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Author Topic: Why a follow up scope could be necessary!!!  (Read 2000 times)

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Offline tenabutter

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Why a follow up scope could be necessary!!!
« on: December 09, 2006, 08:20:29 AM »
I am new to this, have learned a lot reading the different threads.  My severe pain started 12/05, loud click in right knee and loss of movement. I went to OS and had surgery for meniscus tear 3/17/06 and cleaning up the roughage from OA. The OS had an MRI done and with the results first suggested draining and PT until he realized I couldn't straighten knee enough to lay flat for draining.  When I was awoken from surgery, I found out they did a microfracture, no advanced warnings I would be off feet for 6 to 8 weeks. Going through PT and non weightbearing for 8 weeks, I still had knee discomfort. Can now bend and straighten the leg, stiill a lot of pain and can't do stairs.  I did the 5 weeks of supartz injections with no relief.  After the injections the OS informed me that during the surgery the abraision from bone on bone is 2.5 cm and there was no cartalidge intact.  This was a condyle mircrofracture, not even the meniscus!!!  He told me after the injections it is rare that the supartz injection would help. He suggested the Cartalidge Transplant and sent me to a guy that specializes in that. I have had a contrast MRI and found out today that we are going in for a scope in a few weeks. The new OS believes there is little chance that we can do a cartalidge transplant, but our plans are to shoot to take the snippets of cartalidge to manufacture more. He said if this is possiible, the recovery time for the transplant is about 9 months. This is due to the size of the area to cover with cartalidge. Any and all advice and encouragement would be greatly appreciated!

Tena
« Last Edit: December 31, 2006, 12:53:31 AM by tenabutter »
3/17/2006 RK Microfracture
12/28/2006 RK Scope

Offline Mike780

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Re: Cartilage Transplant?
« Reply #1 on: December 09, 2006, 05:37:36 PM »
Not sure where you are but an article in the British Press about a week ago re a new procedure which only requires one to be on crutches for about two weeks , involves growing cartilage on some sort of gel pad thats then implanted in the knee.....early days but looks promising  ;)
Arthroscope L/K 27/07/06 Meniscus tear trimmed, diagnosed with OA Grade IV Lateral compartment and trochlea groove.

Offline tenabutter

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Re: Cartalidge Transplant?
« Reply #2 on: December 10, 2006, 02:49:50 AM »
Unfortunately I am in the US and I am told it will take about 10 weeks to grow the cartalidge and implant the pods. I will be non weight bearing for atleast 8 weeks, depends on the size of the area they need to fill. First OS said if it were a small area, 1 cm, then it is minor surgery, with my area atleast 2.5 by 2.5, that is when it gets difficult. If the unloader relieves the discomfort, I can delay surgery for a while, maybe til the gel pad gets here??

Thanks for that light tho,
Tena
3/17/2006 RK Microfracture
12/28/2006 RK Scope

Offline kalyjoe

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Re: Cartalidge Transplant?
« Reply #3 on: December 11, 2006, 01:13:34 PM »
Check these links out:

http://www.ars-arthro.de/downloads/ak_pdfs/ak_patbrosch_eng_v6.pdf
 
http://www.arthro-kinetics.com/product_knee_1.php


Right now, the US has a clinical trial going on and more will be starting.  These are for small defect at the moment, but from what I understand, eventually they hope to be able to treat larger lesions.  I'm not sure what your pain level is and how long you can wait....but just wanted to pass it along. 

I'm part of this trial, but I have a very small defect.  To me....it sounds good and has had good results in Europe, but not sure how large of a lesion has been treated as of yet. 

Good luck to you!  These boards are a great source of information.

