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The SPECIALIST'S OFFICE => Meniscus => Topic started by: LateralMeniscusIssuesGuy on August 09, 2017, 04:26:59 PM

Title: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on August 09, 2017, 04:26:59 PM
FYI after much deliberation and then months on a donor list, I went ahead at the beginning of July with a LMT and OATs plug for my lateral compartment of my right knee.  Performed by Tim Spalding at Warwickshire Nuffield, UK.

As a reminder I had a very thin rim of meniscus remaining (part of one horn lost) from two previous surgeries.  I am 34YO male, 5'11", 80KG, always been fit.  Had remaining meniscus removed and replaced with a donor flown across from the US.  Also had a single 8mm diameter plug from my own trochlea, into my femur (the area that taken weight at 20-30deg bend).  It was commented that I had grade II thinning on a 20mm diameter area of both my femur and tibia.  It is hoped that the replacement meniscus better protects those thinned surfaces going forward.

Very early days, rehab has not been pailful but has been very inconvenient. Am gingerly able to walk pain free but not with a full gait.  Am wearing a DonJoy unloader brace that was provided for free with the procedure.  Will likely get something custom in the future.

I'll update when I have significant news to provide.  Hopefully this is helpful to people.  It will be something like a year or even two to see whether I am in a better situation than I was before.  I do have perhaps unrealistic aspirations of returning to competitive sport, its has been done once before on a mid 20s patient of Tim's who with the same procedures returned and still plays professional rugby.

I will persevere and try to do everything right, lifestyle permitting.

Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on August 31, 2017, 10:40:17 AM
8 week update:

Seems things are on schedule with respect to swelling, flexion, strength and scar mobility.

Have had several instances of pain in localised areas during the 8 weeks, all have come and gone, I am now relatively pain free.  Nothing was ever excruciating, but as I am a worrier my mind would always go to the worst circumstance and assume I had a major issue.  I will not be having a follow-up MRI until 6months so am hopeful so far that everything is as expected with regards to the meniscus condition and the OATS plug.

I have approx. 100deg action flexion, approaching 115deg passive.  Almost waling with a normal gait, however slower than normal speed and being careful not to pivot.  Can walk up stairs slowly but walking down is not possible without taking much of my weight through my hands on the rails.  Physio work is mainly all done sitting or laying on a physio bench using ankle weights or thera bands, no machine or free weights and no exercises while standing to still reduce the stress on the meniscus.  I am also having fortnightly MLD massage, not sure how effective it is but my swelling seems less than I expected as a result (I am a notorious sweller).  Diet still quite clean too, hope that has helped reduce the atrophy to a minimum, tho has certainly been some (perhaps 25% of VMO lost, possibly more its difficult to say, even more perhaps lost on outer quad).  Am inching the recumbent cycle saddle slightly more forward weekly to increase flexion.

So long long way off knowing whether I am in a better place, but for now I seem to be somewhat on schedule or slightly ahead in some categories.

Will probably post again at the 4 mth phase when I should be starting to embark on regaining muscle bulk.

Hope this is useful to anyone looking at either procedure.

Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on September 26, 2017, 11:41:38 AM
A very brief 12 week update:

Several instances of pain around the kneecap while trying to increase range of motion and mobility, most seemingly due to muscle imbalances, most pain has gone now.  My ROM has progressed to approx. 130 degrees.  I am walking without any issue on flat ground, and climbing stairs without much issue.  Decending is still very gingerly.  I think my muscle firing is off as my VMO doesn't seem to be doing anything when walking stairs, so I have lots of training to do.  I am moderately swollen at the end of each day, which goes away over night.

Focus is on ROM and muscle firing, bias towards the former based on the assessment of my PT.

Am now managing to cycle with moderate cadence and some resistance, and I am managing to get on it about every other day.

Scar mobilisation is decent and I continue to work ok it.

So far no major setbacks, next consultant update at 4 months.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: akawai on October 04, 2017, 09:28:11 PM
keep at it. keep us updated.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on October 22, 2017, 07:50:18 PM
Lateralmeniscus guy,

Thanks for sharing your story. Would be interested to see how the progress is going. I am 32 yo M very active in football and skiing with prior menisectomies, 3 months ago while playing football noted swelling in my knee- turns out I have full thickness chondral defects of large area in tibia and femur- life changing findings that I did not expect and its tough to deal with- being recommended OATS (allografts) + meniscal transplant though its scary to think about give mixed outcomes. Another is recommending symptom management as long as possible followed by partial knee replacement. Read my full post if you are interested, would be very curious to have your guidance.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=71161.0

Anyway best of luck, I know how scary it must have been to make the plunge. Best of luck and keep us updated.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on October 23, 2017, 10:42:11 AM
Itís about time for my 4mth update so this is good timing.  Just shy of 4mths, I have finally started descending stairs, however, gingerly.  Key to this seems to be a pain reduction in the knee, meaning I seem to have made progress with my firing of my quad muscles in more movement scenarios, resulting in less end of day swelling and more flexion.  I am about an inch away from passive heel to glute stretch.  I think the pain reduction, upon reflection, was mainly nerve pain around the shin area.  It has improved significantly with the passage of time.

Scars are barely visible, aided by hair regrowth, but also incredibly neat.  The scar mobilisation and patella mobilisation seem to be going terrifically well, so happy for those as have helped knee mechanics further. I still sleep with a raised leg, and wake up most mornings with only the swelling in my capsule to be present.  It does still shock me how stiff my leg feels in the morning after being raised and very straight overnight, but I think it is necessary not only for swelling but to make sure I retain full extension, it does only take around 5 minutes to warm up, but it is still shocking and not something I have experienced in my life before.  As I said in another post, swelling is of real interest to me, the different types of swelling in the various structures of the knee.  At the end of the day I am more swollen but with an hour of dedicated raised stretching and flexion and massage exercises, I can get back to what I imagine to just be capsule swelling.  I am looking forward to my knee swelling being zero occasionally and seeing if that means for a further breakthrough in flexion and also muscle firing (swelling interferes with those messages as far as I have read).  Muscle activation seems to be key for me at the moment in that, I continue to use a TENS machine when doing exercises that should utilise the quad, such as the leg extension (on ultra-low weight) so try and make more of the muscle fibres respond on request.  The more my muscles are doing what they should do, I imagine that will ease strain on the joint surfaces, reduce swelling, make muscle firing better etc. itís an endless cycle, on which I think activation is the easiest to achieve at the start right now.

So far I am not Wolverine, but it would appear, in the absence of a scan, I am healing on schedule in an ideal way, so I couldnít be more satisfied given how apprehensive I was pre surgery.  You certainly need very understanding family and work colleagues to go through this procedure and not get frustrated or do something silly.  The empathy from most has worn off since I ditched the crutches and the limp, and so its those few who remain supportive and appreciate the length of time ahead of me, who have been truly crucial.


Hi Badleftknee1,

Devastating to hear of people given similar news to me.  I was still actively representing my country at 32 in my sport when they saw the issues on the inside of my knee (now 34).  My articular cartilage defect area was much smaller than yours (about 1cm squared area) and was treated with a single plug.  As I have come to terms with the length of the recovery, I am very patient and happily taking my time with minor incremental improvements each week.  Iím happy to just keep plodding away (donít mistake that for being pedestrian about it, I am going full tilt with workouts and physio, in the gym every day, some days before 4am, getting under 6 hours sleep just to fit it all it, despite knowing how important sleep is).  I just canít go any quicker, as long as I know I am going as fast as I can and putting max effort into anti-inflammatory and muscle building diet, and workouts, and rest, its leaving me with a peaceful mind.  So there is potential benefit to having surgery it seems, so far anyway.

For what it is worth, I spent the best part of 6-12 months deciding what to do after I got the news of my knee condition, I was in good condition relative to you and most in that I didnít have pain unless I did some kind of activity that aggravated it (which didnít include normal daily routine or most gym work).  But I want sport again, and to be able to kick a ball or race my son, so I went for it and had the surgery.  All I can recommend is that you speak to surgeons experienced with both procedures, I think I spoke with 6 in the end, which cost me plenty, but I ended up finding a guy who gave me real confidence.  My research was geared towards small defects so I donít know about the success rate of OATS for a large area of defect, or much about the medial side in general.  Itís possible the exploratory arthroscopy reveals things not to be as bad as thought (it was the opposite for me where the MRI didnít indicate full thickness wear, but upon inspection it was).
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on October 24, 2017, 01:23:33 AM
Lateralmeniscusissues,

Thanks for your thoughtful response, very helpful. I am glad everything is going quite well for you, I really hope it continues this way. It very much sounds like you deserve it.

I was curious. I am actually in medicine myself and have a fairly active job. So beyond even the medical questions, I don't know how I would find time for this procedure and its recovery. If you had to take time off from a job (where you are on your feet for much of the day) post-procedure, what do you think is a reasonable time line to get back to work (limping around would be okay, as long as no damage being caused)? I am told 6 weeks NWB post procedure, but am thinking much more time would be needed off. An advice here would be great.

Thanks again. Wishing you the best in your continued recovery. Keep me updated on it.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on October 24, 2017, 08:11:41 AM
Badleftknee1,

I had 5 weeks off of work, and spent it entirely laying down apart from performing my exercises for portions of time during the day.  I too was NWB for 4 weeks, partial after that but to be honest wasn't really putting much weight through it until 6 weeks, I can't remember when I came off the crutches but was off them by 8.  I would not advise being on your feet much even now (4 months).  The only reason I don't want to be laying down with my leg raised is unless I am on a bike or doing other physio work.  I do not respond well to standing or walking for long periods of time, but I am a notorious sweller from previous surgeries too.  I really can't recommend enough having an extended period off of work, and that if you return that your workspace is adjusted so you can have your leg raised (the ideal is above your waist but that is usually unsociable) and certainly not standing all day.  Your muscles will have wasted and deactivated, so you put too much unmanaged weight through your joint, even now, unless I am really concentrating on having everything fire, nut perhaps I am just not a very present person and that would come back to you more quickly.

