The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: mongaboo on October 28, 2005, 02:42:50 AM

Title: Deep bone bruise following microfracture procedure -help!-
Post by: mongaboo on October 28, 2005, 02:42:50 AM
I posted a thread earlier this summer about post-op pain following a microfracture I had back in March.  The responses were great and I have meanwhile been pushing on, hoping for improvement.  Finally, after more than eight months, I have somewhat of an answer.  I am hoping that there is maybe someone else with a similar situation that can give me some advice, or that maybe my experience can help someone else avoid all this pain.

A bit of history:

scoped in March for chondromalacia...found two tears, one down to bone on medial chondyle of the femur.  Woke up with microfracture and told to full weight bear after only two weeks.

I was in extreme pain for months, but was told this was normal.  LOOOONG story, but I was brushed off.  I switched OS after four months.  More PT (was told should have been NWB for 8 wks)....still much pain.  Chronic ache, sharp, shooting pain w/walking.

I just had an MRI last week (8 in a half months post op) the results Monday.  Shows there is something covering the deficit...but i have a very deep bone bruise at the site (medial chondyle of femur) AND on the lateral chondyle also.  The OS did his residency with Steadman, and HE can't even compare my case since this is very rare.  He has said that my options are:

Try to go as much NWB as possible.  Hopefully in 2 to 3 months the bruises will heal, and then won't come back when I return to normal activity.  If it does...I'll need a scope with possible further open knee surgery (OATS, cadaver transplant)


Doe the scope now...possibly won't see anything, have to do the 2 to 3 months NWB anyways.  Or, they will see a mechanical cause for the bruising which requires further surgery that I really can't afford to do anyways.

Does ANYONE out there have any similar experience as this?  I am only 33 and am VERY active. The past 8 months have just totally changed my way of life and this not knowing, or even being able to get advice from the OS on how to procede since there is nothing to compare me to is very disheartening.  How can I heal best from these deep bone bruises??  I have been in chronic pain for over 8 months now and I just want it to be over.  Any advice would be much appreciated!

Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: clueless on October 28, 2005, 04:14:47 AM
I can't give you any advice about what to do about the deep bone bruise but I do know a bit about what you're going through. Both my knees are severely damaged. The left one can be explained by an old ski injury. There seems to be no rhyme or reason, however, why the articular cartilage in my right knee has destructed so spectacularly. Because of this enigma, my OS does not want to operate on my knee at all. Don't it suck to feel like such an odd ball?:)

Just wanted to let you know that you're not alone in your frustrations and that we're here to support you.

Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: stgiles16 on October 28, 2005, 12:45:37 PM
Hi, if you are going to have to go 2-3 mnths NWB either way, why not try the non invasive first? I was only NWB for 2 wks after my first micro on my MFC and it failed. I did not get a bone bruise, I got no new fibrocart. and had to have it redone. This time, 8 wks NWB, 2 wks PWB, then on to a cane for 2 mnths. This one worked but I think that it has begun to wear out at only 18mnths. I go back to the OS in Dec. to see what is the next step, right now, I am trying to calm down bursitis in both knees. If I could avoid another surgery with just NWB for a couple of months, I would definately do it. I realize that if that does not work , you would have to have the surgery and do the NWB all over again but I hate surgery enough to give it a shot.
goood luck
Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: Beauzer on October 28, 2005, 01:08:35 PM
I have a situation that may be similar.  I'm now 6 months out from OATS to the MFC.  On 9/30, I was just walking around work and my knee went "pop" and I couldn't put any weight on it.  It literally felt like somebody hit me with a baseball bat.  My MRI showed a large amount of marrow edema on the MFC all around the plugs.  My OS thinks I have a stress fracture around the plugs, but isn't sure whether the other stuff is a big bone bruise or AVN, because they essentially look the same on imaging early on.  (Note, my OATS was done for an OCD lesion, which is like AVN).

