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Author Topic: Back from consultant - so many things said!! Help!  (Read 947 times)

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Offline itigo

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Back from consultant - so many things said!! Help!
« on: November 01, 2005, 07:03:28 PM »
Hi guys

I have posted on here before:
I posted on here a while ago about my left knee which dislocated in 1990 with torn cartilege. I am now 31 with an 11 month old and my knee has started to really play up. Some background....... I was misdiagnosed for 5 weeks at the outset so was weightbearing on my dislocated knee. When they went in to repair the cartilege they found the dislocation and had to shave (?) the back of my kneecap (they gave me the shavings back afterwards - cute eh?!) as it was mashed up after the walking I had done I guess.

It is getting harder to walk up the stairs as it is painful and makes a dreadful crunching sound. At my Drs. request I have tried Voltarol for a month which helped the pain a bit but not the crunching. It wasn't consistent relief and I could still jar it. The Dr. has now said that the joint seems quite stable but may be misaligned slightly or he mentioned arthritis. I am now trying to lose some weight as I know this doesn't help.


Today I had my consultant appt. and am confused as I didn't go with anyone (husband had the baby). The registrar did all sorts of patella tests and made me extend, flex, walk up and down etc. When he pushed on a point to the side of my knee he was surprised when I yelped and said it could be more old torn cartiliege? I said it felt like a pressure point, and when I do the other knee in the same place it feels the same......anyhoo, he is sending me for an MRI and referring me to the main knee guy (thank God!). He said that there were lots of possibilities - rescrape the back of my kneecap, suck out debris from behind kneecap, put holes in kneecap to encourage cartilege to form (?), repair any other torn cartilege, and finally cartilege transplant. Whatever course it takes, he said they will need to go in, especially as I'm so young they'll want to get it sorted. Does this sound reasonable? I haven't got a clue and am now worried about surgery! Hopefully the consultant will have a more definite idea after the MRI.....

Itigo xx
1990 dislocated LK in hockey
1990 arthroscopy - debridement, cartilage removal
05 LK unstable and painful
May 06 dx tilting kneecaps
Nov 06 arthroscopy and open LR
Oct 07 debridement arthroscopy
Sept 09 - May 13 subluxing frequently
May 13 TTT and MPFL reconstruction

Offline Doc79316

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Re: Back from consultant - so many things said!! Help!
« Reply #1 on: November 01, 2005, 07:17:43 PM »
Hi Itigo,

I think at the moment your best bet is to wait for the MRI results. There are occasions when an MRI may not show a problem that is very definitely there. DOn;t worry about this though - you can request an ultrasound scan if it's considered that you have soft tissue damage.
If your doc thinks your knee is misaligned or arthritic, this can be seen very easily on an x-ray. There are also clinical test, which or course, you've already had done.
All of these together should show up whatever the problem may be with your knee.
Please don't worry about any possible surgery. You don't know yet if you need any so there's no point in getting stressed about it just yet. If you do need surgery, knee surgery is so common even major knee surgery is almost routine. I'm sure that whatever is wrong with your knee will be easily rectified.
Whatever treatment is suggested to you, remember that if you are not 100% happy, you don't have to have it done. You can also ask for a second or even a third opinion. A doctor won't think any the less of you for doing it.

Let me know hpw it goes.

Regards,

Laura
Left knee surgery
08/06/02-L/Release
13/08/03-Fulkerson TTT
05/06/05-Stabilisation & Medialisation/Tendon Transfer
13/01/06-Proximal Hamstring Superior Stabilisation
06/03/06-RSD/CRPS diagnosed
20/07/06 + 03/04/07-Excision of scar tissue
29/05/15-Arthroscopy
02/03/20-Left transfemoral amputation

Offline blackbeltgirl

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Re: Back from consultant - so many things said!! Help!
« Reply #2 on: November 01, 2005, 09:20:23 PM »
Itigo -

It sounds like they are looking at possible damage to both types of knee cartilage - the meniscus and the articular cartilage.  If they are looking for damage to the articular cartilage, they will (hopefully) use a dye for contrast.  Otherwise articular cartilage shows up  very poorly on an mri.

