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Offline xisbum

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A meniscus odyssey
« on: December 24, 2005, 05:39:04 PM »
Comments, suggestions, other experiences welcome.

Knee Timeline

April 9, 2005      Initial injury to left knee playing tennis on clay courts

April 15         Primary Care physician

April 21                                   Orthopedic specialist – X-ray; try NSAIDs, glocosamine

May 4         MRI

May 10                                   OS – MRI shows medial meniscus tear. Rx: Try rest, prescription anti-inflammatory Oxaprozin 600mg 2/day, glocosamine.

June 3                                   OS – No improvement; schedule surgery.

June 16         Primary Care physician for EKG

June 17         Blood work drawn

June 29                                   OS – Arthoscropy left knee to remove torn medial meniscus; prescription for pain Hydrocodone 5/500mg 1-2/3 hrs; muscle-strengthening exercises only (on memeographed sheet).
                                   (202 pounds)

July 8                                   OS – Removed stitches, confirmed osteoarthritis damage to medial articular cartilage, lateral articular cartilage undamaged; continue Oxaprozin, muscle-strengthening exercises and begin walking.

August 11                                   OS – Cortisone shot, new prescription anti-inflammatory Diclofenac 75mg 2/day; can try light tennis in about a week; asked about possible physical therapy, told okay if I could arrange “something non-weight bearing” on my own. Continue walking and bump distance, if possible.
                                   (192 pounds)

August 20                                    Light hitting against wall, slight pain

August 21                                    Light hitting against wall, slightly more severe pain
                                    (190 pounds)

August 24                          Light hitting against wall, more severe pain
   
Sept. 15                                    OS – 1st Synvisc injection; asked about unloader brace, OS noncommital
                                    (179 pounds)

Sept. 22                                     OS – 2nd  Synvisc injection
                                    (179 pounds)

Sept. 29                                     OS – 3rd and final Synvisc injection, OS said did not want to see me again. I asked the next step if Synvisc didn’t work, he said could come back in for another cortisone shot. Can try light tennis in 3 weeks. Continue walking.
                                    (177 pounds)

Oct. 18                                     Light tennis hitting with another player, minor stiffness, very little pain
                                     (172 pounds)

Oct. 22                                     Social tennis, stiffness and minor pain for 3 days after
                                    (171 pounds)

Oct. 23-26                                     Some residual pain (3-hour airplane trips Oct. 24 and 25)

Nov. 12                                     Social tennis, stiffness and minor pain for 3 days after

Nov. 19                                     Social tennis, stiffness and more severe pain for 5 days after

Nov. 26                                     Social tennis, stiffness, more pain, often severe, every day since.
                                     (168 pounds)

Dec. 8                                     Called OS to ask for cortisone shot the next week; was informed Dr. would be out of town all the next week. One of his partners might see me, but would probably not give a shot. Suggested asking Primary Care to give the shot. Did not pursue the issue.

Dec. 12-14                                     Air travel to New Orleans via Chicago (total air time, 4 hrs.); knee very tender and sore, often severe shooting pains while walking and while seated on airplane.

Dec. 15                                     Cancelled social tennis scheduled for Dec. 17; pain too severe.

Dec. 17                                     Began walking with a cane, even around the house, to alleviate the pain. Stopped Diclofenac, started naproxen.
                                     (170 pounds)

Dec. 19-23                                     Still using cane for walking between Metro (subway) stop and office (about 1/3 mile); pain waxes and wanes, although if my foot hits the ground a certain way a sharp, sudden pain strikes. Sleeping is sporadic because of medial tenderness; cannot lay other leg on it or lay left leg on right leg for any length of time.

January 2006                      Changing insurance companies and changing orthopedic specialist. Will request unloader brace for possible pain relief and possible return to tennis courts.

Rob in Virginia
Baby boomer and tennis nut raging against reality.

Offline Cindy Bailey

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Re: A meniscus odyssey
« Reply #1 on: December 30, 2005, 07:13:44 PM »
Rob, how did you manage to lose so much weight? That is quite an accomplishment, you must feel really good about it. I hope that you are continuing to get better.

Offline xisbum

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Re: A meniscus odyssey
« Reply #2 on: December 31, 2005, 03:53:43 AM »
Hi, Cindy. Happy New Year.

The OS said the one thing I could do to take some of the stress off the knee was lose weight, and the more weight I lost, the more time I could possibly buy on the tennis court.

That was all the incentive I needed. I got ruthless on counting calories, slashed my intake by two-thirds and started a regular weight program (light weights) targeting upper body tennis muscles. I allow myself one "go crazy" night every 2 or 3 weeks, usually dining out at a nice restaurant. Otherwise, my limit has been between 1,000 and 1,400 calories a day, all from balanced meals and healthy snacks (very few).