Kristi
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline kmmbradley

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Re: Cartalidge Transplant?
« Reply #4 on: December 14, 2006, 03:18:57 PM »
Hey Tena
Sounds like the OS is talking about ACI, Autologous chondrocyte implantation.  My son this surgery in June of 2004 and has never recovered.  He was 17 at the time. 
The idea of an ACI procedure is to take a few cartilage cells from the knee, grow them in the lab, and once millions of cells have been grown they are implanted into the area of cartilage damage.
I found this explanation from another knee Geek patient, it explains it very well:
ACI is a technique for rebuilding damaged articular cartilage and is a two-part process. In the first stage, a biopsy of an individual's articular cartilage is taken from a relatively non weight-bearing area of the femur. This cartilage is then sent to a laboratory (Genzyme) where additional cartilage cells (chondrocytes) are cultured. These cells are the same as those manufactured by the patient's own body. The term autologous refers to the fact that the chondrocytes are derived from the individual's own cartilage. After six weeks, the new cells are ready for implantation into the defective areas.
Like I said before my son had this surgery for a large defect in his medial femoral part of the knee. His lesion was kind of large, if I remember correctly it was about 5x7 cm.  He first came to the surgeon in 2002 for pain in his knee and had his first scope then.  He was DX with Osteocondritis but the cartlige was still in place.  In 2003, he had a 2nd MRi and then another scope with debridement of some bone fragments and then sent home again to continue in sports.  My son played football and was a pitcher on the baseball team.  He pitched for the varsity team as an 8th grader and I think this contributed to his trouble.  Anyway, in early 2004 when we went for another MRI the lesion they had cleaned up in 2003 has dislodged from the area and looked to be detached from the medial condyle. We then went for another surgery in Mar 2004 and thought they were doing microfracture, the OS came back after only 30 min and said that it was to advanced for microfracture and told us about the ACI and scheduled us to return a few weeks later for the ACI.  The ACI went off as scheduled, insurance okayed the procedure and after almost 3 yrs thought we were finally going to be FIXED.  The rehab was horrible, especially for a 17 yr old active male.  Total non weight bearing for almost 6 months, total rehab was almost 18 months.  Absolutley the worse year he ever had.  It has been 2 1/2 years since the ACI and the pain is still unbearable, he is in his 2nd yr of college and has a handicap sticker because he can't walk stairs.  We have recently found a new surgeon because his old OS went in again 3 months ago and declared the ACI a success, funny how the pain is still there.  We will see this new OS in a couple of weeks and hopefully find an answer if this is to be a lifelong thing.
I am so sorry this was such a long email but please be totally prepared mentally and physically if you are going to go thru with such a  procedure and know that even when they call it a success pain is still a possibility.  If you would like to talk to my son I can give you his email, just let me know your email and I will send it to you.
He is 20 yrs old now and will probably have a lot to add to my story.
Dee

2002-arthroscope w/debridement(rt knee)
2003-arthroscope w/debridement(rt knee)
2004-arthroscope/ACI biospy(rt knee)
2004-ACI(rt knee)
2005-arthr. debridement & meniscus repair(lt knee)
2006-arthroscope-debridement

Offline tenabutter

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Re: Cartalidge Transplant?
« Reply #5 on: December 14, 2006, 07:25:02 PM »
Dee,

Thanks for the detailed explaintion your son has gone through and I am truly sorry to hear of his pain. I know what he is going through.  My OS that I have now is very good and I believe very leary of doing this procedure for me. He has been detailed as in your email, but silly me thought he was just trying to make it sound worse than it was. That was why the initial post to get some feedback from someone that has been through it. I am 45, and as most know if you sit around we gain weight and it doesn't disappear anymore!!!! My main concern is walking up stairs, I have OA in the knees and the left knee is headed down hill so in the tri-level home, stairs are there. When we go for the biopsey the 28th, it will be more exploratory to see if the lesion has gotten too big for this to be successful. Of course, until done we won't really know. I did have the mircofracture in March with no success. I didn't even know that was going to happen or a possibility until I was told non weight bearing for 6 weeks. I was actually total non weight bearing for 7.5 weeks and with crutches for an additional 2 weeks. I complained the pain was still there from the beginning. The first OS then did Supartz, which I found our had about a 3% chance to help since there was no cartalidge. I went to the new OS because I felt a new MRI was necessary since 2 procedures had been done and I still can't use the knee to do anything.  I am not going to worry until after I get the scope on the 28th and see if the brace relieves some pain, but knowing the OS was acccurate in telling me 9 months "hard rehab" will keep my mind open and make it a family decision with what the OS actually thinks is best. Good luck to your son in his next surgery, I wish him well!!!!