I'm really interested in what you decide to do, and of course will help with any knowledge I have accumulated along the way, however since I haven't done any of the research myself, its all just conjecture and what seems reasonable to the layman.  I'm still just praying that I at least get back to my pre surgery position, if I get there, then any more is a bonus and I can reconcile that I am no worse off for the decision.  The conflict you are going through at the moment was the hardest part for me, where I felt I was doing nothing, and had not committed to a life or surgery or no surgery, and my marriage was suffering as a result.  In the end I went with the thing that felt it had a chance of working, but if I am honest I think I went ahead in the end because of a man crush on my surgeon, and irresponsibly because I felt better doing something than seemingly doing nothing.  Not the best reason to go ahead, but I at least got as many bits of information I wanted to hear to make it not be irresponsible for me and my wife.

Sorry for the ramble, but an insight into the mind-set of being in the situation as you touched on before.  For what it is worth, while things seem to be going ok, I haven't felt this positive about life in the last 3 years.

JT
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on October 25, 2017, 12:32:05 AM
JT, thanks again for the advice. Its great to have a true vision on the recovery process. I really do hope it works out for you. I did want to key you in on this paper that came out of Brigham and Women's last year, ACI (not totally applicable to you) + Lateral meniscus transplants- these guys had very good results (75% viability at 5-10 years) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076751/) . One interesting fact I see is that although they had good outcomes patients satisfaction was low; perhaps given expectations. The "6 weeks NWB" that we hear in the office is much different then the great description you just gave of situation that you are currently in. I think we all need to really know what we are getting into before hand. Another point is that nearly 75% of these patients go for a clean up scope, which is no big deal, but likely not explained to folks prior to. My point is, you seem well prepared for the challenges, are positive and optimistic, and you have some good data backing up that it will work. Keep your head up, which it sounds like you already are. Glad things are going well with your wife, I'm sure she has had enough of your deliberating (mine already has).

I will keep you updated on my decision making, scope and stem cells next week. Keeping my fingers crossed.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Catherine88 on October 26, 2017, 08:30:42 AM
May i ask you why they didn't propose to you the ostheotomy procedure? It seems like people can get back to all the sports afterwards, and my believe would be it's more durable/less risky than allograft?
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Vickster on October 26, 2017, 10:53:40 AM
Is osteotomy not only used if the bones are misaligned. It offloads a damaged compartment, doesnít fill in any holes. In case of DFO or HTO, basically doing this hopefully buys time before a replacement is needed, usually a TKR
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on October 26, 2017, 12:23:02 PM
Ya I brought up up osteotomy with my surgeon as well and basically the focus of these cartilage repairs is to not only correct the cartilage, but then to correct the deficit that lead to this. For me, that is deficient meniscus. For some, it is being bow leggged, and putting increased stress on the medial joint space, and these patients may benefit from HTO.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on November 01, 2017, 02:30:14 PM
Lateralmeniscus issues, (also posted in thread I created)

Went for my scope yesterday and a few surprises but overall is what they they thought it was. I knew I had extensive medial 1/3 tibial plateau cartilage loss (grade 4) as well as focal grade 4 lesions of my medial femoral chondyle from the MRI- the scope confirmed this but they also found a more acute flap or articular cartilage in my medial femoral chondyle, which they ended up doing a Microfracture (small holes in bone to stimulate regrowth if cartilage thatbisnless stable than our native hyaline cartilage) on as they thought this may be the pain generator that was more acute for me (the thought is that the tibial plateau lesions may be more longstanding)- they also found a decent amount of shredded meniscus that they thought could also be contributing which they removed.

So the big surprise is that I now am partial weight bearing for 6 weeks, and recovery to sports (if it works out) looking like 6-8 months. The doc thinks it went well and is hopeful for me to get back into sports, with some pain of course but to a lesser degree. For now, Iím in absolutely no pain and already flexing 90 degrees so the hardest part of this is gonna be mobility around work and the house! I will def keep updating on my recovery and let you know if I can get back to some more high impact activity as I go along. This is, fingers crossed, a good enough bridge to get me another decade without a PKR. If it doesnít work, I will need to consider the allograft procedures.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on December 01, 2017, 12:56:07 PM
Hi all, short 5 month update:

I took a two week holiday from work at the beginning of October, spending approx. 5 hrs/day in the gym, split between flexion work, strength work and balance work.  The 100 hours had a profound mental impact on me, and I felt more connected with my leg, however the improvements did still feel only slightly incremental, no vast improvements.  Since then I have continued with my usual gym routine around work.

As of right now I have no issues walking on flats or upstairs.  Down stairs isn't painful, but my knee capsule still feels full, and has constant swelling present (seemingly low levels, but still there regardless).  If I have a rather swollen knee from being sat at my desk the day, it takes about 30 minutes of focused stretching and flexion work to squeeze the swelling down to the minimal level again, and restore the flexion.  It still takes me 15 minutes of persuasion to have my heel touch my glute, but I can do it almost every day now.

My strength and control when bending my knee is better.  I have progressed to being able to single leg legpress half my body weight (40kg), hack squat machine my body weight (80kg) and leg extension 15kg, all manageable 10+ reps for multiple sets.  I'm not trying to test my 1 rep max :) its great to get DOMS occasionally.  I don't feel my leg muscle looks like it has responded to the training in appearance yet, but there is certainly more confidence or control there now.  I can generate approx. 210Watts on a stationary bike for over an hour which feels like something of an achievement, or climb stairs at 200Watts/hr for the same duration.

I don't have much pain in my lateral compartment that I am aware of, an occasional dull ache, but it is rare.  I am aware of the meniscus being there funnily enough, it feels like I have a wedge on that side of the knee, thicker than I am used to.  I'm still terribly grateful to the donor and their family.  My main pain and discomfort comes from different areas around and (I think) under my kneecap.  That around my kneecap has been hypothesised to be the ligaments exhibiting scar tissue from the surgery and prolonged disuse, and the swelling in the knee stretching them perhaps.  The pain behind my kneecap I think is due to the full thickness articular cartilage fissure I have behind there, which plays up in certain movements (like being on the bike and leaning back).  At the time of my surgery the surgeon was aware of the MRI showing the condition of the back of my knee cap, and I think did some trimming of loose material there, I hope that the sensitivity dissipates over time.

The plan is to have an MRI just after new year to assess the 6 month state of the allograft and the OATs.  Fingers crossed it all looks fine, just giving me the reassurance to continue on and to interpret any discomfort as normal to the healing process.  As mentioned in a post on the articular cartilage injection page, my surgeon has thought lipogems might be a worthwhile experiment to see if that can further assist with healing inside the capsule, and perhaps reduce the residual swelling I have, calming things down.  I've had some helpful replies on that and will keep researching seeing if I can have something suitable done for less than the GBP4k I have been quoted here, as that is probably too much of a monetary outlay for something that even my surgeon acknowledged may have no effect.

Hope that's clear and helpful to anyone in a similar situation!  Next reply will have the MRI results!!
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on December 04, 2017, 03:08:07 AM
Lateralmeniscusissues, Iím glad itís going well for you! I canít imagine the MRI would show anything but good given your abilities at the gym and otherwise. Keep up the motivation, your giving me some. I feel like a slacker comparatively..

Thigh just under 5 weeks out and NWB for atleast another week, I also have this low grade inflammation that I canít seem to get rid of after the microfracture, Ebs and flows with acitivity level though never completely abates. I also have some burning in the same compartment, and occasional sharp pains with the wrong movement. From what Iíve read from others microfracture stories this is quite common even 4-6 months out or sometimes longer so Iím sure with your more invasive procedure this would be within the norm.

Keep us updated.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on December 04, 2017, 04:12:37 PM
badleftknee, I'm glad things are going well for you.  I enjoyed aspects of the NWB phase since I was at home and could manage my diet and plan my comeback, but you do get to the point when you just want to go up stairs again without a whole procedure.  Hang in there, sounds like you are nearly at the other side.

The little I have made sense of, I believe swelling is moved primarily through knee flexion (either through the activation of lymph nodes, or pressure in the knee capsule expelling excess synovial fluid), so when you become more active I would hope that reduces down for you.  I say that when I still 5 months on have stubborn swelling, I presume the healing environment in my knee requires the swelling environment as it is still raw healing phase, it would be nice for it to not be there, and get back proper knee function (I have read swelling interrupts brain to muscle messages contributing to poor coordination) but I guess that will happen with time.

I'm rooting for you.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: fro60ol on December 15, 2017, 08:35:13 PM
thank you for all your posts!

i posted in my own thread that i am looking at OATS as well and seeing how you guys are handling it is giving a good sense of what i have ahead of me. 
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on December 27, 2017, 04:29:11 AM
Hey guys, quick update (also in my thread)- now 8 weeks post microfracture and full WB! Damn, it feels good. Progressively came off crutches over 2 weeks, which was absolutely required given I am still a bit unsteady, having to walk slow to avoid odd pains/sensations that seem to come from some locking of the patella (particularly with initiating gait after standing for some time). I am doing ok getting around, but long walks are definitely slow and cautious. I, thankfully, don't seem to have pain emanating from the microfracture site. I still have some very mild residual swelling when I put my knee into full flexion, you can feel bulging around the soft spots around the patellar tendon (this has drastically gotten better with weight bearing). I will say that some of my stiffness issues I had prior to surgery (I was having a lot of "classic" arthritis symptoms with stiffness after periods of immobility, particularly in the back of the knee) are better even with the residual swelling.