I stayed focused on the goal, and the weight just kept dropping, about 2 pounds a week on average. I did lose some discipline after my last tennis outing ended in so much pain; I quickly gained about 4 pounds, but I got over that quickly and am now back down to 168. I plan to keep at this for at least another 20 pounds.

I do feel better without the extra weight, but if I can't get back on the court, I'll have to find some other outlet for all this pent up energy.

I'm changing doctors in January, so maybe we can come up with something that will work.

Thanks for your interest. What's your knee story?

Have a great 2006.

Rob in Virginia
Baby boomer and tennis nut raging against reality.

Offline xisbum

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Re: A meniscus odyssey
« Reply #3 on: January 02, 2006, 06:42:26 PM »
Addendum to the odyssey:

Last Thursday, Dec. 29, I talked with my OS to inform him I was changing insurance plans and therefore orthopedic specialists in January. I asked what I should tell the new OS, and out of the blue he started talking about condromalacia, the first time he even mentioned that term since I first talked about my problem.

Is that situation a normal outcome of miniscus removal? He did finally tell me he removed about 20 percent of the medial meniscus and found grade 3 osteo on about 40 percent of the condyle.

This could change my whole thought process; if a stable patella can allevaite the pain I am feeling, then I may not need an unloader brace afterall. There may be simpler braces that can handle this.

I am at a loss over his decision not to tell me this in the first place. I might have tried stabilizing the patella before agreeing to synvisc injections.

Any thoughts on this turn of events?

Rob in Virginia

P.S. The knee has felt fairly good the last few days. I've been able to walk around the office (gingerly) without pain, although I still know a wrong move will cause that sudden shooting pain.
Baby boomer and tennis nut raging against reality.

Offline Caroline109

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Re: A meniscus odyssey
« Reply #4 on: January 02, 2006, 10:56:56 PM »
I was diagnosed with chondromalacia in both knees about 13 months after my second meniscus removal (not sure of the percentage but my OS said it was a big tear in each knee and no arthritis was found in both knees at the times of their surgeries for torn cartilage). I had PT to help with the problem as my kneecaps were also tracking poorly, and that really eased the pain. Here it is a little over a year after that diagnosis and I now have arthritis in one of my knees. It has been diagnosed officially through an MRI and I know my other knee is getting there as well due to stiffness. So I think chondromalacia and mensiscus tears do go hand in hand (or at least they do in my case--any yours). I never had a brace but at PT, the therapist taught me how to tape my knees so they wouldn't glide wrong and I did a lot of strengthening exercises.
Caroline
Chronic low platelet count
Men. surgery, both knees 2003,2007,2008
R PKR Sept. 17, 2008 - Biomet Oxford Partial
LK-TKR 4/21/2010 Biomet Vanguard Signature Knee
Scar tissue issue next to TKR knee
March 2, 2011: PKR to be revised to a TKR

Offline xisbum

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Re: A meniscus odyssey
« Reply #5 on: January 03, 2006, 01:25:02 AM »
Thanks, Caroline. That's good info. My OS never sent me to PT, although I asked at least twice.

I've found some strengthening exercises on my own, but I don't want to evey try taping. I think I'll try one of the Cho-Pat knee braces to see if they work.

I just wish he had said something about this earlier. Don't understand why he didn't share that information.

How active are you? My goal is to get back on the tennis courts as soon as possible.

Thanks again. There seem to be many helpful people here.

Rob in Virginia

Baby boomer and tennis nut raging against reality.

Offline Caroline109

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Re: A meniscus odyssey
« Reply #6 on: January 03, 2006, 07:57:59 PM »
Until about September, I was riding an exercise bike about 5 miles a day, 5 days a week. Then I started working where I have a lot of physical activity so I did less. Then in October, when my knees started really hurting, I really toned it way way down, to barely a mile a day. Since I started getting the Supartz shots 2 weeks go, I've barely rode my bike but plan to go back to it shortly after the 3rd shot, this Friday. At work, I do a lot of walking and some minor lifting (not heavy lifting, just frequent lifting which makes my arthritic shoulders very tired by the end of a 4-6 hour shift - they don't hurt, they just feel heavy and tired). I still find if I move my right knee (the one currently getting the shots) the wrong way or I twist in a bad way, I do get a reminder that I should be more careful!
Caroline
Chronic low platelet count
Men. surgery, both knees 2003,2007,2008
R PKR Sept. 17, 2008 - Biomet Oxford Partial
LK-TKR 4/21/2010 Biomet Vanguard Signature Knee
Scar tissue issue next to TKR knee
March 2, 2011: PKR to be revised to a TKR

Offline blackbeltgirl

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Re: A meniscus odyssey
« Reply #7 on: January 03, 2006, 08:32:19 PM »
Rob -

Chondromalacia just means softening of the articular cartilage.  It's often considered "pre-arthritis".  How old are you?  It's not at all uncommon for the OS to go in for a meniscus tear and find damaged articular cartilage.  Especially as we get older.  And to a degree, it's like waking up nerve endings. It didn't hurt until the knee was treated, and now it hurts.

