
Makes you wonder if just any doctor should be doing these.  My original OS implied that it was a piece of cake.  Like a hair transplant he told me.  HA!  I dont think so.  I have since moved on and have been plagued with many many other issues with the cartilage.  It all just really makes me wonder.............
Title: Re: Major disaster
Post by: Beauzer on October 04, 2005, 08:55:34 PM
Thanks everybody for the encouraging words.

I'm just back from the hospital.  Good news, although one plug was a bit broken, the rest didn't look too bad.  They cleaned up the broken one, which was likely responsible for the catching sensation.  I also fractured the surrounding MFC, explaining why everything hurt so much.  I ended up staying the night, because we couldn't get the pain under control.  I still feel really woozy today.

So, it looks like everything is going to heal with some TLC (and 6-12 weeks NWB - ouch).
Title: Re: Major disaster
Post by: shadehawk on October 04, 2005, 09:45:56 PM
Danielle,

Glad that you are back home again.  Hope that everything will go as planned now, sorry about the long time NWB - know that is a real pain.

Sending good vibes your way .......................

Shade
Title: Re: Major disaster
Post by: brattkids on October 04, 2005, 10:19:20 PM
at least it wasnt as bad as you thought!! although thats a long long time for NWB  :'(

Keep me posted on how you are feeling

Paulette


HUGS AND GOOD VIBES YOUR WAY
Title: Re: Major disaster
Post by: kathleenj on October 04, 2005, 11:53:21 PM
Danielle,

Glad to hear that it wasnt as bad as originally expected.  I think Janice  (JG) had some sort of fracture of the MFC or was it one of the plugs after her mosaicplasty...I cant remember exactly right now.  She may be able to tell you what to expect in regard to that.  Good luck with the NWB again.  I know it sucks but all in all things should be ok. 

Hang in there!!!
Kathy
Title: Re: Major disaster
Post by: scooter5 on October 05, 2005, 01:43:48 AM
Danielle,

Glad to hear it wasn't as bad as originally thought.  NWB is a pain however, it will be worth it in the end.

Good luck on the recovery.  Keep us posted.

Scooter
Title: Re: Major disaster
Post by: Beauzer on October 05, 2005, 02:50:41 AM
I ended up talking to my other OS (both did the OATS) tonight.  He suspects there still could be some AVN (osteonecrosis) of the MFC to go along with the fracturing.  So that's why the potentially long NWB.  We'll just have to wait and see.  Bleah.

I'm also now stuck in a brace (Breg T-ROM).  Overall it's nice compared to the other post-op braces I've had.  I'm just wondering why I have to wear it at all.  I didn't use one after the OATS.  Initially this time it was to make sure I didn't bend the knee, until we found out if I had disrupted my grafts.  Now I'm cleared to full ROM.  I guess it could help take pressure off the healing MFC fractures in case I put my foot down (not that I'm planning on it, mind you).

Has anybody else had postop fracturing somewhere other than the plugs themselves?  Or am I just weird?

Danielle
Title: Re: Major disaster
Post by: JG on October 05, 2005, 04:33:17 AM
Nope, you are not weird.  I actually was initially diagnosed with articular cartilage problems not from the MRI showing thinning cartilage but from a fracture running up my MFC into my femur.  There was synovial fluid running from my knee joint up the fracture.  They only way that happens is if there is no articular cartilage to stop the fluid from going up there.  I have been battling them since (almost 5 years).  I've also battled with periods when they thought I had AVN. 

I'm training for a century bike ride which is coming up in three weeks and after my training rides of 75 and 85 miles I had really bad swelling (like ROM of 10 - 100) for a couple days.  I called my OS about it and he laughed and said that he didn't need films it was probably either one of my famous stress reaction fractures or another fracture forming in my MFC.   I'm constantly battling all sorts of things with my MFC (subchondral cysts, bone bruises).  I get them for no reason at all really.  It's amazing my grafts looks so awesome.  The underlying bone is shakey at best.

