KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => Topic started by: plaidwandering on June 24, 2016, 12:43:43 AM

Title: Out of surgery with Broyles
Post by: plaidwandering on June 24, 2016, 12:43:43 AM
I don't have much to say yet, super woozy...will continue to update
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 24, 2016, 01:58:15 AM
Had a nap. Report to wife was that he thought it went well, I was probably told some details but don't remember.

PT starts in the morning!
Title: Re: Out of surgery with Broyles
Post by: psny on June 24, 2016, 05:46:17 AM
Thanks for updating this thread! I am very curious myself to see how you progress and wish you the best. Please do post some photos of the arthroscopy if you can.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 24, 2016, 05:48:28 PM
Had  PT, mainly just gentle stretching. Showing me how much 20% is to partial  weight bear

PT is daily for four weeks then trickles down

Pain is ok, had two Norco last night, but just celebrex and Tylenol today

I don't have pics or report yet, I see him Wednesday
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 26, 2016, 01:23:26 PM
First two hours on cpm were uneventful

Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 27, 2016, 06:21:16 PM
Day two of PT and a bit more work for the muscles. The only pain I had was from the skin stretching around the stitches

I've got the cpm on 90 now

Boredom and loneliness are my biggest issues heh

Title: Re: Out of surgery with Broyles
Post by: Pier2043594 on June 28, 2016, 09:13:01 PM
Plaid,

Thanks for the updates.  Keep them coming.  Any pain relief yet from the knee?  Or too early to tell?

Pier
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 28, 2016, 09:58:35 PM
I don't get to walk until August, so can't say

It is a several month process overall
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 30, 2016, 07:07:55 PM
First post op today.

Stitches out

Blood and bone marrow draw for injection. Btw on the bone marrow the anticipation was way worse than the event. It was no big deal and over fast.

I forgot my USB drive for video/pics...will get next week. It looked like a minefield though!
Title: Re: Out of surgery with Broyles
Post by: psny on July 01, 2016, 12:46:17 AM
First post op today.

Stitches out

Blood and bone marrow draw for injection. Btw on the bone marrow the anticipation was way worse than the event. It was no big deal and over fast.

I forgot my USB drive for video/pics...will get next week. It looked like a minefield though!

Great news! I too anticipated terrible pain, but never experienced any with all of the PRP and SVF injections I've received.
Title: Re: Out of surgery with Broyles
Post by: Pier2043594 on July 01, 2016, 01:18:03 AM
Plaid,

I too thought the BMAC withdrawal sounded a lot worse then it actually was.  It just feels like it should hurt like hell.  It does not.

I though have had brief but tremendous pain with the injections.  I wish I was as lucky as PSNY on that front!

Again thanks for the updates.  Even if we don't reply to them all we are reading an grateful that you are sharing your experience.

Pier
Title: Re: Out of surgery with Broyles
Post by: razuzin on July 01, 2016, 03:28:41 AM
plaidwandering,
Best of luck with your recovery.

Are staying in the area all the time?  Does the hospital have some affiliated hotel for long term stays?

It's good to know that BMAC isn't that paainful as I'm scheduled for a BMAC procedure combined with an arthroscopic procedure. The good news I'll be out when injection is done, also it will be combined with a fibrin glue.

What about the site of BMAC drawing? Does it stay sore for a while?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 01, 2016, 03:48:58 PM
I can barely feel the spot unless I press right on it, the one they did during surgery I never felt at all. I've heard from patients that have seen other docs that they have a tender spot for a week or so.

The CPM was a little painful here and there yesterday, probably since the knee was full from the injections. Minor and gone right after though.

I'm here until 5 weeks post-op. There is the bmac/prp/ha injection in surgery after the drilling and then every week for 5 weeks while you do intensive PT. The standard protocol(which mirrors Dr. Saw's that he learned it from) Is three follow up weekly injections at 4 months and 12 months.

The clinic has a slight discount on an extended stay about two blocks away. Still, the stay costs are going to just about equal the non-insurance portion of medical costs. I wish I had a friend in Baton Rouge!
Title: Re: Out of surgery with Broyles
Post by: psny on July 01, 2016, 08:27:21 PM
plaidwandering,
Best of luck with your recovery.

Are staying in the area all the time?  Does the hospital have some affiliated hotel for long term stays?

It's good to know that BMAC isn't that paainful as I'm scheduled for a BMAC procedure combined with an arthroscopic procedure. The good news I'll be out when injection is done, also it will be combined with a fibrin glue.

What about the site of BMAC drawing? Does it stay sore for a while?

What treatment did you decide on to fix your problematic Chondrofix plug? If I had to guess from what you describe Biocartilage?
Title: Re: Out of surgery with Broyles
Post by: razuzin on July 02, 2016, 05:00:00 AM
Thank you plaidwandering,
yes, that what I estimated about costs too.

Psny,  I'm planning to have an arthroscopic procedure mainly to assess the defect, and also do some clean up. It'll be combined with BMAC stem cells which would be placed exactly at the site of defects, in trochlear groove and meniscus, mixed with fibrin glue. The glue will have the cells in place. There are studies showing a slightly better outcome if fibrin glue is used.
Title: Re: Out of surgery with Broyles
Post by: psny on July 02, 2016, 06:43:19 AM
Thank you plaidwandering,
yes, that what I estimated about costs too.