Thanks,
Tena
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3/17/2006 RK Microfracture
12/28/2006 RK Scope

Offline stgiles16

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Re: Cartalidge Transplant?
« Reply #6 on: December 15, 2006, 03:32:25 PM »
Another possibility could be getting into the clinical trials for the arthrosurface hemicap. I was facing cadaver transplant for a large chondyle lesion when my OS offered this. It is basically a titanium screw that is placed in the defect and it fills it up. It is considered a type of PKR. I had mine done in feb 06 after two microfractures. It was a much easier recovery then ACI or cadaver transplant. Let me know if you want anymore info.
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 tenabutter

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Re: Cartalidge Transplant?
« Reply #7 on: December 15, 2006, 06:31:41 PM »
Missy,

My OS and I did talk of the titaniium implant. He has heard of many cases where the screw has dislodged and the procedure redone or another procedure needed. I spoke with my initial OS of it also and he has never used the procedure and didn't have any advice on it. The main problem I am having now, in the Las Vegas area, many OS's are dropping Blue Cross Blue Shield, I am limited to the OS, in stating that, I am with a guy that came from Los Angeles and was the assistant OS for the Lakers, Dodgers, Mighty Ducks!  I believe I am in good hands and he will give me the best care possible.  I wish you great success with your implant and would be interested in hearing more down the rode, the left knee will be with the right 1 at some point.

Thanks,
Tena
3/17/2006 RK Microfracture
12/28/2006 RK Scope

Offline stgiles16

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Re: Cartalidge Transplant?
« Reply #8 on: December 16, 2006, 01:11:06 AM »
I am glad that you are in good hands. So far, my implant has remained exactly where it is supposed to be. I hope that it continues to do so. Where did you hear about the implant dislodging? It is still in clinical trials so there is not much about it on the net that I can find. I would be interested to read anything if you happen to find it.
I will let you know how it goes as the time goes on. Hopefully, we will both have good news to report.
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 tenabutter

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Re: Cartalidge Transplant?
« Reply #9 on: December 16, 2006, 02:49:11 AM »
My OS discussed it with me, the implant is a procedure that was around about 20 years ago, didn't pass because of dislodging. The new procedure is a bit different, but he heard of dislodgeing when he was sitll with the University of PA. I don't know if he was talking of the studies outside of the US or not. So far I have found little on the net for the US with arthrosurface hemicap, infact going to arthrosurface.com, it is not there any longer. I do hope you well with yours.
3/17/2006 RK Microfracture
12/28/2006 RK Scope

Offline stgiles16

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Re: Cartalidge Transplant?
« Reply #10 on: December 16, 2006, 03:27:16 AM »
Teena, I was just on the website. I copied the link, here it is http://www.arthrosurface.com/index.php/content/view/26/41/
That is the patient info section.
Dont know why the website was not working earlier.
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 tenabutter

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Re: Why a follow up scope could be necessary!!!
« Reply #11 on: December 31, 2006, 12:57:16 AM »
I went in for my biopsy scope on the 28th. Much to my surprise and happiness, the only good part of my knee is where the ex-OS did the microfracture. I go for my follow up visit on the 5th, I guess if the knee brace doesn't work we will be looking at a TKR. I am still upset with the ex-OS, had he done a follow up MRi or exploratory scope, he would see that the is a huge crater in my knee and no cartalidge left except for where he microfractured.

Has anyone had success with an unloader brace to help with the pain to avoid a TKR?

Thanks,
Tena
3/17/2006 RK Microfracture
12/28/2006 RK Scope