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The patello-femoral joint / Re: At a stand still
« Last post by Vickster on June 20, 2019, 08:38:10 AM »
Can you consult with a PF specialist directly ?

If you wore out the cartilage repair do you need a realignment osteotomy before or alongside any further surgery? Does the joint not need to be aligned for a PF replacement to work?
The patello-femoral joint / At a stand still
« Last post by Monnster10 on June 20, 2019, 08:20:04 AM »
   So long story short, I had an MPFL on my left knee in 2014, due to numerous subluxations
Fast forward to 2017, after 4 scopes and 3 years of pain, it was discovered that I was missing 40%- 50% of the cartilage under my kneecap. In 2017 I had an ACI(Autologous Chondrocyte Implantation) and TTT (Tibial tubercle transfer) Which by summer of 2018 ( A year and a half) my pain got worse again. It was discovered that I already wore away my ACI patch.

   My ACI patch is gone. The underside of my kneecap is a grade 4 for cartilage damage. The groove for my kneecap to track is currently at a grade 1 for cartilage loss. In xrays there's narrowing of space, subchondral sclerosis, and osteophytosis.

I was scheduled for a partial knee cap replacement on May 14. But my surgeon was talked out of it while at a joint preservation conference by a patellofemoral joint specialist. The last I heard was my surgeon wants to do a Osteochondral Allograft Transfer surgery instead. But she's still waiting on the specialists opinion after overnighting my images and such to the specialist. Which it has been a month and no reply.

So do I tell my surgeon I don't want to play this waiting game anymore and just to do one of the surgeries. Or  do I wait it out until she talks to this specialist?
I'm currently struggling to work with the amount of pain I'm in daily, and I'm honestly struggling with my depression and trying to push through all this pain.

P.S. Side note, I just turned 27. Which is the big reason why she was easily persuaded to not do the partial.
If on a weight bearing surface, that’s probably on the cusp for successful infill with mfx. Were you non weight bearing? Might be worth getting a further opinion from a cartilage specialist. How’s your alignment on the X-ray? Any bowing? What causes pain? Have you tried a brace?

What damaged the cartilage initially? Maybe the MRI will shed some light but often the knee is not the same even with successful fibrocartilage growth

How old are you?
Ive posted my story before but unfortunatly there is a sequel.
My defect was on the mfc, grade 4 and was 2 by 2 cm. I had about four months of PT after surgery which went well and had a close to full recovery (not able to sit on my knees and bent for a longer time).

Im not very sportive, I walk much with my dog, went fine at first. Now back to not even one hour painfree and often take rest in between. Beside that I cycle and swim sometimes. I have done Zumba, without the jumping, PT was fine with that and no pain afterwards back then. Atm I don't do this anymore.

My last PT appointment was 3 weeks ago. Since then trying to continue to do it once a week but it is now close to impossible. My ROM is optimal now, was already good soon after surgery.

In January an xray was made, looked fine according to OS. Now MRI is planned but OS thinks it won't show much. He thinks the only way to know is by surgery again.
How big was the defect and what part of the knee? What activities been doing since mfx. Has there been any imaging done to check for fibro formulatin, any bone marrow oedema, deterioration of defect?
Are you still doing physio to maintain condition, strength and Rom
Since then I been to PT a number of times. I had it scheduled already and couldn't cancel it anymore without not having to pay so ...  Pt thought about scar tissue: after the first week of PT the scar tissue issue was completely resolved (no more pain while rubbing the scar). Then PT said it was a strenght issue so did some exercises but really if did m it hurted for a couple of days so then I tried to rest and limit the use of my right leg so it seemed a bit useless.

Had my appointment at the OS today and MRI is going to be scheduled (think I would have been better of listening to your advice then go to PT).

I made a new threat hoping to find somebody who experienced the same and can help me. OS was very reluctant with MRI because he thinks it won't show anything..
Has anyone had a microfracture or other articulair cartillage procedure that went well and then all of a sudden it got worse again? What was it and were you able to treat it?

I had microfracture surgery in march 2018 with a good recovery. Was able to do most till Novembre. And since then it only got worse over time.
Quizzes, games & fun contests / Re: Word game
« Last post by John42 on June 18, 2019, 06:52:24 PM »

What you describe is almost exactly the same as me.

Also snowboard and get an ache. Also have had problems swimming breaststroke (comes and goes).
Also have had sensation of bone grinding / moving on bone.

I also have lateral meniscus issues (slightly complex tear after 13 years with undiagnosed torn ACL).

The bone moving on bone sensation with clicking is the interesting one.

Read up on your knee anatomy a bit and also look at the tibiofibular joint.
The pain I have which is very similar to what you describe almost certainly originates from that joint.
Previously I would have said it was my knee but it is definitely well below the joint line and on the lateral side.

For me weighted calf raises seem to really help also light running and cycling.
I have high arches, a tendency to roll over my ankle and IT band problems.
All contributing to discomfort / pain.

Obviously I'm not a doctor so don't take advice from me but make sure you find somebody to work with.
Make sure you can describe your pain / discomfort accurately.

Remember "morphology does not equal pathology".
You don't want somebody who will just point to damage on an xray or mri and say that is where your pain comes from.

It might be but also it might not.
Instead of MACI,  have you considered Hyalofast stem cell scaffold? I had it done in the US almost 2 years ago as part of a clinical trial.  I was 52 at the time.  The advantage is that it is a single stage procedure. It can
be done either in an open or arthroscopic surgery.  The recovery protocol is similar to MACI.  The only issue I had is that it overfilled and they had to go back in to trim it down (recovery was quick).  The swelling and pain have gone away and may have taken Advil once or twice since the surgery.  I'm back to playing sports although I do have a little difficulty jogging (sprinting I can do- go figure), I'm hoping that I'm just a slow healer.

Hyalofast is legal in Europe and I recommend you look into it. It has good results with people our age.  I just came across 2 other stem cell treatments that seem interesting as well- RECLAIM from the Mayo Clinic, and Impact. Lastly, Last November when they went back in my Doctor took a piece of cartilage to send to the MACI
lab just in case my knee doesn't hold up- I go back in July for my next appointment. I would be over 55 at the
 time if they do another procedure (hope not), but my doctor thinks that I shouldn't have too much difficulty getting approved. 

Best of luck to you.
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