The next biggest step for me is gonna be weighted knee bends, e.g. stairs, squats, cutting motions. If I can't do these, than I really haven't gotten anywhere with the surgery given these were the deficienes that got me into this surgery! So I am trying to stay optimistic that all this wasn't for nothing! I am now good friends with my PT, who I am gonna start seeing 2x per week in addition to daily workouts, somewhat more extended on weekends, though all are somewhat limited still.

Will keep you updated, and look forward to hearing more about your cases.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on January 12, 2018, 08:30:05 AM
Hi all, 6 month update post surgery:

My 6 month anniversary was last week, and I had my first post surgery MRI on that day specifically to mark a kind of milestone.  I saw Tim last night to discuss the scan, it was an anxious night worrying what news he would tell me despite my steady progress.

To my relief, the meniscus is in position and intact, the OATs plug has fully taken and given me a full articular cartilage again, the donor site has a good layer of fibrocartilage, and amazingly, the full thickness fissure in the articular cartilage in my kneecap groove has vanished, I now have a perfect cartilage surface!  I take the latter with a pinch of salt, as despite taking every supplement I have ever heard of to assist with cartilage health, I know it doesn't grow back easily, but the MRI showed a perfectly continuous smooth full thickness articular surface, where as previously it was a plain as day sharp fissure.  Perhaps the defect somehow fell between the thickness of the MRI slices, but given the nature of the defect previously, it was visible on several pictures / slices, its a welcome surprise.

Things have developed significantly over the last month in function.  Still I have persistent low level swelling permanently, which gets worse as I sit at my desk all day, but can be reversed after 20 mins of focused activity to move the fluid back out.  Otherwise I am lifting all manner of weights in the gym, progressing on balance work etc.  For day to day activities, walking on level or gradients, and stairs (up and down) istrivial.  No stiffness first thing in the morning, in fact that is when I feel best, and I have ditched the 20 pillow leg raise over night to my wife's relief.  Needing to go to work, fit in a proper gym session and get at least 6 hours sleep means my family have bore the brunt of it, seeing me perhaps an hour a day.  While my wife has been supportive she has voiced that this can't go on forever, and I am thankful for her tolerance.  The most tricky part of all of this has not been the discipline or enthusiasm to keep on with the process, but this social aspect.  It isn't trivial and while I had her complete buy-in at the beginning, it has been tested to the extreme in reality.  Of course the unexplained aches and pains which can be present for a week at a time are alarming if you have a sensitive disposition (as I do), but so far I have rode them out, with just a few more grey hairs to show for it.

I'm still not at pre surgery levels in terms of comfort because of the residual swelling, my only idea to relieve some of that is wear a pair of compression socks while I am at my desk to assist with blood and lymph flow around my legs, but it feels like a long shot.  I think it is mainly synovial pooling rather than lymph which would mean needing to compress the capsule rather than the calf tissues, but will try and see how it goes.

All in all, Tim wants me back to sport in the summer.  It still seems like a pipe dream but he wants me focused on that, not that I need a timeline to continue to be motivated, I don't think I can find much more time to rehab in my schedule, or push much harder. He inferred he speaks to other patients of his about me and my progress, so think he is partially keen for me to return to sport to report back what is possible, not that he wants me back irresponsibly early, I think in his mind wanting to wait longer isn't necessary, where I would be willing to wait as long as necessary if it meant long term, worry free sport participation.  Maybe too he has an eye on statistical lifetimes of transplants, and if i spend too long rehabbing, statistically I won't have as much time with it before predicted failure :( that is just conjecture on my part, I remain positive for the future.

Anyway, enough for now, nothing is certain for the future, I still want this knee to last me for the rest of my life which based on statistics still seems like a pipe dream too, yet that is my goal, so i will give it the 5 star treatment every day and take it a step at a time.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on January 16, 2018, 02:15:21 AM
Amazing news! I can only imagine how excited you are....after all the effort, the weekly ups and downs....good news is so vital. I really think you are going through this process well, and now to know that you made the right decision!

The swelling is going to have to pass eventually, right? I can't imagine it would stick around too much longer. I am curious if it is some sort of warning sign that you still need to ease into things, no matter how stable and pain free you are. Perhaps, or possibly even more movement will help it further recede? Either way, small potatoes. I am curious, are you able to walk for extended periods of time at this point or does fatigue and discomfort kick in?

Please do take it slow though, you can't let your cartilage reach where mines at or it gets a lot worse, quickly, and that meniscus is your last resort. Just food for thought, coming from someone who wishes he had caught his pathology as early as you did....when I got my second opinion at Brigham and Womens and was recommended for meniscal transplant, I was told specifically no pivoting sports following; this seems to be the consensus amongst the majority of cartilage restoration specialists and it has to be for good reason. I absolutely want you to reach your goals, but would be crushed for you if something traumatic happened too early in the process. I have read a few stories out there going for second rounds of meniscal transplants after the first one goes!

I still go back and forth on whether I should go through with a meniscal transplant, even while waiting to see how things work out following my microfracture. This, despite my poor cartilage status (given that all major academic articles except those by Stone Clinic seem to predict failure for me with meniscal transplant). I dream (basically, just unrealistic expectations) that even over the last few years surgical techniques have improved, and literature hasn't yet had time to catch up. I will update my thread in a few weeks at the 12 week mark with my progress, but I can promise you lots of ups and downs. I find it difficult to take a step back and grade progress on tiny biweekly and monthly increments, when just months ago I had zero limitations.

One last thing (in attempts to not completely overwhelm your thread), definately agree with the social impact of this process. I am finally able to walk the dog and do household chores with somewhat more comfort, so my wife is pleased (who has been so helpful through this).  But, I have had to avoid so many get togethers, ski/hiking trips, etc in just the last 3 months that it really puts a perspective on the ability to be mobile. I know there are younger patients than I with worse knees, and I envy their will power and strength. And then to realize that we are talking about knees, when in fact there are those out there fighting much worse. Its an eye opening and humbling experience, to say the least, something that I likely needed. 

Keep the updates coming. After perusing this website and others, I feel like long term outcomes are so hard to find and so many people will benefit from hearing your story for years to come. Thanks again for the insight.


Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Mr. Potato Head on January 26, 2018, 02:17:03 AM
Lateral meniscus Guy thanks for your updated report. For all of us thinking about MT its great to follow your progress.  Bad left knee and I are in the same boat. Haha .  Went snowboarding a month ago and it totally swelled my lateral compartment. Knee inflamtion consistent but finally get better.   Got HA injection last week and thats felt great.  Oh knees!!!
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Tai-pan on February 04, 2018, 10:04:17 AM
 LateralMeniscusIssuesGuy

This LOG is a great read. It goes without saying, I really hope everything works out for you.
I will keep following and look forward to hearing the day you are back doing sports...pain-free!
 
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on February 12, 2018, 01:48:02 PM
Hi all, approx. 7 month update.

It doesn't feel like there have been many gains since my last update, but a few new developments.

I have subjected myself to more open chain exercises (leg extension and ham curl) than over the rest of my rehab.  Specifically my physio (Isokinetic, Harley Street, London) had me on their machine which is a combined extension and curl device, which you strap into and it limits the time it takes to move in the arc, irrespective of the force applied, and so can gauge leg power generated and compare hams to quads.  Seems from those tests (which I suffered no ill effect from pushing as hard as I could!! a mini milestone for me) indicate understrength quads.  I guess I know this as I am squatting and deadlifting what my able bodied peers are, but then can't do other more quad dominant exercises anything like as comfortably.  So I am reducing the frequency of the big compound exercises to focus on more functional movements (such as single leg straight leg box squats) trying to activate my quads more.  They look flexed but I'm not convinced they are doing what they should in some movements.

I have put on 5-7kg since my lowest point post surgery, I imagine lots of that is fat, but went with a clean high calorie + protein diet trying to be an anabolic as possible, not sure how effective that has been but it might have fast forwarded me a bit, as least my mind is clear that from a fuel perspective I shouldn't have lost out on any gains in the gym from not eating enough, trying to watch my weight.

I am still low level swollen, I would say where it was reducing month to month, that it has remained constant this month.  That said my flexion has increased minutely again, and I've had improvement again with how quickly at the end of the day I can get full passive end of range movement (down to about 20 seconds now).  I would like swelling to go down as surely that is indicative of the joint being unhappy, but no one has really shouted out about needing to take any action on it yet, so I suppose wait and see.  I would perhaps consider an injection in the joint, maybe removing the fluid in my knee and replacing it with fresh HA, in case something about the fluid in there is preventing it's dissipation.

In terms of problems, I really do have a complaint about the medial edge of my kneecap.  It is near an entry point to the surgery, and when my quad is under load and bending, it is painful, it feels like I have an thickened or scar tissue structure there (perhaps MCL or the ligament type material to the medial side of the kneecap) and that can get irritated with too much stimulation, to the point where flexing past the limit of active ROM is painful.  I've been exploring the pain with my box one legged squats and it wasn't as bad today as last time, so perhaps it is scar tissue breaking up, or its irritation where I have inadequate muscle control for some movements meaning some structures are interacting when they shouldn't. 

Overall I am progressing slowly, but to be honest the introduction of a deadline from my surgeon has introduced a bit of panic into my rehab, and anxiety that I might not be moving at the rate required to meet that goal.  SO I think to enjoy the process more, and stay sane, I will ditch the timeline mentally and focus on the small goals letting them happen when they do, just giving the best effort and attention I can spare.

For all my complaining I am very mobile now, I think I could stand or walk for hours without any real negative effects, joint isn't too noisy (silent after a gym session curiously, make crackly sounds when 'cold', what's that about?  muscle activation? reduced fluid in capsule?), and pain free in the lateral compartment 99% of the time.  I think I get a mild ache one a week for about an hour, something like 99% issue free in my limited but fairly rewarding current level of activity.

