KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: AndrewH on July 01, 2010, 09:38:37 PM

Title: Mosaicplasty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on July 01, 2010, 09:38:37 PM
Afetr having a failed microfracture on the MFC last June I'm going in for mosaicplasty next week on 9th July.

Defect was about 1.5cm2 - hopefully it won't be much bigger, we will see.

Background is that I am 40 and began getting into running in my mid 30s after putting on some weight after giving up smoking. It turned out I was quite good at it - 35.15 10k, 1.22 half marathon my last 2 race times before injury in Oct 2008. Was training with some like minded runners and was probably over training. Was averaging around 70 miles per week when I got injured.

I never really felt at any time that the microfracture had worked. I landed heavinly on my affected leg the very night after the surgery as I almost slipped coming down the stairs. I also landed heavily on the affected leg twice while hoovering on crutches (well, I used the hoover as a crutch and hopped about - before turning and tripping over the wire!) This time around I will be taking things very very easy.

I have 3 weeks booked off work for recovery and will have the wife and kids to help me and keep me amused. I slowly started smoking again during the past 12 months as I knew the microfracture hadn't worked and also had the stress of finding a new job after being made redundant. I have now stopped smoking for the past 2 weeks in preparation for the surgery. I've also been going to the gym more regularly to get in some cycling and keep my upper body strength up for the crutches.

Hopefully this surgery will be a lot more successful. My surgeon says he's never done a mosaicplasty that has failed.
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: mike40 on July 06, 2010, 04:47:30 PM
Hi andrew,

I have a similar story to you. I was a dedicated runner which overdid it everyday. a sports injury led me to have a bad knee which i later found out I had a crater in my medial femoral condyle and an acl tear, this restricted me from doing everything - from walking to even riding a bike (sucked big time). I decided to have both the acl repair(hamstring) and OATS procedure done at the same time and I could say recovery has npot been as bad as expected. It was a 6 week non weight bearing with constant bending and icing of the knee. at 6 weeks i began partial weight bearing which was weird at first but slowly got easier. swelling by this point, at 8 weeks,  is almost gone and the knee feels very good. The only downside is the crutches which are dangerous at times and the loss of leg muscule. I hope all goes well on your procedure and if you have any questions feel free to contact me. I begin full weight bearing next week. which is the defining moment of this experiance so i will keep ou posted. good luck
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: AndrewH on July 07, 2010, 08:43:44 PM
Hi Mike

Good to hear from you.

Did you tear the ACL and damage the cartilage at the same time? How big was the cartilage defect? I presume it was also on the medial fermoral condyle?

Please keep me updated with your progress - I'll try and give regular updates as to how I am doing.

Less than 2 days to go now for me. Dreading it and looking forward to it at the same time! I was 6 weeks non weight bearing last year and lost a lot of muscle. My right leg still looks a lot more skinny than my left leg over a year later - although the fact that the microfracture hasn't worked hasn't helped me with trying to regain muscle. I've tried various exercises whilst trying not to aggravate my knee. Cycling in the gym seems to be the best for it. I did a lot of cycling in the gym in the first 6 months after I started weight bearing again but it tailed off in the last 6 months for various reasons, one being me losing my motivation.

I really hope this surgery works. I would love to try and take up cycling and see if I can attain the same levels as I did with running.

BTW - are you based in the UK? Did you get a CPM machine after surgery? How many nights were you in the hospital?
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: Lottiefox on July 07, 2010, 10:19:29 PM
Good luck for Friday Andrew, I remember you posting about your failed MFX and that you were hoping to do something else this summer.

Sounds like the mosaicplasty has a better outcome rate overall and hopefully will get your knee back to better strength.  ;D

Let us know how things go. Is this done via scope or is it an open surgery?

All the best

Lottie  :)
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: AndrewH on July 08, 2010, 08:51:54 AM
Hi Lottie

My surgeon told me that it will be open surgery.

Iíve been worrying like mad whether Iíve made the right choice to go with mosaicplasty rather than ACI. There were were a few considerations. First up, the local private hospital where I will have this op does not have a licence to ACI (needs authorisation from transplantation authority or something like that Ė I did look into it and so did my surgeon as he used to do ACI at this hospital until the new regs came in). I then enquired about going down to see a surgeon in Oxford (I live in the Glasgow area) and booked an appointment. However I eventually decided to cancel that and go with the mosaicplasty.