I did get my knee scoped on 10/3 because he thought from the x-rays that I had popped out a bone plug (which fortunately, I didn't).  I'm NWB for 6 weeks.  It's very frustrating because nobody knows exactly what happened.  Basically, my OS told me the only thing to do was "hope it goes away", pretty much what your OS said!  I asked him today if I could cut out the NWB a few days early so I could attend a workshop next weekend.  All he said was "well, either it'll be OK or it won't, so it doesn't matter, just try it and see."  I just don't think that there's a good answer for a problem like this.  I certainly know what you mean about it being frustrating, though.  I'm only 31, I'm a general surgeon, and I've spent 3 of the past 6 months on crutches.  If this doesn't work, I'm going to need either a big cadaver allograft or a TKR.

Personally, I would opt to try NWB first.  In my case the scope didn't show anything at all, because the cartilage side of the plugs are OK (sort of what your MRI says for you, there is cartilage from the microfracture covering your defects).  If the problem is strictly in the subchondral bone, you can't see anything on the scope, so why do it?

Out of curiosity, is the OS that trained with Steadman the one that did your microfracture?  The OS that did mine (microfracture, that is, back in 1999) had also trained at Steadman-Hawkins and didn't do long NWB times either.  My cartilage lasted about 4 years, though.  Just wondering.

Good luck,
Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: blackbeltgirl on October 28, 2005, 01:48:55 PM
I'd have to agree with everyone else so far.  I'd go NWB first, and see if that helped.  Why jump immediately to the higher risk option, without any guarantees?  I had MF in December 04, and I was NWB less than a week.  Now my damage was all on the lateral side of the knee and trochlea, so that was part of the reasoning.  But in the end, the surgery basically taught me that ignoring the pain (which I've done since middle school) and doing what I wanted regardless, wasn't necessarily my best choice.  Maybe your knee just needs a true rest period to recover.

Good luck.
Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: mongaboo on October 28, 2005, 11:57:27 PM
Thanks for the replys.

The OS that did the surgery, is NOT the one whoe studied with Steadman.  The surgeon I'm seeing now would have most likely had me NWB for 8 weeks.  It looks like the fibrocartilige is growing back, it's just these bone bruises that haven't healed (hopefully).  The OS's reasoning is that if the pain goes away and then doesn't return when I go back to normal activities, than it was just the bone bruise.  Otherwise, I may be one of those rare patients who, after a MF, continues to have pain even after the deficit is filled in.  His other thought (and why he is suggesting a scope) is that since it is odd to have this bone bruising, there may be something causing it that isn't showing up on the MRI, but a scope would show.

I think I have pretty much decided to try the NWB and see how it goes.  I'm just wondering now if there is anyone who has experienced a deep bone bruise in this area who can make some suggestions on encouraging healing.

Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: nandie on October 31, 2005, 10:14:03 PM
Hi there. I am recovering from a bone bruise as well. There is nothing mechanically wrong with my knee, but I have a bone bruise to my femur due to a partial dislocation of my kneecap (kneecap popped back against my femur during a dance class). My OS told me I have a 4-6 month recovery period--avoid stairs, no driving manual transmission (clutching), generally avoid any activity that causes pain. Tomorrow is 3 months from the original injury and I am finally seeing some improvement. I'd be interested in hearing about your progress as I haven't seen many others with a similar injury. I've been taking anti-inflammatories, as well as a calcium and zinc supplement, and I ice whenever I have any pain. I ride a stationary bike for 15 minutes, 3 x per week to help strengthen the surrounding muscles. I'm 32. The inactivity drives me mad sometimes, but it helps to finally see some progress.
Title: Re: Deep bone bruise following microfracture procedure -help!-
Post by: Tlee on January 30, 2006, 04:26:52 PM
Okay so you can have a deep bone bruise without having any other kind of injury?  All that I have read suggest a connection between bone bruising and ACL tears.