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Author Topic: Need Advice  (Read 1360 times)

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Offline MJ

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Need Advice
« on: May 25, 2006, 07:09:28 PM »
2 years ago I injured my knee while teaching an aerobics class.  Pivoted - got caught up and went down hard.  Unable to bear weight for 48 hours.  Initial thoughts were meniscus tear - but MRI did not show tear - but arthritis both on the medial side of the knee as well as behind the kneecap and a bone contusion. I used to be a runner and  ignored my sore knees for close to 20 years. Was in the process of moving across country so no PT - just cut back on activities.  Started teaching aerobics again 2-3 months later - knee still sore but bearable.  Finally went to OS who prescribed PT - not much help.  Then scoped the knee and performed a lateral release - found significant osteoarthritis both on the medial side (tears in articular cartilage of femur) and behind kneecap.  Went through PT - felt somewhat better after 2 months. Kneecap pain almost gone when going up and down stairs.  But then medial pain returned.  Was told it was from arthritis and prescribed unloader brace.  Cortisone shot also helped.  Now, 1 year later I am still in excruciating pain and have a permanent limp.  Was in PT again because of hip issues on opposite side due to all the limping. This is helping hip but knee still painful.  Primary care physician decided to do another MRI on knee just to see what is going on. I had not returned to the OS because the options he offered me quite frankly scared me (synvisc injections, osteotomy)I was hoping to "get better" on my own.  This MRI showed signficant degenerative changes - to include worn away cartilage on femur and tibia as well as a torn meniscus (which they said was intact when I had my knee scoped) Was basically told there as nothing to do.  Could probably get another scope to clean up the meniscus - but I am so much worse after my first surgery that I am scared to have another.  Before the first scope it was more of an aggravation, now I feel disabled. I am at a loss for what to do.  I can return to my OS with these results - but I am moving again and any surgery will have to be delayed until we get settled. ( I am also wondering - is it possible to miss a torn meniscus when they go in for a scope - the reports says it was intact - could I have torn it since then?) Has anyone managed their pain successfully through non surgical methods? I am fine with swimming, biking - but walking is extrememly painful.  Have resorted to basically no impact exercise and am tryingt to keep up with my quad strenghtening exercise.  I am only 39 and the mother of two young active boys - I hate being a gimp.

Offline blackbeltgirl

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Re: Need Advice
« Reply #1 on: May 25, 2006, 08:26:29 PM »
Sorry to hear you're having these problems.  I'm going to advise you to do a lot of research - both on your condition, and on physicians.

#1) MRIs have a high probability of showing a meniscus tear when none exists.  If there is no sign of a tear on physical exam, don't worry about the MRI

#2)  Did you ever have full leg x-rays?  Standing x-rays, from hip to ankle?  These will show alignment issues (to be corrected with the TTT), as well as joint space narrowing.

#3) During your previous surgery, did your OS measure the size of the damage to the articular cartilage?  It generally starts wearing away in "potholes", vs. being the entire joint at once.  Depending on the amount of damage - both the area of the damage site and the depth of the damage, there are cartilage replacement/regeneration options.  These include microfracture for smaller lesions, OATS, osteochondral allografts, and ACI. 

NONE of these surgeries are easy.  No matter what you decide, you're looking at a minimum 6 month recovery period.  But articular cartilage won't heal on it's own.  Braces and strength can reduce the symptoms to bearable (for some) and give you more time before a TKR.  But some of these other options may either eliminate the need for a future TKR, or postpone it till you're 60, instead of just for a few more years.  I always send people to one website to start their research: www.cartilagedoc.com.  Go to patient resources, and the knees section.  There are a lot of articles on articular cartilage health, the indications and contraindications for the different surgical options, etc. 

Depending on where you're moving to, someone here may be able to refer you to an excellent articular cartilage OS.  Even if someone is an excellent knee OS, they don't all have the same experience with these aggressive procedures for younger patients.

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 MJ

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Re: Need Advice
« Reply #2 on: May 26, 2006, 09:19:58 PM »
Thank You.  I am moving to San Diego CA. If anyone can recommend a good OS I would appreciate it. For the immediate future the cortisone shot and the PT are keeping the pain at bay - but I figure it will wear off eventually.  When the Doctor looks at you and says "your knee is crap" I guess you have to take him seriously.