My surgeon is leading the Active trial in his area to see whether ACI or mosaicplasty is better. He thinks (although he wonít say it outright!) that ACI will turn out to be better. However he does think that both are much better than microfracture and heís never had a failure with either. I could have gone onto this Active trial via the NHS and had the op at a hospital right across the road from my house. However it would have meant more months on the waiting list and then being randomised to either surgeryÖ. I could have waited months and ended up with mosaicplasty anyway!

Iíve done a lot of research of my own however.

Handgody, based in Hungary, has published details of his study of over 1,000 surgeries and has had a 92% success rate with mosaicplasty on the MFC. He didnít use a control group in his study and his success rate is boosted by self selecation of patients who he thinks will be a success Ė but that is what should happen anyway, isnít it?

A study by Saris concluded that ACI was no better than microfracture while a study by Knutsen concluded that microfracture was better than ACI. A study by Gandas concluded that mosaicplasty was better than microfracture while a study by Dozin concluded that the results of ACI and mosaicplasty were equal. There have been a few other studies into mosaicplasty / OATS which have also given good results. In a study by Horas, it was found that the clinical outcome of mosaicplasty v ACI was the same but that the recovery for mosaicplasty was quicker and that there was a greater % of hyaline cartilage.

The one study that has gone against mosaicplasty / OATS was one by Bentley et al which concluded that ACI was better than mosaicplasty and that the continued use of mosaicplasty was dubious. Reading further into this study however raised concerns for me. The average lesion size was 4.66cm2 which is very large for mosaicplasty and favours ACI. In addition, the moasicplasty results were dragged down by patellar failures plus the study also stated that the plugs were placed slightly prominently Ė while all other protocols state that they should be positioned flush. The sample size was also just 100 compared with over 1,000 by Handgody. Yet, despite this, mosaicplasy still had a 74% success rate in this study.

I've also read a lot on this website!!† ;D

It seems to me that all alternatives have pros and cons and risks. Iíll just need to follow the rehab protocol to the letter, be very cautious with non weight bearing for at least 6 weeks before gradually moving to weight bearing (I tripped 3 times last year when non weight bearing and then started weight bearing before the 6 weeks were up and virtually dumped the crutches after only a day of partial weight bearing Ė I regret that now).

Iíll post as much as I can through my rehab. I know there are people who read these things without necessarily replying themselves.
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: AndrewH on July 08, 2010, 08:54:10 AM
By the way Lottie Ė how are things going with you? What is the latest?
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: lis1 on July 08, 2010, 02:04:43 PM
Good Luck tomorrow Andrew

BTW i had this procedure (open) 2 years ago and my cartildge looks good, no more OA and i too was nervous as predominantly i am not an ideal candidate (overweight and previous failed surgery, MFX and ACL)

I had 12 plugs covering quite a vast area, and after last years ACL revision from a new surgeon i actually took the dvd of the op to the guy that did the mosaicplasty to show him because it was such a good job.

Be prepared for the 1st week or so to hurt........quite a lot, but it does get quite a lot easier after that.

Lisa
Title: Re: Having Mosaicplasty on MFC on 9th July
Post by: AndrewH on July 11, 2010, 03:30:43 PM
Thanks for those words Lisa!† :)

12 plugs! I've had 5 plugs in total - 4 on one leasion and 1 in another. Yours sounds horrendous compared to mine! That gives me some confidence that this will work. My weight shouldn't be an issue as I'm well within the normal weight range BMI. In fact, I've put on about a stone in weight since I injured myself and now no longer look too skinny. I'm probably at my ideal weight just now appearances wise. My wife hated my skinny look - in fact no-one liked it! However being the ideal weight didn't stop the microfracture from failing.  :(

Just back home. Had to spend 2 nights in the hospital. The surgeon wanted me to reach 90 degrees on the CPM before he would discharge me. I actually reached it last night but it was too late by then to leave.