Thanks for all the advice and support everyone, I am still aiming for sport return, however reckless, but feel strangely strong and robust, more so than I imagined I would after the surgery, it is almost feeling like my leg now, I often forget that I have had a transplant.

Please all keep updating with your own progress and decision making, as this site was invaluable to me getting this far, I plan to donate in the very near future.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on February 23, 2018, 03:27:16 AM
Keep up the hard work. It sounds like things are continuing to move in the right direction. I'm hoping that swelling goes away for you completely over the next several months- no rush though, as you are now very functional and nearly uninhibited by most activity it would seem. Next up is agility movements, perhaps some running? Looking forward to hearing your continued updates. I still find it hard to find documented success stories despite the growing number of procedures being performed (and knowing that there are many success stories out there).

My microfracture rehab has been a bit shorter than yours from a post-surgical standpoint, but does not obviously offer the degree of benefit that a transplant will. As an example, swelling was nearly completely gone by 3 months, and I don't really have "risk" of tearing an implant (meaning I can start more aggressive rehab earlier). I have started some light agility training at this point, light jogging but mainly only the length of a gym floor. I still have "twinges" often in my medial compartment- isolated knee bends at 30 degrees (hiking, etc) or cutting motions are the worst, and the running isn't great. At 4 months I am trying to determine what success is- and I tend to think its based on 1) progression and 2) my expectations. Currently, my progression has slowed but not completely plateuad, and my expectations are not completely met despite being better off. Gonna repeat an MRI (suggested by the OS) to look and see if the microfracture healed in and see if there is continued bone marrow edema (if so, would suggest continued lack of protection of bone). OATs/MTS remains in the back of my mind....

Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on March 12, 2018, 10:05:07 AM
Hey all, brief 8 month update.

Things have progressed positively on all fronts over the last month, however in tiny bitesize bits.

The negatives first, I still have residual low swelling.  I bought a set of very light compression knee sleeves, not wanting to cause any patella irritation, but hoping the light compression could do something for the pooling of fluid that can happen during my 10 hours sat at the desk each day.  The initial response is positive as my selling has halved and occasionally has been near zero (near zero visible from sweep tests anyway).  So will continue wearing while at my desk to see if I get it flushed more.  I still have some end of range resistance if I donít bend my leg fully at all during the day, can take 5-10 seconds to get entire heel to glute flexion, but if I stretch that a couple of times during the day is is basically always immediate.  Also the joint is noisy when bending past around 110 degrees, I feel what I imagine to be the MCL flicking over part of the knee architecture, and there is a second less extreme noise when getting to 120 deg.  I wonder if some of this is due to the level of swelling still present on the capsule, or whether it is due to thickening of the ligaments and / or scar tissue making their movement during flexion more prominent.  For the avoidance of any doubt, the same clicks are observable in my good knee, but you have to hold the knee to be aware of them (i.e. feel the flick), the noise is so much more subtle.

The good progress:

-   I can comfortably sleep on my front, I spent so many years now sleeping on my back to protect my knee, to sleep on my front is a real treat
-   Fairly impressive increases in functional exercises at the gym (squats, deadlifts, also open kinetic chain exercises are pain free with challenging weight i.e. as hard as I can go)
-   Good balance work
-   No reactive swelling response to any intensity of workout, tho they are all performed carefully with proper form of course
-   Ability to graduate walking down stairs very slowly and carefully and controlled, more so than before surgery
-   My upstairs performance feels identical for both legs, even for double steps
-   95% of the time I forget I have any issues with my knee, and it feels entirely like my knee.

I have not attempted jogging get.  I have tried some jumping and reacted well in a very controlled basic few attempts, but donít plan to no too much until the year is up.  Interestingly the IsoKinetic machine test at my physio (a combined leg extension and hamstring curl) measurement for power had me the weakest male in the gym that day, despite probably looking the most muscular, so I will keep my nutrition to be growth and low-inflammation focused, and work out as often as possible.

I do have one eye on whether a return to sport is possible, I know I would be in a very very small minority who managed to do something like that (just 1 in the c.200 of Tim Spalding went to professional sport and seem still fine, tho he was younger and stronger), but I am obsessed with it.  So to start to build a tolerance to playing I have just started kneeling most days, on my soft sport specific knee pads, just getting comfortable with that.  So far not too many ill effects.  I even got fully kitted yesterday (ice hockey goalie kit) just to explore some of the positions and range of motion.  I was slightly sore in my lateral compartment when I went to bed yesterday evening, which was a setback as hoped it would feel fine, but often through my recovery I have hit movements which have left me sore, even raw pain types, and those have all since resolved, so I hope this is similar to that, rather than indicative of those positions seriously jeopardising my lateral meniscus and repaired articular cartilage.  Iíll do something similar most days and just see how it does, if the discomfort doesnít subside in a few days I will cease until I see Tim again next month for the 9 month follow-up.

I can get into true full squats (ass to grass) but am avoiding doing it too much as my PT has said itís a position of extreme stress on the meniscus so why risk it if not necessary for day to day life or my sport.  I couldnít help but enjoy being in the position as it looks and feels athletic, and want to keep my with my 2 year old who pops down into it no problem, but will hold back.

In summary I am really happy, really relieved, but resisting the urge to step off the gas.  Since I said to people that my surgeon wanted me back in the summer, those I used to compete with have been checking in more often seeing when I am back, which while thoughtful, has added more of that pressure I mentioned previously, and I have to manage their expectations, as unless you have looked into it, no one realises how big a surgery this is or how much of an ask it is to return to sport, but thatís as I have wanted to keep it private so a situation of my own creation.

Iím still NOT at pre surgery capability, I used to run for trains and could be symptom free after (say a 3 minute sprint, most of the time would be fine after, wouldnít make a habit of it), and was leg pressing more in the gym, but the positions of my sport feel mainly pain free, so it feels like the surgery has addressed the lateral compartment issues, and that I still just have more rehab to do to understand my body and truly re-establish the mind muscle connection.  I consider myself a fairly present and thoughtful and dedicated individual, but to be at 8 months post-surgery and still remarking that it feels like my brain still isnít fully in control of my body, is surprising.

Hope thatís a useful update and not too self-indulgent!  My 9 month update will also include a surgeon follow-up.

Cheers all and please feel free to update this post with your own progress and decision making.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on April 27, 2018, 12:57:05 PM
Hi all,

I missed my 9 month update as was away on holiday for a fortnight, so decided to wait for a 10 month update.

Itís been a really exciting few months, combined with some terror, but am now in a good place.

Around the 9 month mark I suddenly developed acute pain in my lateral compartment, right on the outside of the knee, as if no deeper than skin.  It was a fairly constant pain, and persisted for an entire weekend and into the next week.  I didnít panic too much, but did wonder if I was exploring the range of motion too much and had managed to tear the meniscus transplant.  When I was canvasing for a surgeon, I spoke with Dr Stone in San Fran, and I recall him saying that deep flexion seemed to be the reason for grafts failing, so those doing yoga should avoid sitting on knees etc.  I wasnít doing that, but was daily, getting my heel to my glute to keep full ROM going.  Anyway, fast forward a week and I realised my hip was very sore to touch, as was my calf, so I diagnosed that it was just a tight IT band from over training and not enough rest / foam rolling.  A few days later the pain was gone and I continue to do maintenance rolling and stretching and stepped down a bit on the volume of training, still in the gym daily, but fewer quad exercises, a bit more glutes and hamstrings (hip thrusts and deadlifts).

On that, when away for those 10 nights on holiday the hotel had a decent gym, no squat rack, but had a bar and weight plates.  I ended up doing german volume training style work with deadlifts, and so 1000 deadlifts over the 10 days.  The impact to my knee felt fantastic, stairs were not an issue when I left for holiday, but by the time I came back I felt I had full control through the entire graduation of knee bend when lowering my self down the stairs, just like my good leg.  So I have since kept that going 3 times a week, and feel great for it.

Still have the persistent low level swelling.  Not sure if I said before my doctor did say to perhaps expect that forever as could be a feature of how my knee is coping with the meniscus.  That doesnít sit well with me, the presence of swelling, even small, surely means the joint is unhappy.  My surgeon did say we may try HA injections after the 1yr mark if it hasnít resolved.

The knee is a little noisy, there is an audible click or pop when I get to almost full flexion, and is heard again when extending through that angle too, especially if under load.  My interpretation of that is that the excess synovial fluid is making the noises.

The plan with physio is to move into a room with cameras which can track the relative movement of the joints through certain movements (i.e. hopping, or changing direction when jogging) to assess and train proper alignment.  Itís exciting if it helps me further.  The doctor thinks that could also address the remainder of the noice and swelling I have if I perhaps have better movement.  I am certainly strong now, not very very strong, but near my pre surgery strength, which you may remember I boasted to be good, tho I was just restricted in what I could do.  Still on their quad and hamstring strength test I am not even in the top 10 strongest men that they have under their care, and not many of them are more than weekend warriors, yet I have hopes of returning to semi pro sportÖ seems I still have a long way to go.

I have recently been trying to up the work on my legs without more load, one by the GVT as mentioned a few passages ago, but the other with blood flow restriction training, allowing you to get similar muscle fatigue and growth hormone response from lifting just 30% of your 1 Rep Max.  Using it, I have been able to use the leg extension to failure several times a week, experiencing noticeable strength gains and DOMS too.  Itís been a great addition to my strength regime and I would hope the less load going through my joints while building the muscle will be a real help to me and is preserving the condition of the joint.

The surgeon and pts are still encouraging me to have an immediate return to gentle sport, expecting that at the 1 year mark I will be fully participating in team practice.  It seems more realistic since the improvements after the 10 days of deadlift.  My knee is painless all the time, looks very similar to the other in terms of muscle and shape, has full range of motion, and isnít ever stiff.  I couldnít ask for more at this moment.