Psny,  I'm planning to have an arthroscopic procedure mainly to assess the defect, and also do some clean up. It'll be combined with BMAC stem cells which would be placed exactly at the site of defects, in trochlear groove and meniscus, mixed with fibrin glue. The glue will have the cells in place. There are studies showing a slightly better outcome if fibrin glue is used.

I see, very interesting! Did you receive any more relief from the SVF / PRP / HGH injections? I'm beginning to really wonder if injectable stem cells therapies have any regeneration capability without actual trauma for chondral defects. For arthritic patients they seem to offer anti-inflammatory benefits and potentially slow progression while controlling symptoms. Standard intraarticular injections don't seem to be able to really regrow any cartilage or even regenerate softened cartilage seen in mild chondromalacia. If there is some regrowth it is usually very minor. At least from what I've seen on these forums. I am not far along in my quest yet with SVF / PRP to know if anything has changed.

All of the studies around cartilage regeneration involve marrow stimulation (microfracture), a scaffold, or fibrin glue. Standard microfracture creates a poor repair due to the repair tissue not filling the defect completely in addition to healing mostly as fibrocartilage. This is likely due to there being too few drill holes in the area of damage, thus forming less vascular channels from the bone to allow cells present in bone marrow to create new cartilage. Although, I guess in theory if something is done to hold the cells in the place of damage then even without microfracture they can begin healing the area. This is being researched now for tendon injuries. Creating a scaffold that can hold growth factors in place long enough for tissue to heal.

Dr. Saw's drilling method isn't even comparable to what is typically done during microfracture. He, as the original poster of this thread mentioned, creates what appears to be a minefield. The drill holes are very close together and deep. He doesn't use scaffolds or fibrin glue and aides healing by injecting cells and hyaluronic acid for a set number of weeks after. The modified microfracture technique with the additional cells seems to take healing and defect filing to the next level. You can see in his videos that the repairs later on are almost indistinguishable from a undamaged knee.

Video of Dr. Saw's drilling technique:
https://www.youtube.com/watch?v=v8TAbBEBqsA
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on July 03, 2016, 06:19:41 PM
I really hope all goes well for you. I'm flying to San Fran on Wed to meet Dr. Saw and see what he has to say about my knees. Please continue to post updates. Take Care
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 06, 2016, 02:55:22 PM
Planning to update for a long long time, they just won't be as frequent

PT continues, gaining back rom quickly, I only had a few degrees lost prior though so. cPM has been on 120 for days, it's max. The leg will go to 160 on its own, but the cpm Broyles said is more for giving it some pressure to stimulate and not for flexibility


I am trying to venture out to the world a bit more, but the arms exhaust quickly on the crutches.

I guess I should look up a grocery delivery service to restock the fridge in room.
Title: Re: Out of surgery with Broyles
Post by: razuzin on July 06, 2016, 07:46:56 PM
Thank you plaidwandering,
yes, that what I estimated about costs too.

Psny,  I'm planning to have an arthroscopic procedure mainly to assess the defect, and also do some clean up. It'll be combined with BMAC stem cells which would be placed exactly at the site of defects, in trochlear groove and meniscus, mixed with fibrin glue. The glue will have the cells in place. There are studies showing a slightly better outcome if fibrin glue is used.

I see, very interesting! Did you receive any more relief from the SVF / PRP / HGH injections? I'm beginning to really wonder if injectable stem cells therapies have any regeneration capability without actual trauma for chondral defects. For arthritic patients they seem to offer anti-inflammatory benefits and potentially slow progression while controlling symptoms. Standard intraarticular injections don't seem to be able to really regrow any cartilage or even regenerate softened cartilage seen in mild chondromalacia. If there is some regrowth it is usually very minor. At least from what I've seen on these forums. I am not far along in my quest yet with SVF / PRP to know if anything has changed.

All of the studies around cartilage regeneration involve marrow stimulation (microfracture), a scaffold, or fibrin glue. Standard microfracture creates a poor repair due to the repair tissue not filling the defect completely in addition to healing mostly as fibrocartilage. This is likely due to there being too few drill holes in the area of damage, thus forming less vascular channels from the bone to allow cells present in bone marrow to create new cartilage. Although, I guess in theory if something is done to hold the cells in the place of damage then even without microfracture they can begin healing the area. This is being researched now for tendon injuries. Creating a scaffold that can hold growth factors in place long enough for tissue to heal.

Dr. Saw's drilling method isn't even comparable to what is typically done during microfracture. He, as the original poster of this thread mentioned, creates what appears to be a minefield. The drill holes are very close together and deep. He doesn't use scaffolds or fibrin glue and aides healing by injecting cells and hyaluronic acid for a set number of weeks after. The modified microfracture technique with the additional cells seems to take healing and defect filing to the next level. You can see in his videos that the repairs later on are almost indistinguishable from a undamaged knee.

Video of Dr. Saw's drilling technique:
https://www.youtube.com/watch?v=v8TAbBEBqsA
psny,
this is exactly the question I'm trying to answer for myself. I've done SVF/PRP/HGH over 9 months, and it's hard to attribute my progress to any of these treatments. Day-to-day progress wasn't very visible either, however I've had a tremendous improvement since 9 months ago.