Well, the news was mixed. The original dameg last year was a 1.5cm x 1cm defect on the MFC. I was worried that it would have got bigger. However the surgeon told me that it it was now 1.4cm x 1.2cm and was filled by 4 plugs. He said that the defect had actually filled with fibrocartilage from the MFX op last year but was still soft and obviously hadn't given me pain relief. He therefore cleared it and did the plugs (makes me wonder would I have been better leaving it a few months more???)

That was kinda the good news - ie the damage hadn't extended.

The bad news is that I had further damage on the patellar which wasn't there last year - 2 lesions. That was a nasty suprise as I haven't really been doing anything that could have caused more damage. The surgeon reckoned it might have been there before or was soft and its just progressed.

There was one lesion on the medial side of the patellar, 8mm x 6mm, in a sort of v shape he said. He inserted 1 plug into that. There was also a slightly larger area of damage at the margin of the patellar he said and he microfractured that area.

So that's me now on the rehab. I am going to hire a CPM tomorrow so that I can keep doing it at home.

The pain was much worse that MFX alone. I can't really move the leg myself and the pain has been really bad at times. Not too bad just now though. Got a big line of staples up the middle of my knee. The surgeon explained that they now cut you up the middle of the knee as that is what will happen if they need to do a knee replacement in future.....† nice to plan ahead!† :D

I've been given paracetamol and also a morphine based painkiller which I get for a couple of days only. I've also been given dicolfenac but am not taking it was NSAID's can impair bone healing.

I'll continue with updates. Please feel free anyone to givce me any hints, tips or anything else. Any stories about recoveries, etc welcome.


Title: Re: Mosaicplaty on MFC and Patellar plus microfracture on 9th July!
Post by: lis1 on July 11, 2010, 07:10:59 PM
Andrew welcome to this side of the horrendous mosaicplasty, but please be assured that it gets better.  At times you may get frustrated, i know i did but all in all i have to say that being arthiritis free right now means that there are definately no regrets, and now i have had that beautiful open scar down the middle opened twice!!

Hints...................mmmmmmmmmmmmmm do as you are told basically.  Dont try and rush the recovery, they say a year to get over it totally and thats a real year too, but as time goes on you get stronger all the time.  Get the swelling down if you can, that will help the healing and get plenty of rest.

My microfractures didnt work either and the surgeon who did them basically said i was too big to help further, go away you have arthritis learn to live with it and i will see you when you are old enough for a new knee.  I was fortunate to find another surgeon who although was honest in saying that my weight was not a good factor, was willing to weigh that against how fit i was and give me a chance.  Thank goodness he did because it was a success.  Are you on facebook?  i have some knee pics on there?

Lisa
Title: Re: Mosaicplaty on MFC and Patellar plus microfracture on 9th July!
Post by: Lottiefox on July 11, 2010, 07:17:06 PM
Hi Andrew

Great to hear that you're through and home and recovering. Bit of a bummer about the patella damage but it sounds like perhaps addressing it at this stage will stop anything further happening. Keep us posted on the recovery, are you completely NWB or can you toe touch?

You asked about me - I've been lucky enough to see some progress with religious PT but the lesions obviously remain. I am limited from running or impact work but otherwise the pain is pretty well controlled apart from the odd PFS type of flare on the kneecap. I am still favouring the Cartifill option and waiting for that to be available via scope next year and for further results to be made known about the initial patients going through it with Mr Shetty in Kent and around the globe. The bad news is that my foot gave up the ghost this year - big toe problems and I am in for foot surgery this week - eeek! Typical! Joints are a nightmare. †::) :o

Good luck with the next few days and I hope the pain comes under control,

Take care

Lottie †:)
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on July 11, 2010, 11:37:49 PM
Thanks for the replies guys!

I'll keep giving updates.

Lisa - I almost can't believe I'm having to go through another year of rehab! I'm at the stage now where I can't imagine what it would be like to have a normal knee again....  :-\

Going to give it all my all to get better though. Just resting just now though. Going to hire that CPM machine tomorrow morning though.

Lottie - I'm NWB but physio and surgeon have said I can touch toe down in order to keep balance, eg going up stairs or where necessary. Better to keep balance and avoid falling.  Pain is not too bad just now - although I did take an oxycodone tablet 4 hours ago and its been helping! I've got a supply for 3 days so I'm hoping the worst will be over by then.

