The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: avdhe on August 05, 2004, 05:46:45 PM

Title: 13 yr old - 2 surgeries already, need help!!
Post by: avdhe on August 05, 2004, 05:46:45 PM
  My daughter, whose 13th birthday is in August, has already had two surgeries on her knee.  the first was to repair memiscular damange (tears) and now she has had surgery which showed severe damage to the articular cartilige.  The MD said he drilled into the bone hoping to increase blood flow to the area, in hopes that this would promote healing.  Still no mention of WHY this is happening to her.
 She is moderately active-played intramural basketball, and took some clinics.  She has been considerable less active this past year (following her first surgery in March).  She wants to play sports and dance.  I want her to.
We need advice!!
Thank you in advance,
T's Mom
Title: Re: 13 yr old - 2 surgeries already, need help!!
Post by: Ron22 on August 05, 2004, 09:59:04 PM
hi t's this an ortho or GP?  Did they do an MRI and examine the knee for stability, and range of motion?....could be a lot of things...hnow is she feeling a lot of pain? any numbness?  swelling? is the knwwcap warm?  have they (if it's an ortho) labelled it any kind of syndrome?  do they feel it's bone related or a problem with the joint.....sorry for all of the ?'s ...but if you can provide some more info some flks wil start to throw their 2 cents in...everyone here is glad to help

hang in there,

Title: Re: 13 yr old - 2 surgeries already, need help!!
Post by: avdhe on August 05, 2004, 10:13:24 PM
Thanks for your interest...I don;t mind the questions--they give me a better idea of what questions I should be asking (the first step)
Some time ago, when she was experiencing intermitten
knee pain, someone (I believe it was a physical therapist or her GP) suggested she might have Osgood Schlatters.  There were no specific tests mentioned.  All have done range of motion, especially when she was in PT (before and after the first surgery in March 04).

Since the repair of the torn meniscus, she has had three episodes of pain with the knee following what I would call fairly moderate activity (for a 12 yr old)--shooting hoops (not a game with running), or just coming down stairs.  During those times, her knee has been swollen and warm.

She is now home, surgerywas yesterday--we see the Surgeon, an Ortho in about a week.  I'm not getting any indication from him (yet) as to what the future holds.  Perhaps he is waiting til our meeting.

We are curently icing it and she's taking anti inflammatory meds.
Any info, or suggestions of sites to look up info would be greatly appreciated.
Title: Re: 13 yr old - 2 surgeries already, need help!!
Post by: avdhe on August 05, 2004, 10:16:31 PM
  I forgot one of the questions--Yes she has had a MRI--prior to the first surgery which showed the tears to the meniscus.  After this second surgery I was shown the pics the Doc took while inside, showing damage to the cartilige and the repaired/healed meniscus.

No one has mentioned problems with the joint or bone--or what has caused these injuries.
Title: Re: 13 yr old - 2 surgeries already, need help!!
Post by: Ron22 on August 05, 2004, 10:21:51 PM
hi..the ice and anti inflamms are certainly helpful...osgood schlatters used to be called "growing pains" (it's really painful somtimes even in the shin area...the bones don't keep up with the rest of the softer more plaible elements....kind of like wearing a tight t shirt on a hot day..very uncomfortable....the meniscus can be a factor here...sound like there's defintely some irritation in the joint...w/ all of these factors..pain and swelling are not unusual even with just limited activity...check out the main pg on this site there are some good links..also go the "bulletin board" main page and there a list of topics to choose from ..youy'll find good info on meniscus issues and i have seen some os' stuf in there some of the posts too..there are some really well informed knee folks in here and many of the posts contain some good links and articles.....hope this helped a little...

good luck

Title: Re: 13 yr old - 2 surgeries already, need help!!
Post by: Heather M. on August 05, 2004, 10:22:53 PM
It sounds like your daughter has severe chondromalacia--also known as chondral damage.  This could be the result of poor mechanics (think of a care with misaligned wheels which wears out tires unevenly--this is what's happening in the knee).

I would strongly recommend that you seek out one of the very few patello-femoral specialists out there.  These are knee surgeons who specialize in damaged articular cartilage in younger people--usually athletes.  The damaged articular cartilage that your daughter had could have been a result of the surgery (some people respond very badly to the trauma of surgery) or it could be from doing impact sports and being very active when she has poor knee mechanics.  So someone who knows the difference will need to evaluate her.  

The knee problems she is having at such a young age are not going to go away unless her case is managed very carefully.  If it is, she can go years--even decades--without further troubles.  Like her, I first had my knee issues identified at 13.  Luckily, my doctor refused to do knee surgery because he said the results were far from certain (this was 1985, remember).  I wish my doctor had told me to stop swimming competitively and running and such--I might have listened.  Instead, I continued until the pain got so bad I lost one by one all the activities that I loved.  At age 32 I was told I had severe knee arthritis and would knee a knee replacement within 10-15 years!

So all I can do is urge you to see a patello-femoral specialist.  This is an orthopedic surgeon who does open patellar realignment surgeries like the Fulkerson, Maquet procedure, Elmslie Trillat, TTT (tibial tubercle transfer), and the like.  A generalist orthopedic surgeon--one who does not specialize in knees--will usually only do arthroscopic knee surgeries and replacements.

A good place to start would be the surgeons listed on this web page, but not all of them are patellofemoral specialists.  You might look at the web page for the International Patellofemoral Study Group--the members are all dedicated to improving the lives of young patients like your daughter, who have very early chondral damage.

The next thing to do is to inform yourself!  Inappropriate or hasty surgeries for this condition can make things worse--or at the very least set your daughter back a few years.  She has already had the microfracture procedure done (that was poking the holes in the bones to promote scar carilage).  But if she doesn't have the realignment done to improve the knee mechanics, then she will likely wear down the new cartilage just like she did with the old.  Go up to the General Info tab above, and pay special attention to Step 5--patellae.  Another GREAT resource is my surgeon's web page--if you are willing to travel, this is where I would go to see the guy who puts Olympic athletes and professional sports figures back together.  He pioneered the microfracture procedure that was done on your daughter.
This first link deals with damaged articular cartilage:

This next link is dealing with PFS, which is a catchall phrase meaning Patello-femoral syndrome--likely the category that your daughter falls into.  This covers all sorts of alignment issues and mal-tracking kneecaps.  After all, something had to grind away her articular cartilage prematurely....

The last link is on microfracture from the doctor who pioneered it.