For your next steps:
1) request a copy of your medical records from your old OS.   You'd be surprised the stuff in your file that was never discussed.  Look for any measure of the arthritic areas.  In patients under 50 there is surgical treatment for focal arthritis, which is what your situation sounds like.
2)Request a copy of your surgical records from the hospital or surgical center.  These are not the same thing as the medical records.
3) Once you know the size of your lesions, research the surgical options.  They are microfracture, OATS (or allograft cartilage plugs), and ACI.  None of the surgeries are fun, but they could restore your quality of life.
4) Make sure your new OS isn't just a knee specialist.  Look for someone in a sports medicine practice, and preferably someone with expertise in cartilage injuries.  They're not as common as you'd think.  (And it really does make a difference in how they treat your knee.)

it is now time to take on the role of educated patient, so you can advocate for yourself.  Some good sources for research, in addition to this site, are:
cartilagedoc.org (go to resources, knee)
orthosupersite.com
carticel.com
You should be able to learn a lot more about articular cartilage health and treatment, so you can work with your OS, instead of just doing whatever he suggests.

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 xisbum

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Re: A meniscus odyssey
« Reply #8 on: January 04, 2006, 01:42:09 AM »
Thanks, Jess. Good advice. I've been trying to get educated as much as possible, but it was difficult when the OS didn't want to talk much or discuss what I thought would work. And he is a sports specialist; his walls are full of photographs of professional athletes he treated.

He never prescribed anything other than the standard quad flexing exercises for my upper leg muscles, and they were always the strongest part of my body. I've done enough research to piece together a strengthening program I can do at home without injuring the knee further.
 
All I want out of this is something that will let me get back on a tennis court. I can deal with the current amount of pain, mostly just when I step a certain way, in my everyday life, but I really need tennis for more reasons than I can list.

There has to be something short of more surgery to compensate for this. That's what I'm looking for.

Surgery was done at the OS's outclinic, so I can get both sets of records from the same place. I am transferring them to my new doctor, who happens to be a friend of the guy I'm leaving. I didn't know that until I asked for the record transfer; I picked the new one on the advice of some tennis-playing friends here. If he doesn't want to work with me to help get where I want to be, I'll find someone else. I'm not letting anyone else cut into my knee again without some serious persuasion.

For the record, I had the surgery on my 59th birthday; I'll be 60 in June. I have dropped 35 pounds since the surgery, too, and I'll drop another 30 if it will help ease the pain.

I am determined not to let this beat me. I guess it's that old Baby Boomer competitiveness.

Thanks again for the good advice. I've seen your posts in other places, and you seem to have a level head on several issues relating to what we are going through.

Rob
Baby boomer and tennis nut raging against reality.

Offline blackbeltgirl

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Re: A meniscus odyssey
« Reply #9 on: January 04, 2006, 01:25:32 PM »
Rob -

Make sure you read through your records, don't just have them transferred.  You may find it quite enlightening.

Since you're 59, I doubt you'll find an OS who wants to offer you surgery, other than partial or total replacement.  And as you so wisely concluded - if the only limitation you're facing is on the tennis court, that's not a great reason for more surgery.  I'll be 32 4 days after my next surgery.  I don't want it, and I'm not in much pain most of the time, but I'm looking at preserving the next 30-40  years. 

As to non-surgical intervention - orthosupersite has some pretty interesting studies.  They have addressed the injections (synvisc and it's like), PKRs, bracing, etc.  I've never used an unloader, because my damage is the lateral side of the knee, but you may be right to pursue it.  But if there is damage to the back of the patella, or to the trochlear groove, that may make it hurt worse, not better.  That's what I mean by reading your records.  Many OSs try to simplify reality for the patient.  Partly because when you're a new knee patient you may not understand everything.  Partly because many people want the big picture, but not the nuances.  Partly because it can be overwhelming.  And I'm sure lots of other reasons.  You may find out that reality is a little more complicated than you think.