I'm at least now able to get up and down from seats and into bed myself. That was really bad yesterday.

I'm actualy quite optimistic now that I've had the op> I now at least feel as though I'm heading in the right direction.  :)
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on July 13, 2010, 07:50:21 PM
4 days post op now.

Pain is okay, well below 5 on a scale of 1-10. I'm only taking paracetamol now a couple of times a day. The CPM machine arrived today and I've done a couple of hours on it so far. Got the flexion up to 90 degrees so far.

Strength in my quads has disappeared though. I'm totally unable to lift my leg at the moment!

Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on July 16, 2010, 10:26:07 PM
That's one week post op today. Pain levels have been up and down this week. Today has certainly been the best in terms of pain.

Had my first visit back to the surgeon today. Nothing really happened, had a quick chat, got the dressing changed and he stressed how important it was that I did static quad exercises.

I cannot do straight leg raises with my affected leg at the moment. My quads just do not have the strength at the moment.Surgeon reckons its because I have work done on the patella, which was also my thoughts. I'll need to keep working away at those static quad exercises then.............
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: ski-bum on July 28, 2010, 04:19:23 AM
Glad to hear that you are doing well.  I've been following your threads closely and really happy that you have moved forward and making progress by the day.  I may be close behind you with regard to OATS and have been quite impressed with many positive results discussed on this board.  Good Luck!!!!  Keep up the good work.  Post often and if/when you get down ask for support!
Marc
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: Lottiefox on July 28, 2010, 12:56:44 PM
Hi Andrew

How are things going? Hope progress is smooth!  :D

Let us know how you are,

Lottie  :)
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on July 29, 2010, 08:23:01 PM
Hi Marc & Lottie

I'm doing okay so far. Just back from a few days holiday down in York & Scarborough with the family. Crutching about was hard going but I got into the right frame of mind by thinking of it as a good work out!

My knee is still swollen at this point although it is going down. Its still very stiff and a bit sore when I bend it. Can't bend it really any further than 90 degrees so far. Don't have any pain at rest but have no strength in my quads to lift my leg upwards (eg like a straight leg lift). Spent my time away doing a lot of active bending though and trying to activate the quads.

The scar down my knee is healing nicely now and doesn't look as though it will be too noticeable.

The big point will come in 3 weeks when I start putting weight on the knee again and getting back to weight bearing. I virtually ditched the crutches in a day last year but won't be doing that this time. For a start I can't even do a straight leg lift yet whereas I could do that immediately last year. Going to make it a gradual progression this year.

I would have been a lot more confident of success with this op if it wasn't for the fact that I've had work doen now on the patella on 2 small lesions. That really does worry me. However I wasn't really having any problems or pain with the patella before the op so hopefully it will be okay.

Marc - I take it that you still have had no joy with your microfracture?

My surgeon told me that my microfracture last year had worked in that the lesion was fully covered over with new cartilage. He said it was fibrocartilage though and appeared a bit soft. It certainly wasn't giving me any real pain relief but I have wondered if I'd left it a few more months if things might have got better. But that was 13 months so I suppose I would have noticed more improvement by now. Plus if I hadn't gone ahead with it then the patella damage might have worsened.

Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on August 06, 2010, 11:50:26 AM
4 weeks post op now.

Swelling in the knee has come down quite a bit but still can't do a straight leg lift with my quads yet. Losing quite a bit of muscle. Still non weight bearing and getting around on the crutches is a great workout. It takes me 30 mins to crutch up the road to work in the morning when I get off the train and same again on the way home.

2 weeks to go now until I can start putting some weight on my knee. Seeing as I can't even lift my leg yet I think that's going to be difficult. Will see how things go over the next fortnight.
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: Lottiefox on August 06, 2010, 03:40:38 PM
Hi Andrew

Good to read that the swelling is reducing, that must be helping the overal feel of the knee. You'll have an upper body like a gladiator with all the crutching about!!

Does the quad fire at all, but is lacking in strength? I'm wondering if your PT or anyone has tried any e-stim at the same time as you contract it to get it more responsive and try and trick it into a leg lift. I think your slow and steady approach will pay dividends this time around - all fingers and toes crossed!