Last long weekend I played tennis three days in a row. I felt quite sore afterwards and had to take a couple of NSAIDs but overall not too bad. I'd say I'm at 70%-80% of my pre-injury level.  Nine months ago I had pain from walking for 5 minutes, couldn't do stationary bike at a medium resistance. So in terms of pain, inflammation, function I had a huge improvement.

At the same time it's possible that my defect in terms of cartilage deterioration haven't changed much. A big part of assessing the condition of it will be the arthroscopic surgery combined with BMAC.
Scaffold and exact placement will definitely help. However, not sure whether the healing effect will be comparable with the procedure combined with microfracture - no MF will be done in my case. Clearly drs. Saw and Broyle showed a success of MF+ stem cells approach.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 07, 2016, 05:34:18 PM
Another injection done, and weight bearing increased to 30%( from 20)
Title: Re: Out of surgery with Broyles
Post by: psny on July 07, 2016, 10:00:37 PM
Another injection done, and weight bearing increased to 30%( from 20)

Do you know what sort of separation equipment Dr. Broyles uses for PRP and BMAC? Also, what brand of Hyaluronic Acid does he use?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 08, 2016, 04:17:31 PM
I don't know what equipment they use for that.

Here is what it looked like after drilling on day of surgery
Title: Re: Out of surgery with Broyles
Post by: dal_knee on July 08, 2016, 06:39:13 PM
vomit..... :o
Title: Re: Out of surgery with Broyles
Post by: psny on July 08, 2016, 06:54:11 PM
I don't know what equipment they use for that.

Here is what it looked like after drilling on day of surgery

Looks almost identical to the video I posted above from Dr. Saw. Great updates to this thread by the way!
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 14, 2016, 08:55:23 PM
no change in weight bearing, 4th injection went fine today. It's a piece of cake after the first awake one heh.
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on July 14, 2016, 11:52:15 PM
How's your knee feeling...are you still in a lot of pain killers? Was your damage in the weight bear area?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 15, 2016, 01:43:10 AM
I haven't taken a pain killer since the first night after surgery. Pain is mostly a 1 if any, very occasional 2 or 3

damage was in weight bearing portion of MFC, I go up to 40% in a week.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 21, 2016, 05:36:22 PM
PT had new things for the start of week five. Some patella loading, stationary bike, and one leg gait motions on treadmill with partial weight. No trouble with this or progressing to 40% weight bearing

Injection #5 though got me riled up though, for some reason really sore this time. It seems to be tapering off at least, but it was an unhappy first fifteen minutes. As compared to the prior ones being forgettable after thirty seconds.
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on July 22, 2016, 01:11:35 AM
Thanks for the updates, please keep them coming. I'm curious you indicated you had damage in the MFC, did you also have meniscus damage? If so did Broyles do injections into the meniscus? Thanks
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 22, 2016, 01:22:23 AM
Nope,  healthy meniscus in this knee
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 28, 2016, 11:12:30 PM
injection 6 down!

no real changes in routine until next week though.

my quad can fire more/harder than in years with all the PT...
Title: Re: Out of surgery with Broyles
Post by: razuzin on July 29, 2016, 11:54:12 PM
injection 6 down!

no real changes in routine until next week though.

my quad can fire more/harder than in years with all the PT...
Do they draw BM from the same spot? It must be sore after six drawings.

I just had a BMAC injection during an arthroscopic surgery, it didn't hurt as I was under general anesthesia, but the spot is being sore for 3 days already, wouldn't want to have same procedure repeated each week.

Btw, when they did the MFX procedure did they make the BMAC during the arthroscopic? If yes, did they use fibrin glue?

Thanks.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on July 30, 2016, 12:01:55 AM
plaidwandering,

Are you staying in Baton Rouge past the 6 week mark to continue the PT protocol or return home?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 31, 2016, 05:32:22 PM
sites rotate around, I have had varying degrees of tenderness, some for a handful of days...others like this Thursday, I didn't feel at all

I have left, Friday was travel day, I still swell when not elevating, so it was rather plump by the end.

I will continue the PT protocol at home, and return late October for the next series.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 04, 2016, 04:11:41 PM
exciting(and a bit scary) day!

progress to FWB as tolerated, expected time frame is 2 weeks
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 09, 2016, 02:32:11 AM
Doing about 75℅ weight bearing so far. Fairly ok, still no more than minor aches and a few stronger throbs a day.

I got let go as soon as I showed up at work today, without even the courtesy of saving me the walk on crutches in.
Title: Re: Out of surgery with Broyles
Post by: mulberrysdream on August 11, 2016, 07:04:53 AM
Glad to hear you're doing well overall.

I just had my meniscus transplant repaired...and at Dr. Laprade's recommendation will be beginning to undergo a series of BMAC injections with Dr. Evans here at the Steadman Clinic as I have lots of cartilage defects as well.

Do you get some sort of anesthesia for every injection? at Evan's office they are done in clinic and they just prescribe a sedative/pain medicine for the procedure...which i'm worried might not be enough?

I had PRP and BMAC, but during surgery, and had my bone marrow drawn while still "awake" but under IV anesthesia.