Offline stgiles16

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Re: Need Advice
« Reply #3 on: May 27, 2006, 11:30:59 AM »
I agree with Jess. There are several options for articular cartiledge damage. None of them are fun but since the articular cart. will continue to erode if not addressed, what choice do you have?  I have heard of several good docs in CA. I am sure that someone will post one for you. YOu can also look on this website for an OS near you.

good luck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline derwood8

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Re: Need Advice
« Reply #4 on: May 28, 2006, 03:04:18 AM »
I have two pieces of advice.
First, see a new doctor.  Sounds like your current OS is not getting the job done.
Second, you mentioned quad strengthening exercises but not hamstrings.  The key to the knee is the quad/hamstring ratio.  Too much quad strength coupled with too little hamstring strength is a dangerous condition.  Try some leg curls. Start with some resistance bands and slowly progress to weights.  As your hamstrings get stronger, your knee should become more stable. 
As for the meniscus tear, I can tell you that is going to just hurt until it is repaired.  I just had mine done last Friday.  The 5 weeks waiting for surgery were excruciating when I walked or otherwise stressed the injured knee.
As for the articular cartiledge damage, when you find a new OS, ask him/her about options.  Medical technology has come a long way.

Hope this is helpful.

Offline Jaci

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Re: Need Advice
« Reply #5 on: May 28, 2006, 03:50:48 AM »
MJ,

You might want to look up Dr. Bugbee in San Diego. He's well known for his work in cartilage restoration and transplantation. Here's a link to a website with info about him.

http://medicine.ucsd.edu/ortho/faculty_and_staff/bugbeehome.shtml

best wishes,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline blackbeltgirl

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Re: Need Advice
« Reply #6 on: May 29, 2006, 10:10:48 PM »
Bugbee is who I'd have recommended in San Diego as well.  I haven't seen him - I'm on the east coast, but there are several kneegeeks who see him.  And when I started researching articular cartilage health, his name came up with some frequency.  I'd make that appt as soon as you know when you'll get to San Diego, because it may be a long wait to get in as a new patient.  And don't forget to take copies of all your medical records, surgical records, MRIs, x-rays etc. from your current OS and physicians.  Otherwise you'll either be paying for duplicate scans or paying for the old OS to mail them to you.

Best of 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 Heather M.

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Re: Need Advice
« Reply #7 on: May 30, 2006, 07:26:51 AM »
I'm going to go out on a limb and predict that Bugbee won't be able to help, because it sounds like you have degenerative changes that are global (in all three knee compartments) rather than a focal area of damage from an impact.  I saw him, he's wonderful and VERY thorough.  But he said he couldn't help me and cited the reasons above--plus, I have scar tissue, which is also a problem for cartilage restoration.  Normally, cartilage restoration techniques are for small, highly localized areas of damage that were due to, say, a knee hitting a dashboard in an impact injury.  The way Dr. B. put it to me is that he prefers patients who 'had a perfect knee until they were injured' and not someone like me, who had a history of knee sisues.

Anyway, I certainly can't speak for this surgeon!  I'm just letting you know the advice I was given.  It was certainly worth seeing him to fully understand what my options were--and he recommended a particular test I haven't had done yet.  But if I'd been going with the hopes that he would 'save my knee' I would have been devastated.  So that's the only reason I wanted to raise a caution flag for you--it sounds like you have pretty extensive damage in several compartments and at least a couple of different mechanical issues.  What caused the early wear and tear on your knee?  Until that is addressed, restoring the cartilage won't do any good--you'd just rip up the new stuff like you have the old.  Only faster, and the new stuff would be extremely expensive...as in upwards of $40K for both knees.  So while I was disappointed that Dr. B. couldn't help me, I was very grateful for his honest and thorough evaluation, and the fact that he may well have saved me a lot of money and heartache.

When you have extensive damage in all three compartments as you are describing, often a knee replacement is one of the few options.  Obviously they wait as long as possible.  And as long as you are able to swim and work out, a TKR would be premature.  But pain management, an unloader brace, visco-supplementation, and things like acupuncture and myo-fascial release may make a huge difference in your life, as well as activity modification.

I absolutely don't want you to get down and lose hope.  As others have pointed out, you have LOTS of things left to try that can really improve your quality of life.  Finding a good doctor and good PT would be on the very top of the list...it doesn't sound like you've had good experiences with either.  But a good PT is worth his or her weight in gold and can work with you to figure out what you can do, how you can change x and do y in such a way that it reduces your pain and improves your function.  It really isn't a brush-off to prescribe PT, it's good medicine!  But not all PT is equal, so make sure you find a good one.

Hang in there, help is on the way in the form of lots of ideas from kneegeeks who have been through it and will go through this process with you.  I basically need a knee replacement, too, but at 36 am too young.  So I'm looking for other ways to live with the pain....

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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