Keep us posted

Lottie  :)
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on August 06, 2010, 05:27:47 PM
Quads don't seem to fire at all. I've been doing loads and loads of static quad contractions but its just not happening.

Its a bit like trying to move you ears. No matter how hard you try or how hard you think about it, you just can't move your ears......  :D Well, that's my analogy anyway - but in reality, I can actually move my ears!  :D But you know what I mean.

I've been to physio twice now. The second time, the physio was trying to get me to do some quad work but I've decided against doing anything other than static quad contractions. From what I've read, quad work puts a lot of pressure on the patella and that's not what I need just now. I'm willing to accept some severe muscle atrophy just now in order to let everything heal up first. I'll deal with strengthening my quads later.
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on August 13, 2010, 06:53:21 PM
5 weeks post op now. Looking foward to starting to put some weight on the knee next week.

Decided to try and drive today and managed it no bother. At least that gives me some freedom back. The knee is still swollen in comparison to the other knee and the skin all around the scar is still numb. Have been able to do some leg raises this week. I'll not say straight leg raises as I can't do them without a slight bend in my knee but at least it will start the strengthening of the quads. Don't want to put too much pressure on the patella though so will continue to go easy on them for the next week.

Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: and4400 on August 24, 2010, 11:28:45 PM
Andrew just wondered how you are doing, how's the weight bearing going? I'm going to the doctor tomorrow so I'll update my progress then. Andy
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on August 25, 2010, 08:15:18 PM
Started weight bearing again, still using 2 crutches, last Thursday. That was a day short of 6 weeks. Since then I've been alternating between weight bearing with 2 crutches and 1 crutch and have also taken a few short walks in the house and office without any crutches in the past couple of days.

Went to see the surgeon yesterday but didn't get really much out of that. Going back to see him in another 6 weeks.

Pain in different places in my knee. Sort at the front of my knee, I think basically coming from the scar / wound. One side of the scar feels numb while the other side feels a bit sore. Surgeon says this is normal. Gives a sort of tight feeling when I bend my knee when walking. Its also irritating when rubbing against my trousers when walking.

My quad is also a bit sore just above the patella but is becoming less so ever day. I have been strengthening my quads with leg raises (not yet completely straight). Surgeon told me I can now start using ankle weights and also to heat my knee up before exercising (eg with a hot water bottle).

As for pain from the grafts on the mfc and patella, microfracture on the patella and donor sites? Who knows. Its early days. When I type all that out I realise what a mess my knee is in now! On my side however is that the lesions are relatively small. My surgeon also tells me that he's only ever had one patient who's had any problems after he's done mosaicplasty. From my reading it seems that the surgeon doing a good job is critical and I have complete confidence in my surgeon. He even described the work he did on me as "beautiful"!  :o

I'll give updates on how my knee progresses over the next few weeks / months. At this point I'm hopeful and confident that all is going to turn out okay. I'm now approaching almost 2 years since I initially injured my knee and having a normal feeling in my right knee is something that I can't remember!
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: kevin3004 on August 26, 2010, 09:07:15 AM
Started weight bearing again, still using 2 crutches, last Thursday. That was a day short of 6 weeks. Since then I've been alternating between weight bearing with 2 crutches and 1 crutch and have also taken a few short walks in the house and office without any crutches in the past couple of days.

Went to see the surgeon yesterday but didn't get really much out of that. Going back to see him in another 6 weeks.

Pain in different places in my knee. Sort at the front of my knee, I think basically coming from the scar / wound. One side of the scar feels numb while the other side feels a bit sore. Surgeon says this is normal. Gives a sort of tight feeling when I bend my knee when walking. Its also irritating when rubbing against my trousers when walking.

My quad is also a bit sore just above the patella but is becoming less so ever day. I have been strengthening my quads with leg raises (not yet completely straight). Surgeon told me I can now start using ankle weights and also to heat my knee up before exercising (eg with a hot water bottle).