Danielle, you should really look into seeing Gross, Cole, or Bugbee about the shell allograft.  At minimum your OS should call for you.  My guy made me talk to 3-4 of the top guys before he would do my big mosaicplasty.  The one thing I've not had, popping plugs and failing plugs, but I was NWB for a very very long time and I waited and waited to get back to normal life...like 9 months before I went for normal walks (3-4 miles).  That was key. 

Good luck,

Janice
Title: Re: Major disaster
Post by: Beauzer on October 06, 2005, 04:26:08 PM
Pain is a funny thing.  So after nothing but excruciating pain since last Friday (when I apparantly crunched my MFC), today I woke up with none at all.  Gone.  Doesn't make much sense to me.  In fact, the very thought hadn't occurred to me until I realized that I had hopped straight out of bed and WALKED to the bathroom.  Oops.

Interestingly, that didn't really hurt either.  I mean, I'm a little sore, like normal post-scope sore.  But I haven't even taken anything today (not even tylenol).  So...  What does this mean?  I've been cautiously doing short hops around the house off the crutches and it feels OK.  Something certainly hurt like the dickens for the past few days, but whatever it was seems to be gone now.

My OS's don't really agree on what the significance of my MRI is or whether or not there is actually fracturing of the MFC.  One thinks the marrow edema may not be abnormal for this stage postop OATS and once the symptoms are gone, we just re-image it and go on about normal life.  The other thinks I should be strict NWB for 6-12 weeks.  Certainly, life would be much easier with the shorter course of NWB.  I just don't know.  Maybe everything was just from the screwed up plug.  What to do, what to do? 

The issue is that the literature on AVN doesn't really support conservative treatment in adult patients (once the growth plates are closed) because it generally doesn't help heal the area.  It may be helpful short-term for symptoms, but doesn't change the outcome.  I don't know if I'm different because I'm post-OATS or not.  Even my more-conservative OS says that if this whole thing is AVN, there really isn't much to do with it.  Just watch and wait and see what happens in the future.  So if NWB only helps symptoms and currently I'm not having any, why exactly should I be NWB?  If things hurt while I'm putzing around without crutches, I guess I'll have my answer.
Title: Re: Major disaster
Post by: Beauzer on October 07, 2005, 01:37:54 PM
OK, OK, I'll answer my own question.

WB = crunching = pain. 
I get it now.  I'll stop being an idiot.
Title: Re: Major disaster
Post by: blackbeltgirl on October 07, 2005, 02:19:21 PM
Danielle -

Don't ya just love it when you rbody communicates that clearly?  I wish my knee had been able to explain that before the damage got so bad.

Have a good weekend!
Jess
Title: Re: Major disaster
Post by: Beauzer on October 12, 2005, 06:32:12 PM
Hi all,

I had my postop check today.  So, first off, my plugs (except for a very small area of cartilage tear, not bone, I misunderstood, in my dilaudid-induced haze) were nice and stable at the op and looked fantastic overall.  My problem seems to be the subchondral bone.  There is probably some AVN and I "microfractured" it around the plugs, which is what hurt like the dickens.  He said it's almost like a really bad bone bruise (bone bruise?  this happened just walking around at work, it's not like somebody smashed a football helmet into my knee ;D - I am in Pittsburgh after all, poor Ben...but he'll be back before I am)

My OS is encouraged by the rapid decrease in the pain, but nearly smacked me when I admitted to walking on it some.  I'm still not allowed to drive (unless I absolutely have to, like next week when my hubby is away, I was able to bargain that one, at least).  I don't have to use the brace anymore, which is great as it was very uncomfortable.  I'm still NWB.  Follow up and likely repeat MRI in 3 weeks, yadda yadda.  I forgot to ask if I could start the stationary bike again.  I guess I'll just try it with no resistence and see what happens.