I felt so confident that last night I got kitted in my ice hockey equipment and took 30 minutes of shots during the team practice in a very controlled scenario, I was not performing complex or kneeling movements, essentially just standing in a squat position using my hands to make saves and side stepping to move into the path of shots.  I didnít experience any ill effects during or after, so will work on a very slow progression while I need to order an Ossur CTI OA custom knee brace to offload the lateral compartment when I play, or at least reduce the peak forces that compartment may experience in instances of mayhem when I am thinking about the game, and not my knee.

I donít feel out of the woods yet, and am obviously anxious to not undo any of the work done my Tim Spalding, but he is encouraging me to get back, and I obviously want to, as being back continues to inspire my rehab efforts.  I still am not running or jumping, I have attempted them a bit without an issue really, but only light jogging for a few seconds, and small hops.  I donít plan to do much of them but soon I should build a tolerance / re-train the skill to do them a bit, which I will mention in the camera physio sessions.

So apart from the IT band pain, things are going well, Iím trying not to get ahead of myself, but Iím obviously in a good place physically and mentally at the moment, so my family are reaping the rewards of a mobile and pleasant man around them, rather than the gloomy sod I was pre surgery.  The gamble is workingÖso far.  Remember, I wasn't that bad pre surgery and so I was chancing the house going ahead with the transplant in the first place, although the OATS was probably needed, and seems to have gone well.

If people are interested I can upload photos (if you can via this site) of the surgery pics, and my stages of rehab.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on June 01, 2018, 02:27:28 PM
11 month update:

Things are looking fine at the moment.  Leg bulk seems to be more or less even across my two legs, and my single legged exercises seem similar in power and control (tho perhaps not endurance).

I'm mid way through 6 weeks of physio where I am getting assistance with hops and jumps and changing direction.  In these situations my rehab leg still has a way to go, this new training has really exposed me and so it looks like I need to change my training regime to be more quality of movement based rather than the usual straightforward strength exercises.

I do currently have pain on the outside of my knee and various places on the outside of my leg, it feels like a familiar pain from my time when I had (what I think was) IT band related issues, and admittedly I have neglected my glute foam rolling and perhaps not enough variation on my glute exercises.  Of course there is a nagging doubt in my mind that the pain is lateral compartment related, but I haven't been reckless in my training and can't think when I could have damaged my OATs or meniscus...time will tell if my IT band recovery training addresses my discomfort.

Got 3D scanned today for my Ossur CTI OA Custom, it is being built with 5deg of angle into it to protect my lateral compartment, but that degree shouldn't put irresponsible pressure on my medial side so said the fitter,  I will have it in 2 weeks and he feels confident it will be a really sensible addition to any kind of dangerous physical activity (i.e. if I should go snowboarding, or attempt a return to ice hockey).

Its a very similar regime of calorie surplus, eating clean, lots of protein, supplements to try tackle inflammation.  I can't believe it has been 11 months, time really has flown.  I can't imagine I will be playing sport in any sort of competent manner in a month from now, even with the brace, as my surgeon hinted he would like, but if it happened at all and I could compete in a responsible way, this will obviously be the greatest against the odds story of my life, so far the risk of the surgery is paying off.  I don't feel very different for the journey, still somewhat fragile of mind and feel like a boy in a mans body, things that I feel stopped me making it professional in my sport and impacted my relationships throughout life, but my body is different from the diet and dedication to the rehab, and I have a profound appreciation for anyone who has been thought any kind of body altering injury and returned to normal life.

Next update at the 1 year, which was always advertised as the recovery period, tho that recovery state was always disclaimer with impact activities not being sensible even at this stage of recovery.  Despite that the surgical and support teams behind me are keen to see how far I can go with this gifted meniscus.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on June 06, 2018, 02:11:02 PM
You see this? For some motivation. These recovery times seem so unrealistic but they keep posting them!

http://www.stoneclinic.com/Tracy-Porter-Stone-Clinic-Patient-Ambassador?utm_source=Stone+Research+Foundation+List&utm_campaign=d1a03554a9-EMAIL_CAMPAIGN_2018_06_04_07_23&utm_medium=email&utm_term=0_9a0b3ecad8-d1a03554a9-393111757&mc_cid=d1a03554a9&mc_eid=3cae4ad6b1
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on June 07, 2018, 12:58:06 PM
I hadn't seen that!  That is truly unthinkable, but these athletes are barely human and very motivated and can rehab all day with the best equipment and physios...I wonder what the extent of the articular cartilage defects were, to bone implies grade 4 but how large etc.

The real truth will be in the comeback, tho they are willing to play through pain and dysfunction for the enormous paycheck where the normal man has to be more conservative.  If there were an article on me at this point, it would be saying how good the procedure is and I'm ready to return, but I honestly have no idea how far I can progress.

We are the same weight and height.  I can't see lateral or medial in any reports, I may have missed it.

Thanks for bringing the story to my attention, I will keep an eye on him :)
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on June 08, 2018, 01:38:14 AM
Ya the degree of cartilage injury truly is the key. If the quick snippets of imaging they showed are in fact his- he looked to have moderate to severe medial joint space narrowing and extensive bone marrow edema on both tibia and femur- suggesting bipolar kissing lesions....makes it even more unthinkable.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on July 04, 2018, 05:22:22 PM
Finally the 1 year update!

1 year is reported by many rehab protocols as the time required for a meniscus transplant recovery, so I have been curious this entire time how I would feel on that 1 year anniversary of surgery date.  Would my leg feel pre surgery still, or more like a normal leg.  Would I regret the year of work and money invested as it didnít yield a knee I felt I could live with?  So many questions swirl when you are thinking of going ahead with a serious surgery.

My current response to all of that is satisfaction and relief.  I am largely ache and pain free, zero Ďvisibleí swelling, and getting stronger and more athletic month to month. I donít have discomfort in the mornings, I can get full flexion at any time on demand without easing into it, in honesty itís been more successful than I had hoped!

I remarked on pains in and around my knee recently, and in fact throughout the rehab process, all of which have resolved. I suspect the majority if not all of which were brought on by waking up muscle patterns, over training / under training, essentially me not coordinating properly leading to imbalances and so muscles tugging on ligaments and structures to the point when they become painful.  Spending lots of time following the guidance of a man named Trevor Bachmeyer (youtube channel ďSmashwerxĒ), spending upwards of 30 mins a day essentially massaging my muscles, peeling facia layers, gaining ROM in my hips and other jointsÖand it seems to resolve all onsets of pain.  Iím still trying to shift what I think is some plantar fasciitis, but itís much better than a fortnight ago.  I think this work may be a vital component of rehab that isnít addressed by any physios I had access to, I do really recommend his channel.

The unloader brace came in, and it is a great piece of kit.  When wearing it I feel very supported, and have already been pushing myself skating with it, performing skating strides which would have been agony before my surgery without issue.  I think this brace will be excellent for any kind of sport outside of the gym, and wonít be visible under my equipment.  I will report back more on it after more use, but after 10 hours in it, I think its vital for me to responsibly engage in impact, twisting and valgus loaded movements, and so thankfully not £700 wasted.

The scaredy cat in me is concerned that I may just be pain free due to the OATS and actually slowly working through that new articular protectionÖbut that wearing away was previously accompanied by massive swelling which there is zero sign of now, so Iím slowly permissioning myself to not think in such a conservative way. 

The physio sessions have stopped now, I wonít get access to more care, just a final MRI follow up with the surgeon next month to confirm everything looks ok inside my knee.  The end stages of the physio which focused on movement patterns in things like quick squats, hops and quick feet was interesting, challenging, and valuable.  I didnít realise in so many movements how much I was attempting to protect my lateral compartment, such as walking up stairs my stride was very different on one leg to the other as I climbed and descended (twisting my hips, less knee bend, foot placement not under bodyÖ), being made aware of these things seems to have left me more balanced and again addressed some pains I would develop.

Whilst this all sounds good, I must stress Iím still not at the activity level that ďfully recoveredĒ probably implies in the mind of most persons when they have hopes of what this surgery can do for them.  I have perhaps been more conservative than most with my progression through to impact activities.  I need to apply myself more with a return to running and jumping, but since those activities arenít core to my sport I have avoided them.  When I have ran for a train recently, I have been pleasantly surprised by the lack of pain or swelling and the spring in my step.  So someone else might instead be able to report flawless running at my stage of recovery, but while I have probably been guilty of overtraining in some ways, I have been cautious with impact. 

Also, I still get pains, but again, I really do think these are muscular / nervous system related due to improper movement or inadequate body maintenance.  They all resolve with time though sometimes reappear.  I can only assume as my movements become more trained that the maintenance time required will reduce, as I obviously have never had to do this amount of stretching and massage before to keep pain free, and still do very little for my good side.

Iíll update after my MRI, which will be approx a 13.5 month update, by which time I should have progressed my attempts at a return to sport, have more time in the brace, and perhaps even some moderate impact work.

So, again, so far so good, pleased I went ahead, if I could turn back time to my initial injury I would have sought out Tim Spalding to attempt my first meniscus repair, and regardless of whether he managed a repair or had to do a partial removal (as happened with the surgeon I went with), I would have committed to this custom OA unloader brace to participate in sport.  Ah, sweet hindsight!

JT
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: AndrewC on July 07, 2018, 05:14:04 PM
Thanks for the detailed reply. It is great to hear of a success story from this treatment. Im a 42 year old fit male who has always been very active, well until recently. I have a post in the general forum about my current situation but basically, my medial meniscus is torn and extruded from the joint, no articular damage yet according to MRI but it is still very limiting in what I can do at present. Partly through fear, the other part through pain.

NHS said 'cant help' so I will be seeing Tim Spalding and Nick Black and maybe one other opinion depending on choices to see if they can repair it as an attempt to would be the case in America going on my very extensive research. I already had my lateral meniscus repaired in the same knee years ago.... bucket handle tear, and that side is ok thankfully.