Hope things keep improving!
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 11, 2016, 04:58:11 PM
Lidocaine for a minute before he punctures hip
Title: Re: Out of surgery with Broyles
Post by: paladyr on August 14, 2016, 12:54:31 AM
Doing about 75℅ weight bearing so far. Fairly ok, still no more than minor aches and a few stronger throbs a day.

I got let go as soon as I showed up at work today, without even the courtesy of saving me the walk on crutches in.

What kind of work do you do? That really sucks!
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 16, 2016, 05:33:45 PM
small business server stuff... I was probably leaving at the end of the year anyway, so not terribly upsetting, just have to trim the budget some

bit of a hiccup yesterday. the PT up here at home is apparently really aggressive. I was full walking about 10 minutes in the session, and I got sore in the joint after which is still here this morning. I was excited and not tracking/thinking about the time up, but it was clearly too much too soon. That's about as much as he wants me to be walking period before 3 months are up.(a month from now)

Hopefully I don't have to back off for too long, but even heavy partial is tender currently.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 18, 2016, 01:01:24 AM
Heavy partial weight bearing no longer tender
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on August 26, 2016, 09:27:08 PM
So I'm good for a few minutes walking. As long as it is well spread out I am ok to do it 10ish times a day.

It feels slow of course, and I have to remind myself that it's expected to be.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on September 27, 2016, 06:20:54 PM
So past three months mark

Walking,. But very limited

Definitely still worse than pre-op there were some issues with the PT at home who decided upon themselves to go away off of the protocol without telling me. I eventually figured that out after talking to dr. Broyles and him asking what was going on we were doing angles and loading far in excess of what was called for

Still have had some progress in the last month the, just not as . much as most
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on October 19, 2016, 07:52:52 PM
Back in baton rouge for four month series

MRI is showing cartilage over drill sites, 75-90% thickness already

It also shows some inflamed scar tissue, which is probably what's bugging me the most. Hopefully it will settle down/finish remodelling on its own
Title: Re: Out of surgery with Broyles
Post by: dal_knee on November 11, 2016, 11:41:20 PM
Just curious on an update from you.  Hope all is well.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on November 14, 2016, 06:24:24 PM
Hard to say at the moment.

Dr. Broyles didn't want me to try pushing things again until the six month mark.
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on November 18, 2016, 10:45:44 PM
You indicated in your previous update the cartilage has regenerated up to 90% already....is that normal?  Also, did Dr. Broyles tell you the quality of the cartilage via mri? Thanks
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on November 23, 2016, 12:55:35 AM
Pretty sure you can't tell that from MRI, that's why people in Dr. Saw's originL studies had to agree to re-arthroscopy  and some biopsies

It is also too soon/ immature to be in its final state...

I'm still using a go cart for grocery trips or I feel it, I had the impression I'd be paste that by now, but I'm told not to worry that it's doing well
Title: Re: Out of surgery with Broyles
Post by: Vlad on December 06, 2016, 09:29:49 PM
Plaid, I have moderate-sized horizontal tear of the medial meniscus posterior horn, mild medial compartment osteoarthritis, mild patellofemoral osteoarthritis with moderate chondrosis in my right knee and I'm trying to get a consultation with Dr Broyles (I still have to ship the MRI CD, so it will take probably couple of weeks before I get to talk to him), but in the meantime I'm trying to educate myself about possible procedures/treatments and doctors.
6 months in, are you happy with the procedure and with the doctor? Would you recommend it?
I'm trying to decide if I should go for this kind of extensive procedure, even though I have only mild arthritis for now, or should I try just stem-cell/PRP first (i.e. Docere/Dr Adelson).

I live in Denver, CO, so I'd have to fly to both doctors, but Dr Broyles is much more expensive (money and time) and with much higher chance of getting the complete regeneration.

Thanks.
Title: Re: Out of surgery with Broyles
Post by: psny on December 08, 2016, 05:23:29 AM
@plaidwandering From the videos I recall seeing from Dr. Saw that included testimonials from patents the recovery time for full return to activity was around 1 year. At 8 weeks post-op most of the patients were doing normal daily tasks and were doing PT. This coincides with standard microfracture surgeries as well. The recovery time is usually around 8 weeks non-weight bearing followed by a slow return to activity after PT.

Have you inquired to Dr. Broyles as to why your situation is different? I am not claiming anything is wrong, or that your recovery time is any longer then normal. I am not too familiar with how Dr. Broyles recovery protocol differs from Dr. Saw's, nor am I really familiar with Dr. Saw's. I only know what I saw in the YouTube video pertaining to his procedure.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 11, 2016, 02:19:52 AM
vlad, while my injury is not the same as yours, I will tell you I did 5x prp, then 5x bmac prior to this surgery with no relief at all.

psny I'm not sure what you mean, I was told full recovery was a year also, and I'm at 5.5 months now. I had the impression from other patients that I'd be doing more at this point, but it's going to vary more

yes, I am starting to worry some. I still am worse off than the day before surgery. I still have pain in places I didn't have before surgery. Yet, the cartilage shows that good thickness on mri. I don't know what to think of it. Dr. Broyles is blaming scar tissue, but it's getting harder to accept as the cause. I hurt in three places in the knee, only two of which can be tied to the scar tissue that also shows on the mri.