I started back to work today, out of sheer boredom.  I only spent 8 days trapped in the house and was absolutely climbing the walls.  I can't really do much though.  Fortunately the division secretary found out I was gone and fed my poor fish (no floaters today,  :P).  Gee what a difference the workouts (and losing 30 pounds since my OATS) have made in crutching around.  I actually feel OK today (although my knee is hurting from having it down all day - is it time to go home yet?)

Anyhoo, I'm rambling...

Danielle
Title: Re: Major disaster
Post by: kathleenj on October 12, 2005, 07:24:04 PM
Danielle,

Glad to hear that the plugs are ok. That is definately good news. 

You mentioned AVN or problems with the subchondral bone, possibly a bone bruise?  Gosh, that seems so vague.  I wish there was a way to tell for sure.  It seems like AVN is something that is hard to determine for sure.  I've had one of my second, or was it third, opinions mention AVN but nothing mentioned as far as how to deal with it.  Did your OS say what they would do if it was AVN?  Will the NWB time help the AVN or is that just for the fracture?  It is all very confusing to me.  One doctor thought that maybe the reason all the cartilage was falling off my bones was because of AVN.  He explained it to my husband and compared it to a stroke of sorts.  Saying that over time the bone slowly dies and the cartilage begins to deteriorate.   Have you gotten any specific explanation of AVN or how to treat it?

Sorry to bombard you with questions but I figured you may have some answers since we both seem to be dealing with somewhat similar issues.  Thought I would get your insight.

Anyway, glad you are feeling a bit better.  Hang in there!
Kathy
Title: Re: Major disaster
Post by: Beauzer on October 12, 2005, 08:12:09 PM
The problem is, the AVN diagnosis can be rather vague.  I aked my OS today, "is this AVN?"  I don't know.  "How can you tell?"  You can't, for sure.  "will the NWB make it go away if it is AVN?"  I don't know.  "What does this mean for me in the long term?"  I don't know.  And this guy's been in the biz for over 20 years.  Gee that makes me feel better :-\

From what I've read (which is quite a bit, the past few months) AVN is tricky to diagnose and trickier to treat.  If caught early and in younger patients (whatever that means), NWB may be successful in making it go away.  Or you can try drilling into the area to stimulate bone growth (and clean out the dead stuff).  Or you can do an OATS (wait, isn't that how all this started?)  Or you can do a TKR.  Actually, all the surgical options don't work as well in folks with AVN, because it tends to progress, so what to do?  As the orthopedic establishment hasn't found a good answer yet, I CERTAINLY don't know.  Nobody really seems to know for sure what causes it in most people either.

I have a few things that seem to be related to increased AVN (according to some folks), multiple traumas to the same area, use of one of those heater probe thingys (on my MCL and joint capsule - twice) and possibly even OATS (which is why they don't drill out the holes for plug placement anymore).

I can't see how this is a bone bruise as I haven't done anything other than swim and stand all day at work.  No trauma or anything.  I was just walking down the hall when the crap hit the fan last week.  Dunno.

I'm still hanging in,
Danielel
Title: Re: Major disaster
Post by: kathleenj on October 12, 2005, 08:34:18 PM
Thats what I thought!!  I seem to get the same answers... I dont know, I dont know, I dont know.  The best is "time will tell"  It's really not comforting at all. 

Anyway, thanks for your thoughts.  I was hoping you may have more info than me but it seems that we've been told the same things.

Take care. 
Title: Re: Major disaster
Post by: Beauzer on October 28, 2005, 01:38:39 PM
I'm just sitting here at work going nuts, so I thought I would update this a bit.

My launch date from crutches is 11/9.  I bumped into my OS today.  I was all set to beg to get off the crutches a few days early.  I just found out that I got accepted to a workshop next weekend, which is a really big deal (impossible to get into, all expenses paid, major implications for future job search, yadda, yadda...) and basically decided that I was going to go and participate in it come hell or high water.  I asked if I could dispense with the crutches a bit early.  He just said "either your knee will be OK or it won't.  Try it and see, I don't have anything else to tell you."  Gee that makes me feel better...