I'm a realist though, I know I won't get back to serious running or twisting sports but I served my time doing these, I will be happy to be able to jog after my son and not be in pain so often.

Will see what the consultants say and report back. Please keep the updates coming, it fills me with hope in case this is a route I am offered!! Maybe it won't be and if so, I will have to deal with that.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Mr. Potato Head on August 20, 2018, 04:10:35 AM
Lateral Meniscus Guy,

Thanks for all your updated posts will enjoy to continue hearing how your return is to sport and what you decide you can and can't do.  For all of us thinking about this surgery its great information.

Great updates and best wishes for return to active lifestyle!
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on August 21, 2018, 10:11:04 AM
I'm glad it's even a little useful, even if just an interesting read.

Had my 13 mth MRI performed yesterday, have the report and 'final' meeting with Tim Spalding on Thursday.  I have encountered lots of issues with the knee as I have tried to ramp up the activity level, all seem to have resolved again, but it's a really confusing, worrying, and frustrating time.  I hope that the MRI reveals that everything looks fine internally, and I plan to hire a movement coach, as despite my best efforts, I'm obviously not aware of the haphazard way I move, sit, lay etc.

I have had /still have:

- shin splints
- plantar fasciitis
- IT band syndrome
- foot pain
- hip internal and external rotation issues

Literally my whole architecture has gone through an enormous reset, and its all jumbled up.  I honestly was a very high level amateur athlete, very present, very body aware (compared to the layman), this has been an enormous shock, especially since things were going on schedule, and none of the rehab schedules remarked on these kind of issues, and I literally had them all together.

I hope that things still turn out fine, I am doing really well despite all these complaints that last for a fortnight or more at a time, but I obviously want to be perfect, and far better than my pre-surgery condition.  Maybe in 6 months I will be somewhere I dreamt I would be after surgery, so far I still have a way to go.  What a mountain of a rehab!

Proper update the end of the week
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on August 24, 2018, 08:50:28 AM
I had my "final" catchup with Tim Spalding at the 13th month post surgery mark, and learnt a bit more about the surgery and the condition of my knee.

First and foremost, I seem to have good thickness articular cartilage everywhere.  The site of he OATS has healed well and has essentially filled the 1cm pothole I had on the posterior lateral head of the femur.  The meniscus transplant is fully infact, no rips or tears, which is as I would hope since I have full range of motion.  He did explain in more detail that of course the rest of the surface of the bone which was not operated on didn't have pristine articular cartilage at the time of surgery, and again went through the pictures to show an almost fluffy texture when it should look like smooth marble, but the thickness is essentially full thickness despite this wear.

I did also have a defect in the posterior lateral tibia head, however he elected to simply place the meniscus over this rather than any kind of oats pug, and it seems I have some kind of full thickness fibrocartilage over that.

The OATS donor site has completely healed with bone, and again seems to have full thickness fibrocartilage.  I remarked that I has a full thickness fissure (essentially a small crack) behind my patella, and that seemed to have disappeared on my last set of MRI, but it is back this time, haha, essentially it was missed in the thickness of the MRI scan slices last time.  It has not developed and as far as he is concerned, is zero issue and the underlying bone is fine.  He doesn't anticipate it progressing and thinks much of the population probably have something similar without ever knowing.

He explained better to me that the reason I have a more pronounced bump in the surgical site is due to the suture technique for the transplant, where he retains a 1mm rim of the meniscus, and then uses sutures to attach the donor to this, then tying the horns down using bone tunnels.  I have been a little anxious that my knees don't look the same, and I keep getting remarks from PTs that my right knee looks puffy, but I think it is this protrusion.

He anticipates the low level swelling I occasionally get is probably due to the OATs donor site continuing to mature, that is a nice mindset for me, and while it was robbing peter to pay paul, it doesn't give me any pain, and means I will be less anxious that I should anticipate swelling as an issue with my lateral compartment.

I will try and upload some pictures of my knee to this post to show some of the progress and where I am at the moment.

So essentially from when I met Tim 18 months ago, I dreamed I would be at this stage.  I have had 3 sessions back at ice hockey, taking it very slowly, without issue so far.  I am performing well at the gym, but want to take things to the next level.  I am hiring a PT, likely for the next year, who I think will really assist with my quality of movement.  I have been doing some work recently on my hip mobility, and that has been a huge step up for my knee function and comfort during exercise and all times really.  So I want to sent that into overdrive, as while I can do that myself slowly using YouTube, I suspect it will take some time to become self aware to the point I will realise all the compensatory habits I have.  His website and YouTube content is really good, have met him, and start training tomorrow, I think it will be a great investment https://movementfirst.co.uk/.  Together with the Smashwerx youtube channel, and movement videos from Dr Spina, I think I am doing things the wrong way around, and that quality of movement should have been sought pre surgery and much earlier in the rehab.  As much as Isokinetic was a good rehab practice, there is a whole other world of quality of movement out there, which would have probably help avoid injury in the first place.

So essentially I am pain and swelling free 95% of the time. I would say a couple of days a week, I have a swelling sensation at some point during the day when I have been sat down for a long period of time, but I can flush it out with a bit of bike work or even just low compression while going through active ROM. The crepitus is reducing, though still that knee is more audible than my other.  I am really excited what I can achieve in the next 6 months.

For all the success, Tim was careful to say that this was still salvage from his perspective, I don't have a new knee, just a new to me knee.  That said, I can't believe the typical meniscus transplant patient will be taking all the supplements and dietary considerations I have, and will be working out in the balanced way I have tried, and this new approach to proprioception and movement quality, and no plans to run (which almost everyone else does), so I'm optimistic this salvage will be a very long term fix / project.  He said the hope would be this gives me 5 more years of international level sport, then reduce down to something like cycling, and it should keep going until my 60's (currently 35YO).  So lets see, but I will put all my chips in to get a little bit more out of my prime.

Thanks all for reading.  Tim has also released a website called meniscaltransplant.com which has some other patient stories and information, is a work in progress, but a good resource, which I will contribute to soon.

I'm very open to advice or support or questions and will be as honest as I can.

Warmest regards
JT

Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on October 10, 2018, 08:27:14 AM
15 month update.

For the past month I have committed my rehab towards FRC (Functional Range Conditioning) and that combined with my continued supplement combination, and perhaps more sleep, and just the passage of time, has me in the position of feeling the best I have since surgery.

I have done some light jogs to catch trains without issue, but don't intend on trying anyt serious running, I will try to increase my tolerance for it, but slowly, however I was never a runner.  The FRC identified so many issues with my ROM, both active and passive, its a work in progress over a lifetime but a month of work seems to have got me functional in squat positions and really assisted the control in my hip internal rotation, crucial for my ice hockey goaltending.

I have returned to sport, an adjusted less demanding and less competitive level for now, and haven't had any issues.  I want to have months of training once a week without any consequences before I notch up the intensity.  The custom knee brace is probably also helping protect my compartment when I train.  I'm in a happy place most of the time at the moment.

There are those days when I detect some swelling or discomfort, normally when I have gone off routine, but I can do heavy gardening, plenty of gym, just about anything that is slow and controlled.  Its speed that has me anxious.  I hope to become more comfortable with speed as time goes on.  I am doing work with my FRC which is training my nervous system to unlock active ROM, when that is sufficient across my joints, my trainer is happy for me to start to introduce speed drills, but not before as much responsible slow control is in place that he feels confident.

So overall I'm really happy, 9 months away from a 2yr follow-up MRI with Tim Spalding, after which time I will have lots of hockey under my belt.  Assuming I don't detect an injury during that time, it will be a nerve-wracking moment to see what thinning or damage the MRI shows, if any.  For now I feel I am just about toeing that line between being responsible and living life, everyone will have an opinion, and those closest to you will normally recommend you boas towards caution, no one can say what is right for you such that you will look back at a life well lived, such a conundrum, for now trying to live each day maximally, within reason.  Sorry for the flowery nonsense.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Catherine88 on October 17, 2018, 12:46:10 PM
15 month update.

For the past month I have committed my rehab towards FRC (Functional Range Conditioning) and that combined with my continued supplement combination, and perhaps more sleep, and just the passage of time, has me in the position of feeling the best I have since surgery.

I have done some light jogs to catch trains without issue, but don't intend on trying anyt serious running, I will try to increase my tolerance for it, but slowly, however I was never a runner.  The FRC identified so many issues with my ROM, both active and passive, its a work in progress over a lifetime but a month of work seems to have got me functional in squat positions and really assisted the control in my hip internal rotation, crucial for my ice hockey goaltending.

I have returned to sport, an adjusted less demanding and less competitive level for now, and haven't had any issues.  I want to have months of training once a week without any consequences before I notch up the intensity.  The custom knee brace is probably also helping protect my compartment when I train.  I'm in a happy place most of the time at the moment.

There are those days when I detect some swelling or discomfort, normally when I have gone off routine, but I can do heavy gardening, plenty of gym, just about anything that is slow and controlled.  Its speed that has me anxious.  I hope to become more comfortable with speed as time goes on.  I am doing work with my FRC which is training my nervous system to unlock active ROM, when that is sufficient across my joints, my trainer is happy for me to start to introduce speed drills, but not before as much responsible slow control is in place that he feels confident.

So overall I'm really happy, 9 months away from a 2yr follow-up MRI with Tim Spalding, after which time I will have lots of hockey under my belt.  Assuming I don't detect an injury during that time, it will be a nerve-wracking moment to see what thinning or damage the MRI shows, if any.  For now I feel I am just about toeing that line between being responsible and living life, everyone will have an opinion, and those closest to you will normally recommend you boas towards caution, no one can say what is right for you such that you will look back at a life well lived, such a conundrum, for now trying to live each day maximally, within reason.  Sorry for the flowery nonsense.