No I can't say I'm happy yet obviously, but they say it's not a done deal either. Still being less than 1/3rd as capable of walking than prior to surgery is definitely weighing on me.

I know Danielle, who doesn't seem to be posting here, had him do both knees a year apart and is happy.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on December 11, 2016, 04:10:53 PM
Hi Plaid

Can you remind us the areas of the knee you had drilled?  Femur, tibia, trochlea, patella?  Any kissing lesions?  Do you recall the size of the defect(s)?

Regarding scar tissue.... you might be able to break some of that down by using friction massage or Graston (typically done at a chiro).   Are these areas of scar tissue tracking back to the arthroscopic portals?  Is that the area of "pain?"  Also scar tissue can take 2 years to "remodel" and break down; it's considered normal.   (Does not apply AF, though)

 
Title: Re: Out of surgery with Broyles
Post by: newkneecartilage on December 11, 2016, 05:48:31 PM
Hey Plaidwandering, sorry you are having problems!  Where did Broyles say your scar tissue is?  Dal_knee suggested graston which is great if the scar tissue is close to the knee surface. Definitely ask Broyles if he thinks that is an option for your.  He is pretty good about staying knowledgeable on things that physical therapist can offer.  I'm going down in 2 weeks for my next check up. I don't get on here very often unless someone messages me.  Danielle
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 11, 2016, 06:42:49 PM
The scar tissue he sees on the mri is over the medial trochlear ridge.

The areas that were drilled were medial femoral condyle, and somewhere on the medial side of the patella.

The new pain area is between the top medial corner of the patella and the femur. Old pain spots that haven't abated are pain in MFC with weight bearing - right now it's fine for not quite 10 minutes before that starts. I can do 3-5 minutes many times a day with no issue. The last spot is what I swear is a little sore spot on my tibea just below and more medial to the MFC defect. It's always sore to touch pre/post no change. No one has ever seen anything there on any of the many MRIs or two arthroscopies though.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 11, 2016, 06:46:06 PM
also something new last night - I have been able to stationary bicycle with nothing to note for 15 minutes since 8 weeks post-op. Last night I had a slight popping with nearly every rotation. It wasn't hurting, but I'll definitely be paying close attention next time to see if it happens again.
Title: Re: Out of surgery with Broyles
Post by: Clark on December 16, 2016, 07:23:43 PM
Keep the updates coming.

I'm new to this forum and would appreciate help from anyone. I have bone on bone under my knee cap in the groove. Injured it about 20 years ago with heavy weight lifting (I've simplified this). It currently doesn't prevent me form getting a descent workout but my days are numbered. Oddly I can do some fast interval running (12mph) and careful leg presses but I can't even bike medium hard (forget about an elliptical too). I ice my knees after each work out, sleep with a pillow under my knee, and take glucosamine (all a must for me).

Should I consider dr stones paste graft or should I try dr broyles procedure? Sounds like Adam Ans in Florida isn't an option if you can end up in the control group. It's hard for me to be away from the office for 6 weeks straight. I wondered if dr stones paste graft would work.
Title: Re: Out of surgery with Broyles
Post by: Vlad on December 17, 2016, 01:23:15 AM
vlad, while my injury is not the same as yours, I will tell you I did 5x prp, then 5x bmac prior to this surgery with no relief at all.
Plaid, thank you for the input.
I've scheduled the sugery with Dr Boryles on Jan 23. Now I have to see how much time off from job I can negociate with my employer. If I can be off work only 3-4 weeks, then I'll have to fly to Baton Rouge 2-3 times. Pretty inconvenient when you can use only one leg.
In the meantime, couple of days ago I did a PRP injection here in Denver, in the hope that within couple of weeks it will take away the chronic inflamation of my knee.
The PRP injection was the most painful thing I did ever, even more than the 2 colonoscopies without anesthesia I did in the past few years.  ::)
One day after injection, my knee is better than before (it doesn't hurt almost at all), but this could also be due to the early Santa's gifts I received (a Drive Blue Streak wheelchair and crutches... :()
The doc that gave me the PRP, said I should try to be no-bearing on the leg for couple of weeks, but I'm almost 100% sure this injection will not fix the complex meniscus tear, so I might use the wheelchair and crutches on-and-off until I get to the Dr Broyles' surgery.
At this point I'm not sure which one is less bad: using the wheelchair to protect the meniscus tear from getting worse and irritating the knee joint, or getting all my leg muscles atrophied by using the wheelchair.
I'll trying to use the gym to do some upper body and core strength, and I'll give swimming a try in the new year, for the 3 weeks before the surgery.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on December 17, 2016, 01:59:54 AM
Vlad

Can you post what Dr Broyles surgical plan is for the complex meniscus tear and any relevant comments.
Title: Re: Out of surgery with Broyles
Post by: Vlad on December 19, 2016, 05:59:57 PM
Vlad