What part of VA are you in?  I'm in Richmond, but I used to live in DC, Alexandria, and Arlington.
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 shade

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Re: A meniscus odyssey
« Reply #10 on: January 04, 2006, 04:38:12 PM »
Rob,

Hi, hope you get some treatment options from your next OS.  I wear a cho pat dual action strap on one of my knees & find it helpful with stairs & inclines.  Keeps pressure on the patella/quad tendon while walking, it is very helpful for tendonitis.

Jess,

Wouldn't microfracture still be an option that could be offered to Rob, I thought that there was no age limit on that procedure.  Can't understand why people have to just put up with pain after 40 - such nonsense.  Don't understand insurance companies at all, doing nothing costs so much more money in the end & causes more damage to peoples knees.    ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline blackbeltgirl

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Re: A meniscus odyssey
« Reply #11 on: January 04, 2006, 05:15:13 PM »
Shade -

The age limits, which are not set in stone, are not based soley on insurance protocols.  As we age, our body produces fewer stem cells.  Microfracture drills to the bone marrow, and if I remember correctly, it's not just about having a "bloody scab", but about the stem cells helping produce the fibrocartilage.   But don't quote me on that, I didn't feel like double checking before I responded.  But at 60 years old, even with focal arthritis, most doctors aren't likely to offer micro, OATS, or ACI.  They all have a very long recovery.   And none of these procedures make you "good as new".  Post microfracture the avg person is still pretty limited in high impact activities.  Most of us are not professional athletes, willing to destroy our bodies in the long run for money today.  The younger you are, the better your odds, but no guarantees.  it sounds like Rob only has trouble playing tennis.  I wouldn't plow ahead with major surgery at 60 to preserve the ability to play tennis socially.  If he had trouble getting on with life overall it would be different.  But he wasn't so interested in surgery either.  Once he finds a doctor willing to pursue the non-surgical options, and see how much improvement he can get, he'll have to decide if tennis, with whatever residual pain he has, is worth it.

Just my 2 cents-
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 shade

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Re: A meniscus odyssey
« Reply #12 on: January 04, 2006, 05:42:48 PM »
Jess,

Thanks for the reply, I have also looking at this surgery as a resolution for my lesion.  I'm not Rob's age but I'm over 50.  I'd heard that people still could have good results with microfracture over 50, if they understood that this was a long healing process.  My lifestyle has been really hampered by this chondral lesion & hopefully something like this could be possible just to give me some pain relief because just regular walking is painful for me.  Hopefully I'll get the answer soon when I see my surgeon. 
Thanks for all your help and hope you have great luck with your upcoming ACI surgery. 

This article indicates that microfracture surgery can be done up until age 65 years - so hopefully that is true with most facilities because that would be very beneficial to alot of people......     ~Shade

http://www.athletesperformance.com/spj/article.php?id=65
« Last Edit: January 04, 2006, 07:00:59 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline xisbum

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Re: A meniscus odyssey
« Reply #13 on: January 05, 2006, 12:03:51 AM »
Shade,

I've ordered a ChoPat dual strap to see if it helps; it's not too expensive for a trial and error, but I don't expect to try tennis even if it helps during a regular walk. I will wait until the first visit with a new OS.

Hey, I'm starting to feel old here, with Jess a 30-something and you not quite my age yet. But I feel great, especially after losing the weight. I do intend to find a way - short of surgery - to get back on the tennis court. I'll keep you posted. I am not too keen for more surgery unless that the absolutely final solution, and then I would think a long time about it.

Jess,

I live in Vienna, work in DC. You are right in asserting my aversion to more surgery. I do hope your next one works for you. During all the years I played, I never thought of a serious injury, and my legs were always my biggest strength. I took them too much for granted, I guess.

You are so knowledgeable on all this; are you in the medical field?

I do plan to get copies of my medical and surgical records and give them a close perusal. I've learned a great deal already, and I intend to learn more. I'm hoping the strengthening exercises, plus continued weight loss, plus perhaps a brace of some kind will get me back on the court. I did play about 3 times with bearable pain afterward following the Synvisc injections, and my game was better than it's been in years, primarily because of the weight loss.

Thanks for the great advice and the support.

Rob
Baby boomer and tennis nut raging against reality.

Offline shade

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Re: A meniscus odyssey
« Reply #14 on: January 05, 2006, 12:41:30 AM »
Rob,

Good luck with the brace.  Don't blame you about avoiding surgery if at all possible.  You have done very well with the weight-loss - good for you.  I only mentioned the article on microfracture because so many doctors shy away from helping with this type of surgery if a person is over 50.  My belief is that a microfracture surgery would be much better than having a total knee replacement surgery.  I'd want to hold off on that as long as humanly possible.
Good luck to you and hope the exercising works.....  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT















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