Hi, happy to see you are doing so well, but 15 months??! To feel ok! What changes if any, do you feel you are experiencing from before the surgery, as I assume you are not yet full on the sports you d like to do. Iím asking casue what you are describing Iím experiencing as well, without lateral meniscus, and with thinned cartilage, and a meniscus allograft have crossed my mind, but if itís to go through another operation plus much recovery To feel OK, i donít think itís worth it. To be fair, i have slight symptoms and a pain level on a scale of 3 sometimes. Nothing that prevents me doing loads of gym work or function day to day like most of the Ďhealthyí people. I d like to know your improvement, whether itís worth it, itís true I donít jump like before, and Iím more careful, but that I suppose Iíd. Have to be anyway, even with a meniscus replacement, is that the case?
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on October 19, 2018, 08:53:35 AM
Hi Catherine,

Yes its 15 months so far, it does feel like forever, I anticipate perhaps another +6 months ahead of me, I think this is really a 2 year recovery.  But earlier (I think after the first 9 months) you are able to do all normal living activities (wash the car, all manner of gardening and house work), so the face I am rehabbing still to work towards jumping and running and sport is fine for me, as I am kept busy with my young family.

It was the toughest decision of my life to go ahead with the transplant, it took me a year to decide, as I had a decent quality of life before the surgery, so could be taking a step backwards if/when it fails, but the pull of my sport won in the end so I bet the house, so far it seems I may managed to make it back to my sport fairly soon, so I'm very lucky and very grateful for how things have turned out.

My expectation is that the condition of your articular cartilage in the area will have a significant impact on the success of the surgery, and the choice of activities you do in the future.  Avoiding running and cutting sports, and being willing to take my time, and having a fairly small area of articular cartilage defect seems to have me pain free atm.

Good luck with your continued management!
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on November 16, 2018, 12:22:04 PM
Quick 16 month update.  Massive sport progression.  I can't singe the praises of FRC training enough.  I wonder if I had been doing this type of training and joint articulation training from before my injury if I would have had the initial injury.  I feel that without it, I would have pain manifest in my lateral compartment due to insufficient range of motion in my hip and ankle, and imbalances throughout my body.  I personally believe the training is massively responsible for relieving these pains.  I continue to take a vast number of daily supplements and a fairly strict nutritional regime, which I hope helps.

The sport progression is me playing full ice hockey goaltending without restriction.  Function jogging (to catch a mode of transport that is about to leave) is no issue, as is running up or down stairs, hopping, all manner of squats and kneeling.  Its a work in progress, I'm exciting for how robust and 'in-control' I might feel 6 months down the line when I can reintroduce certain resistance training into my routine alongside FRC (no time due to the arrival of a second child).  I would hope by the beginning of the summer, unless I have an accident, I might be approaching peak confidence and fitness and playing the sport at the highest level I aspire to again, a real dream come true.

Absolutely no complaints with my current state, i'm not indestructible, but am tailored to the things I consider important and enjoyable and am steadily unlocking them all, where they have been off limits for 5 years.  It will be another 8 months until I have a 2yr MRI to determine if my current activities are having a negative impact to my cartilage state, for now I don't have any swelling or pain during or post exercise, vastly different to the massive reactionary swelling when I was eating through my articular cartilage before.  I do have many more anti-inflammatory supplements in my system now compared to back then which could be suppressing that reaction, so who knows, for now I will be guided not only by pain but also function.

Good luck everyone in your constant managing of your bodies.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: badleftknee1 on November 20, 2018, 11:01:44 PM
JT- This is great news and inspiring for those of us in the potential que. Some questions for you...

-How are things like prolonged walking and standing- do you get any discomfort or sense that you should unload the joint?
-How are repetitive motion activities such as cycling, elliptical, hiking (if you have tried)? 
-Does your gait feel completely normalized, and has it changed at all from pre-operative?
-Can you officially say you are better off now than pre-surgery?

One thing that very much struck me as I checked back in at your story was the expected lifespan of the transplants- man, how nice that would be!

Best of luck with your continued recovery and thanks again for your updates.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: left knee on December 19, 2018, 08:46:12 PM
Hi JT,

I am 6 months yesterday post lateral meniscus transplant. It has been very helpful following your post. I am definitely not back to baseline yet and have good and bad weeks.  I had an MRI yesterday which indicated some graft extrusion. From reading the literature it is very common and seemingly doesn't affect outcome of graft ( I find it hard to believe)

Just 2 questions, from your MRI did you have graft extrusion? You mentioned you had an abnormal bump at the lateral aspect which Mr Spalding put down to suturing technique. I too have this and feel it may be meniscus related given MRI results
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on December 21, 2018, 04:15:25 PM
badleftknee1

-   Honestly, rarely but it has happened with prolonged standing, less so as time continues, I can be on my feet most if not all day now without pain or swelling, prior to surgery if I was standing more than 30 mins the evening would mean reactive swelling
-   Only cycling of those you mention, in the saddle I feel very strong, and feel confident to push to my max exertion, out of the saddle im not stable enough to crush down on the peddles, perhaps that will also come if I train it more
-   Iím not a very present person, so canít give a confident reply to that, I think far too much about my walking, my instinct is my left and right side are identical now
-   I can in more ways than I am not.  I had more confidence with a short sprint pre surgery (tho the fallout in the evening could be severe), but in every other aspect I outperform pre surgery

left knee

-   I canít recall any remarks from my surgeon regarding extrusion or shrinkage of my graft when observed using MRI, I believe every graft probably has one of the two, but I guess mine was unremarkable
-   Yes I have a protruding almost nobbly knee where the existing rim was used to sucture the donor meniscus to, meaning it sticks out now.  Bit funny that my knees now look very different, but I guess that was unavoidable, and not an issue if not painful.
-   You have done amazingly well to get to the 6 month phase, have you got more on your journey on this site that I can read?
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: left knee on December 28, 2018, 09:15:27 AM
Hey

I haven't actually logged progress up till now. Im just over 6/12. Current issues low grade swelling , not visible to physio/surgeon but feeling of fullness in kneecap. Similar to you i have a bit of medial kneecap pain close to entry port. IT band has also been an issue. Function wise I am back in work, swimming a few times a week and cycling out on road up to an hour twice a week. Need to up my rehab in gym to start building up VMO etc.
Overall Im definitely not back to baseline. Have pains intermittently but different from previous pain which is reassuring ...... I too have high expectations of returning snowboarding by next winter , getting back to golfing regularly without pain after and possibly doing the odd 4/5km jog. Seems like the impossible at the moment but hopefully will get there and longterm delay the knee replacement by 10/15 years...
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on January 02, 2019, 11:08:47 AM
I am obviously a sample size of 1, but my brief experience has convinced me that if I have to go through this again, I will get into FRC training much earlier in my rehab.  The ankle and hip work with those movements seem to have been transformative to some of the discomforts I had, but it could simply be the passage of time (18 months).

I am about to embark on 3 months of Keto diet + OMAD, in an attempt to retain and gain muscle, while stimulating autophagy, hopeful that could have some positive impact to the cells within my knee capsule.  Even if it doesn't, it should mean I am a good deal lighter which in it's self will be helpful.

I am continuing my FRC movements and feel more and more comfortable in ass to grass squat positions, I am hopeful for the spring / summer!  I didn't mention previously however I competed in a hockey tournament in December and won it with my team, a really satisfying milestone, with much less fallout than I expected or would have had should I have done that post my initial partial meniscus removal.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on February 11, 2019, 01:12:32 PM
Very brief note update.

Diet went well, basically ate calorie maintenance and didn't lose or put on weight as best I can tell.  Probably a beneficial move in body composition.  Knee swelling is good but by instinct is that going full keto didn't have much if any impact from that angle, so will likely stay low carb but increase protein for better muscle gain and retention.  Eating once a day is convenient and has really helped cut down on unhealthy snacking.

I have had a session with a Neural Kinetic Therapy (NKT) professional and they have deemed that the impact if the surgery has left a neural lag / road block that needs retraining and stimulating to get full proprioception of my leg again.  After 1 session I think I am seeing a difference, she wants me to lay off the lower body work and hockey for 2 months to give this a go, so no sport until April.  Excited that this might be the bit I was missing.

Will update probably at the end of that treatment.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: AndrewC on April 11, 2019, 08:34:47 PM
Very brief note update.

Diet went well, basically ate calorie maintenance and didn't lose or put on weight as best I can tell.  Probably a beneficial move in body composition.  Knee swelling is good but by instinct is that going full keto didn't have much if any impact from that angle, so will likely stay low carb but increase protein for better muscle gain and retention.  Eating once a day is convenient and has really helped cut down on unhealthy snacking.

I have had a session with a Neural Kinetic Therapy (NKT) professional and they have deemed that the impact if the surgery has left a neural lag / road block that needs retraining and stimulating to get full proprioception of my leg again.  After 1 session I think I am seeing a difference, she wants me to lay off the lower body work and hockey for 2 months to give this a go, so no sport until April.  Excited that this might be the bit I was missing.

Will update probably at the end of that treatment.

Please keep the updates coming! Im enjoying reading your progression!! Sounds like it is going very well.

I am probably going to have to travel this route myself at some point not too far away. It seems a very long road  :(
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on April 16, 2019, 08:14:28 AM
Hey AndrewC,

It is a very long road, and I'm running out of road hahaha!

So NKT is legit, I feel the treatment is really switching on my movement chain, she is very happy with my progress.  She does note there have been internal structural changes from the meniscus but I am sloe to being able to move to impact movement training with her.  She has done sufficient work on me that she has permissioned me to get back to lower body weights, where I had stopped that for 2 months.