Can you post what Dr Broyles surgical plan is for the complex meniscus tear and any relevant comments.
Before I decided for the Dr Broyles procedure, I've had consultations with other 6 doctors about this, including Dr LaPrade and Dr Karli from Steadman Clinic and Dr Adelson from Docere Clinics, plus 3 orthopedic surgeons here in Denver.
The consensus was that just based on MRI and xRay, they cannot say for sure (until they go in with arthroscopy), but most likely a good part of the meniscus tear has no chance of healing by itself, because it's in the part of the joint that receives no blood.
I don't have a high hope for fixing the complex meniscus tear with Dr Broyles procedure, but I'm hoping at least a part of it can heal/regenerate itself following the cleanup of the tear during the surgery and the 12 stem injections.
The best case scenario that Dr Broyles presented was the cartilage will grow to fill up at least part of the meniscus that didn't regenerate. If I'll get to that, I'll probably only know in couple of years time. At that moment, if the meniscus is still a problem, I will look into other options (i.e. transplant, graft, etc)
Do you think is there another option for me at this point?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 29, 2016, 11:03:11 PM
6 month mri, cutting out unimportant parts where there are no problems, these two compartments are where there was drilling

medial compartment: The root of the medial meniscus is normal. The posterior horn and body are within normal limits. The articular cartilage is irregular throughout the lateral half of the medial femoral condyle, and there is is underlying subchondral bone marrow edema. There is also a postoperative artifact along the anterior aspect of the trochlea.

patellofemoral compartment: The cartilage of the patella is intact, and the trochlear cartilage is normal. A small joint effusion is present, and there is a small loose body in the medial gutter of the suprapatellar pouch. This measures up to 4mm in craniocaudal height.

Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 30, 2016, 01:13:26 AM
that was the radiologist's report, Dr. Broyles just called me with his take. He thinks that spots have thickened more, those that were 70% are further along. He doesn't think it's a loose body, the shape does not match his experience. He still thinks it is scar tissue that is bothering me.

He says almost this whole wedge is scar tissue, which developed from a shelf of plica
Title: Re: Out of surgery with Broyles
Post by: dal_knee on December 30, 2016, 10:52:31 PM
Hi plaid,

Hope things turn around for you soon.   Does Dr Broyles recommend going in to cut out the scar tissue? 

Did he comment on the bone marrow edema?  Btw, that's one of the only mri findings that can be unequivocally related to "knee pain".    Did you have that finding prior to the subchondral drilling surgery?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on December 31, 2016, 10:19:38 PM
He has said cutting it out and cauterizing it may be necessary in a couple months. Right now he wants me to see if I can find a local ortho with an ultrasound willing to put a cortisone shot inside the lump of scar tissue. Only directly inside it, as he doesn't want it touching the cartilage. Just once to see if it will chill it out enough to shrink some.

He didn't mention he bone edema, it wasn't there pre-drill. It's possible the radiologist is mistaking the drill sites for that. They are still visible, but becoming less distinct on each subsequent mri.

The latest locking at extension was really bad last night. I was standing brushing my teeth, when I was done I couldn't bend the right knee. That much happens fairly often, and I just shift the weight to left foot and I can bend. Didn't work. Picked the right foot up, still no bend. Had to kind of dangle it a minute and then it finally and stubbornly decided to start moving again. A moment after that it was moving fine and no issue rest of the night.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on January 04, 2017, 12:53:46 AM
Hi,
I'm certainly wondering if the locking is related to the scar tissue wedge overgrowth, getting trapped in between the joint surfaces?   What is your take?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on January 04, 2017, 06:49:33 PM
it certainly felt like something was jammed in and I had to shake it loose. I sent the same description down to them this morning and he just called me and wants to go ahead and schedule cutting it out, and I am for it.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on January 10, 2017, 08:12:35 PM
scheduled 1/30
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on January 31, 2017, 05:44:46 AM
Recovering now. I will get to see pics Wednesday.

Doc said there even more scar tissue wedging in there than seen on MRI, so hopefully things start improving rapidly now.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on February 01, 2017, 09:42:56 PM
Boy there was a ton of junk in there, and you could see the red raw spots from it rubbing. I forgot a USB drive unfortunately
Title: Re: Out of surgery with Broyles
Post by: dal_knee on February 01, 2017, 10:15:14 PM
Crossing fingers for smooth sailing & thanks for updating.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on February 08, 2017, 09:11:23 PM
5-6 minutes walking a handful of times a day is already ok

got stitches out this morning

Title: Re: Out of surgery with Broyles
Post by: dal_knee on February 09, 2017, 04:49:37 PM
great news! 
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on February 23, 2017, 09:24:23 PM
definite improvement, I'm up to about 10 minutes once a day, with a few 5 minutes spread out. Prior to the scar tissue trim, 10 minutes would ruin me for the rest of that day and possibly the next.

I still had one step where something caught and was a big ouch but just for a second.

Surgery swelling is still working its way out, about halfway gone now.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on March 08, 2017, 03:13:14 AM
I've had a few more rare steps that zing me for a second

However seriously delayed flight landed me for my layover at 2am with no staff to wheel me. Forced about 30 min of walking.