We also opted for no brace with WB.  He doesn't think that the postop brace will really help.  What I really need at this point is an unloader brace.  But since my unloader stretched out my MCL plication (which fortunately, scarred down to an acceptable level of instability from my big arthrotomy for my OATS) we're both a bit reticent to use it again (OK, scared as hell would be a more apt description).

I've decided that I'll try some PWB between now and next Thursday.  He said it didn't really matter if I did some PWB or just stayed completely NWB from a healing standpoint.  I just think it'll be easier to survive two full days on my feet if I wasn't NWB right up until that day.  So I guess we'll just have to wait and see.

Darn knees!
Danielle
Title: Re: Major disaster
Post by: blackbeltgirl on October 28, 2005, 01:40:59 PM
Danielle -

Congrats on getting into your workshop.  Just remember that you may not abosrb as much new stuff if you end up doped up on painkillers.  Bring the crutches with you, even if you decide to just use 1, or some other compromise. 

Good luck!
Jess
Title: Re: Major disaster
Post by: Beauzer on October 28, 2005, 03:36:42 PM
I'd already thought about that.  I'm driving, so taking the crutches isn't a big deal.  Unfortunately, the majority of the workshop consists of standing and practicing skills requiring the use of both hands for two full days.  I'm not sure how well I'm gonna do, but we'll see.
Title: Re: Major disaster
Post by: brattkids on October 28, 2005, 04:34:37 PM
Danielle,

I am in nursing school and on crutches I have found very inventive ways to be able to use my hands and still crutch. I put the crutches under the arms and pull them back and forth with my body while still being able to use my hands. It took a couple days to get it down but it has helped me greatly in getting around and doing my school work.   Just a suggestion hope you do well and I will have my fingers crossed for you!!!

Paulette
Title: Re: Major disaster
Post by: Beauzer on November 01, 2005, 04:48:49 PM
Just a quick update. 

Overall things seem to be going OK.  I've been doing the PWB thing since Friday.  I can even go short distances (like around the house) without crutches.  But I can't make it very far.  I also limp/waddle when I walk without the crutches.  Not very attractive.  Walking is somewhat uncomfortable, although PWB is painless.  I imagine it will take a few weeks until I can tell how this is going to go.   

Actually, I can't get too ahead of myself.  I was PWB for 2 weeks after 6 weeks NWB after my OATS and getting FWB was difficult.  This time around, I make big strides on a daily basis.  I started back on the exercise bike this weekend too (carefully, with no resistence at all).  I can't wait to get back into the pool.

On a down note, I'm getting a lot of patellofemoral maltracking which hurts.  I think it's due to my quad being so weak since I wasn't allowed to do any rehab.  This has me worried as I'm being "released back into the wild" after my appointment next week.  (Well, I can probably beg out of the OR for a few more weeks, but I'm back on call, so if anything comes in afterhours, I'm SOL).

I'm going nuts and getting anxious about getting back to my life.
Danielle
Title: Re: Major disaster
Post by: Beauzer on November 07, 2005, 06:05:13 PM
OK, so now I'm confused.  ???   I just bumped into my OS in the hall and he yelled at me for being off crutches.  I pointed out that I asked him two weeks ago if I could get off a few days early because of the workshop this past weekend.  He said "yeah, but that was just supposed to be for the workshop".  Huh?  First off, that's not what he said.  Anyway, that doesn't make sense.  It's OK to walk and stand for two days, but not after that? 

So, it wasn't easy to go from being NWB to standing for two days.  Saturday my knee hurt a good bit, but I stood for 3 hours and then drove 6 hours home.  So, duh, it's gonna hurt.  It's OK now.  I told him that.  He still wasn't very happy.  I tried to remind him that I sort of expect it to hurt a bit when I walk on it, since I've been NWB for a long time.  I'm going to try to get a repeat MRI before my appointment on Thursday.  I also promised that I wasn't really back to normal activities and was trying to stay off it as much as possible. 