I do feel the best I have felt since surgery, knee feels the most versatile and normal it has.  Its not aggravation free, if I do overdo it I sense a reactionary swelling occurring inside even through it isn't visible, or if it is, barely.  Its feels obvious to me that I needed this surgery given the situation I got myself into, and that I picked the right surgeon, but its still not clear how versatile I will be in future, will I, another year from now perhaps, be a fully operational athlete, or am I reaching the limits of my recovery, and should stay away from impact and explosive fast movement, living a very normal active life without excessive exercise / sport.  I still don't know, I still train very often and watch what I eat and take buckets of supplements, so I'm in a good place mentally, and physically I guess (to look at I function really well and look fine) but I am still short of the nirvana.

I plan to have a followup 2yr MRI in a couple of months to see for all the hiccups and scares, whether the meniscus and OATs are still fine.  If they are, thats a tremendous green light to not be put off but the lumps and bumps.  I participating in a national championship and played a fair bit of my sport in the last year, if the scan comes up fine I'll be so relieved and allow more activity little by little and tackle pains that onset with my NKT and FRC trainers.

Hope that's helpful, not a very technical update, but essentially at 21 months I'm doing well physically and mentally, but still think this is a 2 year process, minimum.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on June 13, 2019, 12:23:20 PM
Hi all,

More or less my 2yr update.  Just came back from the surgeon office after reviewing my recent MRI.  For what its worth the MRIs indicate my plug and meniscus are as good as the day they were put in, I have a full thickness continuous articular cartilage surface where I had the grade 4 (full thickness) defect, and the meniscus is in place with no signs of tears.

Its a great relief to hear that, as I do get episodes of light swelling, which was the indicator I ignored before this surgery, where it was trying to tell me I was chewing through my articular cartilage.  My Osteopath (and NKT specialist) has different theories on the source of the swelling, but is really happy with my function, and believes as long as we tackles compensations and imbalances as they crop up, I should be a very capable man, able to participate in sport in a balanced way.

I have played in another tournament since my last post, and training ice hockey without significant issues.  My tolerance for playing is increasing gradually, seemingly to no detriment of my knee architecture.  I'm on of the 9 out of 10 for whom a MT improves their life (Tim's statistics).  I am very fortunate to be able to afford all the supplements and additional treatment I have, I can't say definitively but my instinct is they all help.

As such, for now, I am very happy, will continue my daily work to improve (which I have come to enjoy) and hope for a fun filled future.  Tim has recommended either Lipogems or nStride as possible injections to get the capsule to settle down even more, as things are improving I'm unsure whether to invest and risk it at the moment so will do some reading.  If anyone has any opinions I would be grateful.  For the avoidance of any doubt I still don't run or jump really, I didn't train those yet and may never again, I am choosing my battles, and to return to my sport is my number 1 goal.

Its a long road, but for me and my set of circumstances I seem to have satisfactorily salvaged the situation.

JT
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: Samiul27 on August 19, 2019, 10:28:24 PM
Hi all,

More or less my 2yr update.  Just came back from the surgeon office after reviewing my recent MRI.  For what its worth the MRIs indicate my plug and meniscus are as good as the day they were put in, I have a full thickness continuous articular cartilage surface where I had the grade 4 (full thickness) defect, and the meniscus is in place with no signs of tears.

Its a great relief to hear that, as I do get episodes of light swelling, which was the indicator I ignored before this surgery, where it was trying to tell me I was chewing through my articular cartilage.  My Osteopath (and NKT specialist) has different theories on the source of the swelling, but is really happy with my function, and believes as long as we tackles compensations and imbalances as they crop up, I should be a very capable man, able to participate in sport in a balanced way.

I have played in another tournament since my last post, and training ice hockey without significant issues.  My tolerance for playing is increasing gradually, seemingly to no detriment of my knee architecture.  I'm on of the 9 out of 10 for whom a MT improves their life (Tim's statistics).  I am very fortunate to be able to afford all the supplements and additional treatment I have, I can't say definitively but my instinct is they all help.

As such, for now, I am very happy, will continue my daily work to improve (which I have come to enjoy) and hope for a fun filled future.  Tim has recommended either Lipogems or nStride as possible injections to get the capsule to settle down even more, as things are improving I'm unsure whether to invest and risk it at the moment so will do some reading.  If anyone has any opinions I would be grateful.  For the avoidance of any doubt I still don't run or jump really, I didn't train those yet and may never again, I am choosing my battles, and to return to my sport is my number 1 goal.

Its a long road, but for me and my set of circumstances I seem to have satisfactorily salvaged the situation.

JT

How much did you pay for the procedure with Tim Spalding?
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on August 20, 2019, 04:58:27 PM
Hi, I didn't pay, I had Bupa health insurance, I don't know what cost would have been billed to me if I weren't covered.

Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: xbrett82 on September 12, 2019, 12:32:47 AM
Very brief note update.

Diet went well, basically ate calorie maintenance and didn't lose or put on weight as best I can tell.  Probably a beneficial move in body composition.  Knee swelling is good but by instinct is that going full keto didn't have much if any impact from that angle, so will likely stay low carb but increase protein for better muscle gain and retention.  Eating once a day is convenient and has really helped cut down on unhealthy snacking.

I have had a session with a Neural Kinetic Therapy (NKT) professional and they have deemed that the impact if the surgery has left a neural lag / road block that needs retraining and stimulating to get full proprioception of my leg again.  After 1 session I think I am seeing a difference, she wants me to lay off the lower body work and hockey for 2 months to give this a go, so no sport until April.  Excited that this might be the bit I was missing.

Will update probably at the end of that treatment.

Hey, so I am getting a lateral meniscus transplant in about a month. I'd love to ask you some questions. shoot me an email if you get this: [email protected]
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: LateralMeniscusIssuesGuy on September 12, 2019, 12:14:54 PM
Happy to send you an email, however if you have any questions you feel happy to share online, the community might benefit from us discussing your questions and concerns.

As a 2.25yr update, things are going really well.  Ice hockey is getting better, any subtle pain is normally reducing.  I am as convinced as I have ever been that pain manifestations are due to function and muscle imbalances that my Osteo (Sue) does amazing work to fix.  I'm being asked to compete at national level by many teams now as I am 'back' in their eyes despite my age.  I have lost 5 years of my sport due to the initial tear and processes since then, looking forward to the future with real enthusiasm now, hope to have my children play with me.

I will say you have to straddle the line between being cautious and not being consumed by worry.  Pains and mishaps occur, but have faith they aren't major and really invest in someone like Sue to manage you though the years after the operation.  I still am selective about the activies I engage in, but that is also responsible given im 36 now, not a spring chicken.  I'm not participating in a 5k run with my friends today, as it just seems to risky atm.

Those who read the whole post might recall when my surgeon told me about a rugby player he treated who returned to national level after 2.5years.  Given where I am now, that does feel like the time frame required for me to also feel not just strong and durable, but able to express my strength quickly with control (i.e. power).

In summary I have occasional pains, I have driven my family mad with my time demands to get myself fit and healthy, I do 30 mins of work every morning in the gym from my osteo, then an hour of gym, then stick to an anti-imflammatory diet, and structure many life choices towards the protection and betterment of my knee.  This scale of commitment won't be appropriate for everyone.  But maybe I am an average or below average healer, and so that scale won't be necessary for others.
Title: Re: I took the plunge, Lateral Meniscus Transplant + OATs
Post by: AndrewC on September 18, 2019, 01:18:57 PM
Happy to send you an email, however if you have any questions you feel happy to share online, the community might benefit from us discussing your questions and concerns.

As a 2.25yr update, things are going really well.  Ice hockey is getting better, any subtle pain is normally reducing.  I am as convinced as I have ever been that pain manifestations are due to function and muscle imbalances that my Osteo (Sue) does amazing work to fix.  I'm being asked to compete at national level by many teams now as I am 'back' in their eyes despite my age.  I have lost 5 years of my sport due to the initial tear and processes since then, looking forward to the future with real enthusiasm now, hope to have my children play with me.

I will say you have to straddle the line between being cautious and not being consumed by worry.  Pains and mishaps occur, but have faith they aren't major and really invest in someone like Sue to manage you though the years after the operation.  I still am selective about the activies I engage in, but that is also responsible given im 36 now, not a spring chicken.  I'm not participating in a 5k run with my friends today, as it just seems to risky atm.

Those who read the whole post might recall when my surgeon told me about a rugby player he treated who returned to national level after 2.5years.  Given where I am now, that does feel like the time frame required for me to also feel not just strong and durable, but able to express my strength quickly with control (i.e. power).

In summary I have occasional pains, I have driven my family mad with my time demands to get myself fit and healthy, I do 30 mins of work every morning in the gym from my osteo, then an hour of gym, then stick to an anti-imflammatory diet, and structure many life choices towards the protection and betterment of my knee.  This scale of commitment won't be appropriate for everyone.  But maybe I am an average or below average healer, and so that scale won't be necessary for others.

Thanks for all the updates, very interesting to hear them.
I see, BUPA would for sure be a massive bonus !!! I believe the transplant is in the region of £15k with Tim Spalding ++ extras and on costs (for the person who asked) but this is just what I heard, I am not in the position of needing one it seems (or not yet..).

Had an operation a few days ago with Prof Nick London who is a top tier knee man as well, and although its early days in my recovery, I have a feeling he may have worked some of his notorious magic (lovely chap for anyone else considering him as a surgeon).
Not spoken to him post surgery (was 1.5 hours ish I think) but the constant pain I had behind the knee is not there (its more a post arthro ache!) and the feeling of a steak knife rubbing on my tendons behind the knee is for sure not there... The notes say repairs to lateral and medial meniscus from tear caused by sport injury (could be trimming most likely) but there is no other issues noted and no followup instructions except an appointment with him in a few months....

So... we shall see. Hopefully this will buy me some time, will see what the follow up appointment says! Sorry for the off topic - I still have Tim Spalding as my last chance saloon!