Now it wasn't easy, muscles ached a lot. Swelled a bit more too. It was not comfortable at all, but it wasn't painful in the joint. Beneath the ports is a little sore, but that's it
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on March 08, 2017, 09:59:24 PM
I'm glad to hear that you're doing better and I'm sure that muscle soreness and swelling will go away as you gain strength back. I'm curious when Dr. Broyles went back in,want was the quality of your cartilage and how much has the defect filled in?? Thanks
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on March 09, 2017, 03:19:12 PM
The MFC was 100%, flush with surrounding cartilage and had normal shape. It was glossy and smooth but didn't look quite as dense as the surrounding area. It's only six months though, so a good ways from maturity. The very small spot on PF was only 70%
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on March 15, 2017, 10:16:20 PM
Stood/walked through a 45 minute line last night, no issues.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on March 15, 2017, 10:55:46 PM
That's great plaidwandering, thanks for updating us with your progress.
Title: Re: Out of surgery with Broyles
Post by: jnestor1299 on March 16, 2017, 06:49:00 PM
The 100% is awesome and it's only been 8 months, so I'm sure the other defect will fill in. You are on your way to recovery. Thanks for the update!
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 03, 2017, 06:56:40 PM
So I can be on my feet about that much(30-45) minutes once every few days, in between I need to keep it to a little less or it does get touchy. I really feel that I'm on the edge at that point and if I stayed up things would go south quickly.

it's still quite uncomfortable, and I still have the occasional weird step that just goes ZAP and is done. These happen when I'm standing still and shuffling in place a bit, not usually while walking.

9 months and I'd say I'm only a small amount better than breaking even with before surgery. (prior if I was up 30-45 minutes then I was pretty much done for 6-7 days, so I guess my recovery time has cut in half)
Title: Re: Out of surgery with Broyles
Post by: dal_knee on April 04, 2017, 04:46:33 PM
Hi  plaidwandering

Sorry to hear it's been this slow, what is the feedback from the surgeon?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 04, 2017, 07:28:41 PM
as an example of the above, walked about 30 minutes in sam's club Saturday, felt slightly sensitive

kept it under 15 Sunday and was same

kept it under 15 Monday and was sore much of the day

kept it 15 so far today and was sore while on it

haven't gotten his take in a while. guess it's time
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 07, 2017, 06:16:45 PM
they are ok with that at this point, they don't expect me to be on the normal timetable with needing to recover from what the scar tissue had been damaging
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 14, 2017, 12:37:20 AM
Sigh

Not even five minutes up today and serious pain
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 21, 2017, 11:51:15 PM
mri yesterday, still looks like a good size divet to me

comparing to December, the shape is the same, just the triangle of scar tissue is gone having been cut and cauterized
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on April 23, 2017, 12:36:24 AM
To elaborate on why fresh MRI, things continued to be sh*tty all April
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 10, 2017, 06:52:40 PM
had it drained yesterday locally yesterday, Dr. Broyles thought if the fluid hadn't cleared since Jan surgery it was time to suck it out.

massive grating and popping afterwards, including a few steps so bad I lurched the weight back off that leg and nearly fell over. Four hours later, the fluid pockets were back to same size as before
Title: Re: Out of surgery with Broyles
Post by: psny on May 10, 2017, 10:02:30 PM
had it drained yesterday locally yesterday, Dr. Broyles thought if the fluid hadn't cleared since Jan surgery it was time to suck it out.

massive grating and popping afterwards, including a few steps so bad I lurched the weight back off that leg and nearly fell over. Four hours later, the fluid pockets were back to same size as before

What does Dr. Broyles suggest is the next step? Each patient and knee is different, but from most of the testimonials I've read about Dr. Saw's treatment patients are back to normal activity around 8-10 months, and return to sports at around 1 year. Why is your case any different? Will the divet fill?
Title: Re: Out of surgery with Broyles
Post by: diesiel on May 12, 2017, 11:55:38 PM
you should really be mobilizing the joint/muscles daily (including some passive/active stretching) -- check out steve maxwells encyclopedia of joint mobility for more on that, strengthening must be done as well, even isometrics (which literally is the safest method of training ever) can yield excellent results (can check baye.com for help on that).  Deep tissue / massage regularly is quite necessary as well.  How is the incision site, is the scar mobile?  could be another thing to look into...scar tissue release therapy is known to help for those cases.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 19, 2017, 10:52:25 PM
diesel, it wasn't typical scar tissue, it was very deep, and wedging between the femur and tibia, anyway, it was chopped out in January so is irrelevant now

a week ago, I had a fluid aspiration at Dr. Broyles recommendation.(large effusion showing on last mri)

they sucked it out and it filled back up within a handful of hours, in the interim there was a huge increase in popping and sticking. After reporting that, a cortisone shot was recommended if I was desperate for pain relief to get me through until I could be seen in Baton Rouge.

Honestly - I'm about at the point where I'm ready to call it done and not go back. I'm at 11 months, and it's still a roll of the dice everyday to see if I'm worse than pre-op. A good day now is equal to pre-op. Those few walks back in March were the only time I was a bit better than pre-op and have not even come close to again.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 30, 2017, 10:29:53 PM
got the pics from Jan, the first is the bottom half of the drill site that I remember seeing then

the second is the part the scar tissue was apparently rubbing on
Title: Re: Out of surgery with Broyles
Post by: dal_knee on May 30, 2017, 10:37:05 PM
Is the pink part exposed bone or irritated cartilage ?  Do you think or is Dr broyles saying the overgrown scar tissue wedge rubbed off the articular cartilage ?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 30, 2017, 10:40:49 PM
He said it was cartilage that was irritated so much that blood vessels developed up from the bone

obviously the groove isn't supposed to be there...
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 30, 2017, 10:57:12 PM
the dang irritating thing is that yes, this isn't perfect

but it sure is a lot more cartilage there than there was pre-surgery

so why is it a crap shoot if pain is worse than or same than before surgery?
Title: Re: Out of surgery with Broyles
Post by: dal_knee on May 30, 2017, 11:17:22 PM
But the pink/reddish angry part sure looks like it would be a cause of "new" pain right?   He's not suggesting anything like perhaps a couple of extra PRPs to help further healing of inflamed areas???