So...  Not really sure why he's mad, when he told me I could do it.  Anyway, we'll see how everything looks.
Title: Re: Major disaster
Post by: Beauzer on November 10, 2005, 05:00:53 PM
I just got back from my OS appointment.

Overall, my MRI looks better than it did 6 weeks ago, with much less marrow edema on the MFC.  My x-ray, though definitely looks suspicious for AVN, so that's probably what the inciting event for the stress fracture was.  Also, my MCL (which was loose again, tightened up after the OATS arthrotomy to an acceptable level) is now loosening up again, probably from the inactivity and such, so I'm back in a hinged brace, likely indefinitely.  So...I can walk and swim and cycle again.  I'm OK to do short procedures, but need to try to stay off of my feet as much as possible for another month.  Guardedly good news, I guess.  It just doesn't really feel like it.

Danielle
Title: Re: Major disaster
Post by: brattkids on November 11, 2005, 07:24:15 PM
Danielle,

I am glad to hear that your MRI looked well. I sure hope your progressing well!! I have my fingers crossed for you

Paulette
Title: Re: Major disaster
Post by: shade on November 11, 2005, 08:27:53 PM
(http://chezoceane.free.fr/signature/danielle2.gif)

Wishing you continued progress.  Glad that the MRI looked okay.  Sorry about the MCL getting loose again.

Good luck,

Shade
Title: Re: Major disaster
Post by: Beauzer on December 07, 2005, 06:31:21 PM
Hi folks,

I'm just back from my follow up OS appointment.  The AVN is unchanged on x-ray, which is OK, I guess (would've preferred better...)  I've been having a lot of patellofemoral clicking, which is painful.  My OS said I need to work on quad strengthening and do the bike (which I've been avoiding, because it hurts), but go VERY slow.  And I should be taking NSAID's and icing (which I haven't been) when things hurt instead of avoiding them. 

All in all, he thinks I'm improving (since initially after the fracture I couldn't walk or even touch my knee without screaming), but the area isn't healed yet and I still need to be very careful.

So...I'm not really sure what to think.  More x-rays to come in 6 weeks.  I just need to let the knee guide my activities.

Danielle
Title: Re: Major disaster
Post by: Beauzer on December 12, 2005, 11:39:11 PM
I survived my first full day back on my feet at work ;D.  I sat down as much as I could.  I'm rather stiff, but the pain really isn't too bad.  I just don't want to push my luck.

The PF stuff is really annoying me.  I'll shift my weight and it'll pop, which hurts!

Rather stupidly, I decided to shovel the front walk yesterday while my husband was using the snowblower on the driveway.  Everything was fine (actually the workout felt nice) until I tried to walk down the yard and ended up sledding down on my butt!  The knee seems to be OK, but I swear I saw my life pass in front of my eyes!  My OS would kill me.

Danielle
Title: Re: Major disaster
Post by: blackbeltgirl on December 13, 2005, 01:10:54 PM
Danielle -

Glad you didn't damage anything on that short ride down the  yard.  It is now time to invest in a pair of Yak Trax.  They cost about $20, you can get them at most sporting goods stores, and they fit over all shoes and boots (except for women's dress shoes).  They're basically low level crimpons - they grip the snow and ice, so any sledding you do is intentional.  My house is on a really steep hill, so even though I live in VA, I've had them since my first winter here.  Too dangerous getting from the car to the house and back in icey weather.

Question about your popping - because my knee does that all the time.  It hurts, but not horribly, and the pain dosn't linger at all.  Just pop - ouch - gone.  Have you discussed this with your OS yet?  Just curious.  I have ACI scheduled for February, so I'm not worrying too much about things hurting, on the premise that a) I will hurt much worse before this is finished, and b) they'll be fixing it all soon anyway.