As for pain from the grafts on the mfc and patella, microfracture on the patella and donor sites? Who knows. Its early days. When I type all that out I realise what a mess my knee is in now! On my side however is that the lesions are relatively small. My surgeon also tells me that he's only ever had one patient who's had any problems after he's done mosaicplasty. From my reading it seems that the surgeon doing a good job is critical and I have complete confidence in my surgeon. He even described the work he did on me as "beautiful"! :o





I'll give updates on how my knee progresses over the next few weeks / months. At this point I'm hopeful and confident that all is going to turn out okay. I'm now approaching almost 2 years since I initially injured my knee and having a normal feeling in my right knee is something that I can't remember!
Hi Andrew good to hear youíre weight bearing and Iím sure things will work out for you and your surgeon seems very positive. Are you now driving?
Get those ankle weights on and take it steady and keep posting.
Cheers
Kevin
Title: Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on September 12, 2010, 04:23:41 PM
That's just over 9 weeks post op now. Weight bearing is going well so far. Knee is still a bit numb and sore around the scar but its getting better.

My initial impression is that the pain on the MFC that has been giving me problems for approaching 2 years now feels less painful. Its early days just now so don't want to jump the gun but even at this early stage I'm able to walk about without a limp. There are noticeable improvements every day. Haven't really noticed any patella issues other than the pain at the scar on the oustide of my knee. In fact the worst pain so far has been the scar rubbing against my trousers when walking about althoyugh that has diminished as the days go on. Am able to walk up and down stairs okay and although I haven't walked any great distances, I have done a couple of trips round the supermarket so far.

As I said, early days at the moment but compared to how I felt at this stage last year after microfracture, I'm a lot more confident that I'm going to have a positive outcome this time around.
Title: Re: Mosaicplasty on MFC and Patella plus microfracture on 9th July!
Post by: Lottiefox on September 12, 2010, 10:57:42 PM
Andrew

I shall say this quietly....so not to tempt fate....but things sound good!  ;D

Slow progress is the way to go, and having been through failed MFC repair I think you're well placed to recognise if the OATS is helping more. I have all fingers and toes crossed that things go well this time. I've just had a visco supplement jab in my problem left knee (Euflexxa) - my areas of damage are varied and diffuse and I'm just not sure if any of the cartilage repairs are going to help long term......the OS who jabbed me seems to think it will be bionic parts for me but says that could be 2, 5, 10 or 20 years on....so whilst I am pretty functional and pain free (so long as no running!) I'll keep plodding along..

Good to hear your update, keep us posted and take care

Lottie  :)
Title: Re: Mosaicplasty on MFC and Patella plus microfracture on 9th July!
Post by: AndrewH on October 10, 2010, 12:22:57 PM
3 months post surgery update

The knee feels a million miles away from being normal yet. The skin around the long scar down my knee still has some numbness and pain, although is very slowly getting better. It irritates when rubbing against trousers when walking about.

Have more or less regained full ROM, just feels a bit tight when pulling my knee right back. Am able to walk about okay but I do still feel some of the same pain in the same area on the MFC that I was having pre surgery. I don't think its as bad as before and I think its getting better. Its hard to tell though because of the general achiness in the knee from the actual surgery and the numbness and soreness on the skin.

Am rehabing my doing 20 mins on the bike most days with low resistance and doing straight leg raises with weights every second day. Also using a small cycling machine in the house for short spells every day to keep my knee moving. Muscle is coming back. Have been doing lots of upper body work in order to help keep my weight down. My weight actually went up a bit after I stopped using the crutches, probably because I did so much walking about on the crutches and it was a great work out. Weight has come back down over the past couple of weeks. Am still within the normal weight range on the BMI scale by almost half a stone but would like to lose up to another half a stone to ease the pressure on my knee.

Its still early days. Its hard to get timelines on recovery for this op but as most studies look at results at a year or after, I know that is the timescale I am facing. I found a good study recently of 8 patients which looked at results at 6 months - which is the earliest I have found in any study. There were significant improvements for all 8 at 6 months with some fully recovered at that point and significant progress again after 12 months for the rest. I'm only half way to the 6 month mark and a quarter of the way to 12 months so am being realistic in what to expect.

I've had worked done on 3 different lesions on the knee so I knew it was going to be a difficult recovery. Still feeling confident.