And the groove part that you mention, was that area treated with drilling or not?
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 30, 2017, 11:26:19 PM
well not extra so to speak, there was always a plan for a round of bmac at one year

I just don't know if I feel this has failed too much to be worth flying and 16 days in hotel and procedure cost...pretty much everyone else was walking like a normal person well before 11 months, and any given day I may be limping a lot by 5 minutes

the groove in the pic is right in the middle of the drill site. The two pics show the MFC that was drilled on
Title: Re: Out of surgery with Broyles
Post by: dal_knee on May 31, 2017, 12:01:03 AM
Yeah it's a tough decision to make.   On the one hand you hear that the follow up injections serve to help mature the cartilage to type-II hyaline but also you'll hear commentary from Saw that 3-year mri's can show continued cartilage thickness growth compared to 2-year timepoints.   There may be hope to fill in the groove, in addition to moving the full thickness tissue toward hyaline composition, but it's definitely a gamble.

Hey, what about the "zapping" sensations you have mentioned?  Is that still going on?   Have you had a nerve conduction study done?   If it feels like it's coming from deep within the bone ( and not a skin surface sensation), you may still have some unresolved bone marrow edema.   Just offering my input & thoughts.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on May 31, 2017, 08:04:13 AM
I'm quite positive those are something catching momentarily
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 13, 2017, 02:17:58 AM
had time to go through the video frame by frame

there is definitely still exposed bone, and some places the cartilage has ripped open
Title: Re: Out of surgery with Broyles
Post by: RGB on June 18, 2017, 12:51:47 AM
Hi there. I've done a lot of reading of these conversations but never added anything. I am doing so in the hope that my experience may help someone. I will be brief. I'm posting it here because I think it's relevant to plaidwandering's experience.  I am a 55 year old male, used to a very high level of activity. I am a former ski instructor, rock climber, windsurfer etc, until my knee gave me trouble. This is the story:

1.  In 1993 I had an ACL repair (patella tendon graft). That was successful and I was very active on the knee for the next 17 years.
2.  In 2010 I was diagnosed with a torn meniscus and a full thickness cartilage lesion in the trochlea. I underwent a partial meniscotomy plus microfracture. Very little guidance on rehab was provided by the surgeon and physio. The outcome was poor.
3.  In 2011, I had an debridement. Photos showed there was a reasonable amount of fibrocartilage in the trochlea lesion but there was a new lesion on the central patella. The debridement made the knee smoother but it was still not up to much activity. I had numerous PRP injections over the next year or so.
4.  In 2012 I had a liposuction derived/concentrated stem cell injection. This had no discernible effect.
5.  In 2013 I was unwise enough to go on a 4 hour steep hike. I knew I couldn't/shouldn't but I was past caring. The knee swelled and a subsequent MRI revealed I'd torn off another piece of cartilage from the trochlea.
6. In 2014 I underwent Dr Saw's stem cell treatment in KL. He's very professional and I had the best of care. I followed the rehab protocol to the letter and, believe me, that's not easy to do for 2 years. The bottom line is that it didn't work for me. The knee ended up with a very impressive level of crepitus and a poor tolerance to activity - perhaps slightly better than before but not significantly. I could do about one flight of stairs per day and I could cycle on the flat for about an hour, or row for about 30 minutes, every second day.
7. In March of this year, I had a patellofemoral replacement (Zimmer). It's early days but it's fantastic. A smooth knee, able to tolerate activity at a level that's been unthinkable for 7-8 years and it's still improving rapidly. My knee will shortly cease to be the centre of my physical universe because I will stop thinking about it all the time. I'll probably stop browsing these discussion pages! Yay. I may well need a full replacement in 10-15 years but that's OK by me. I'll get a high level of activity in the meantime and, to be honest, the recovery from the partial replacement has been easy and pain free.

Regards to all.
Title: Re: Out of surgery with Broyles
Post by: dal_knee on June 19, 2017, 12:49:34 AM
Hi RGB,

Does Dr Saw have any commentary/perspective on why this isn't working satisfactorily??
Title: Re: Out of surgery with Broyles
Post by: RGB on June 19, 2017, 02:22:35 AM
As far as he was concerned it was working and I should wait for it to improve. I had all the stem cell booster injections up to and including 2 years. I waited until 2 years 9 months before having the partial replacement and functionality/pain/crepitus had not changed for at least a year. That was long enough for me.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on June 22, 2017, 10:46:09 PM
I am going back for the one year round of injections. I don't really have any expectations, I just know that if I don't then more surgery is absolutely guaranteed.
Title: Re: Out of surgery with Broyles
Post by: plaidwandering on July 07, 2017, 04:57:09 PM
well that went sideways

4 days before my flight down, I got bit my some mystery bug that I didn't even see when it happened. I ended up getting grounded with a major infection in the bite (