Good luck with being back on your feet.
Jess
Title: Re: Major disaster
Post by: kathleenj on December 13, 2005, 01:58:52 PM
Danielle,

Just a quick question about the PF pain.... Did you have an autograft?  If so, depending on where the donor plug was taken, that may be what is causing a bit of the popping you are experiencing.  I had my donor plugs taken from the lateral trocheal groove, supposedly a non weightbearing area, but have been having some donor site problems.  I had a total of 2 plugs taken from that area, one 10mm and the other 6mm, and I have since been told that those plugs were probably too big to be taken from that area.  I have since developed some serious degeneration in that area and it keeps growing because of the pressure from my baja.  On a ct- scan the area looks like a big gaping hole. 

I'm not telling you this to alarm you just to point out that the donor site is known to cause some problems.  The problems you are experiencing could just as well be from weak quads too.  You never know...I just thought I'd throw the donor site issue out there for you to consider.

Take care,
kathy
Title: Re: Major disaster
Post by: Beauzer on December 14, 2005, 02:04:43 AM
I did have an autograft.  Two 8mm plugs from the lateral trochlear groove.  I have some donor site pain from time to time, but this PF stuff isn't it.  Actually, at the time of my last scope, the donor site has a divot, but is completely covered with cartilage and looks OK.  Most of my donor stuff happens when I first get up or if I go outside in the cold, then it's just a bit of aching or grinding. 

My pain's medial, just along the patella and under my big OATS incision, but not medial enough to be the MFC, which feels different anyway.  It is just a pop, ow and gone.  I had some after the OATS itself that went away with quad strengthening.  But it's much worse this time (not allowed to work on quad at all for 6+ weeks, still limited due to that fracture).  I think that some of it is scar tissue too as I've had now 9 scopes and have a big wad of superficial scar tissue in that area.  My OS isn't all that worried about it and told me to deal with it and, hopefully, it will go away again once my quad gets stronger. 

I've also had more problems with my MCL laxity since this last round of NWB too.  We think it's from muscle weakness.  I hope it goes away.  Anyway, I'm back in a brace, which my OS wanted me back in after the OATS, but I wouldn't do it.  Now I don't have much choice.  He told me I'm in it pretty much until I get a TKR (or a knee fusion, as the MCL laxity is problematic even for TKR).  At least I got fitted for a nice comfortable brace.  It's a new Breg and is great, I don't even know it's on (which is a first and I've worn many, many braces in the past few years).

The worst part of the frontyard sledding incident was I wasn't wearing the brace at the time (yeah, really smart, I know...)  I think I'll find some Yak traks.  I think I saw some in the LLBean catalog.  I'm extremely paranoid of slick surfaces right now.  I've actually been paying to park in the garage (up to $20 a day) just so I don't have to risk the parking lot at work (6+ inches of snow and ice on the ground here in PA now.)  Bleah.

Cold weather sucks. 
Danielle
Title: Re: Major disaster
Post by: blackbeltgirl on December 14, 2005, 01:25:32 PM
Danielle -

The cheapest price I've seen for YakTrax is campmor.com.  Here's the link to the product page.  http://www.campmor.com/webapp/wcs/stores/servlet/campmor/iphrase.jsp?command=text&text=yaktrax

Have I mentioned how much I LOVE mine?  And mine are safety vest orange - not so attractive, but incredibly functional.

Jess
Title: Re: Major disaster
Post by: hopalongcasualty on December 29, 2005, 05:47:08 AM
God I wish I had $1.00 for every time I heard a Doc say just live with it.  I could be a Gates.

Not really a Gates but you get the point.

My right knee developed a lot of scar tissue very slowly, I had not realized how far it had advanced until one day I found I could not flex it past 90 degrees when trying to get into the back seat of a freinds car.  I have a knot of tissue at one of the scope insertion sites.  My knee cap actually tracks well, but this knot (lump) of scar tissue actually tracks along the lateral femoral condyle and bumps along the lateral side of the knee cap.

Hang in there, I will be joing you soon with my left knee, I am scheduled for an allograft on Jan 13th.