As to the different surgeries mentiond, I agree with laura.  You don't need to borrow trouble, it will find you if it needs you.  But I can tell you what some of the different procedures mentioned are called, so you can look up the basics on the surgery.

rescrape the back of my kneecap, suck out debris from behind kneecap: usually called debridement and lavage - they clean up the frayed edges, in hopes that it slows dowwn further damage, and you no longer have little frayed pieces getting caught in the joint
put holes in kneecap to encourage cartilege to form: this is called microfracture.  They drill holes in the bone, down to the bone marrow, to form fibrocartilage, which is a type of scar tissue that can fill in the "pothole" in your articular cartilage (6 month recovery)
repair any other torn cartilege: this could be a meniscus tear or damage to other articular cartilage
and finally cartilege transplant - this could refer to OATS or to ACI.  OATS is where they take a plug from another part of your knee (or a cadaver) and use it to full your hole.  ACI they send cells to a lab, they grow them, and they use them to fill the hole.  12 month recovery for both (avg)

Hope this helps.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline itigo

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Re: Back from consultant - so many things said!! Help!
« Reply #3 on: November 02, 2005, 06:51:45 PM »
Thanks for your replies. Only just managed to get online again. They always talk so fast it's difficult to take in what they're saying! With the debridement and lavage which he sounded 90% sure they would do anyway, what sort of recovery time is there and are you mobile walking wise straight after? From what I can remember from my first arthroscopy (learning the terms now!) I remember walking out and not needing crutches. When you give times for revovery, does that mean to full working order where you are almost able to exercise normally? Sorry to be a pain, just interested as I live in a 3 storey house and have an energetic 1 year old! And I teach!!

Thanks for any replies

Itigo xx
1990 dislocated LK in hockey
1990 arthroscopy - debridement, cartilage removal
05 LK unstable and painful
May 06 dx tilting kneecaps
Nov 06 arthroscopy and open LR
Oct 07 debridement arthroscopy
Sept 09 - May 13 subluxing frequently
May 13 TTT and MPFL reconstruction

Offline blackbeltgirl

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Re: Back from consultant - so many things said!! Help!
« Reply #4 on: November 02, 2005, 07:12:59 PM »
Itigo-

The debridement and lavage recovrey is usually relatively short.  You may leave with crutches, but depending on the location of the damage and your doctor's protocol, you may be able to dump the crutches within the first week.  You can find more about the procedure on the main page of this website.  At a guess, your total recovery is probably 4-8 weeks.  (Your doctor should give you a rundown of the procedure, expected recovery, etc.  Ask what to expect the first week specifically - that's when you'd need the most help.)  You may want to try to get some basics set up on the main floor of your house.  Some people really struggle on stairs with crutches.  And if you're not using crutches, 3 flights will still be a challenge for a short while.  As to teaching, it depends on what grade you teach.  If you teach high school, and can sit on a stool instead of standing in front of the board all day long, you may be able to go back sooner.  If you teach 1st grade and you're normally walking around, squatting, kneeling, etc. you may need to take a little more time off.  Your doctor should be able to advise you.

Good luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline itigo

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Re: Back from consultant - so many things said!! Help!
« Reply #5 on: November 02, 2005, 08:07:01 PM »
Thanks for being so helpful Jess! Luckily the tv room and a bedroom and bathroom are on the middle floor so I can lounge and lie all day/night!! I teach 7-9 year olds with special needs so a lot of squatting etc. but I did manage when pregnant so.....! Thanks for the help again, will let you know how I get on. MRI now an early Christmas present - 22nd December!

Itigo xx
1990 dislocated LK in hockey
1990 arthroscopy - debridement, cartilage removal
05 LK unstable and painful
May 06 dx tilting kneecaps
Nov 06 arthroscopy and open LR
Oct 07 debridement arthroscopy
Sept 09 - May 13 subluxing frequently
May 13 TTT and MPFL reconstruction