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Author Topic: TruFit Plug Surgery 8 days ago  (Read 20030 times)

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Offline PieceDesigner

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TruFit Plug Surgery 8 days ago
« on: July 02, 2009, 10:04:51 PM »
First time poster, but I've been reading this site for last few days. Wish I had found this site before my surgery, so I might of known what to expect. 

I stumbled and hurt my right knee 2 1/2 months ago. Not a lot of initial pain, but horrible swelling, then intense pain over next several days. Went to my Ortho Sports Med doctor.  Xrays, anti-inflammatories, rest, cortisone shots. Then had an MRI.  Report read:

A full-thickness area of articular cartilage loss is identified in the central weight-bearing portion of the medial femoral condyle. This lesion measures 1.4 by 1.0 centimeters.

My doc referred me to an OS. I have total trust in my Sports Med doc, and he told me the OS was the best around.  My Sports Med doc told me the different ways that the OS might treat it, but doubted that I would be a candidate for plugs, due to my age (48) and already thinning cartilage due to arthritis.  He told me I would probably be a candidate for TKR in 5 years or so.  My knees have ached over the last few years, but not enough to slow me down.

By the time I saw the OS I was really limping, and not sure when my knee would "catch" on me, and the pain was pretty severe.
The OS gave me options of doing nothing, arthroscopic surgery to clean and debride, or once he got in there he might use TruFit Plug(s).
I asked him the down time for each of the arthroscopic procedures.  He told me a couple weeks if all he could do was clean up, but a little more time on crutches if he did the plugs.   At the time I didn't even question this answer.  Sigh.....

I had arthroscopic surgery 8 days ago, and he was able to use the plug method. I have not talked with him since, but have a post op appt scheduled next week.  He advised my family that he found a lot of clean up work, but plug install went fine.  He provided some pictures he took during the procedure.  I was given written instructions to be NWB until my post op appt, and to do some exercises such as ankle rolls, leg lifts, and work 90 degree bend 3 x day.  The exercises have been no problem. My quads are tender, but not bad.  The only real pain I have is in my calf. It is stiff and very painful. No warmth or redness, and I do have an ankle pulse, so I'm not worried about DVT. The pain, particularly when I'm standing upright on crutches is awful. 

I am not particularly "athletic" anymore, but very active and on my feet all day. I am an outdoors person, and do a lot of landscaping and physical work on our small farm.  I broke 2 vertebre in my lower back 4 years ago, and had a tough couple of years, but refused to slow down too much (although I unfortunately gained some weight).   Other than that I have no other health problems.

After reading all the posts about this knee surgery, I am apalled at the lengthy rehab time. I was not at all prepared for this!  Only 8 days, and I am bored and restless! I found out quickly that I don't have as much upper body strength as I thought. These crutches are a killer!

Thanks for everyone's posts, info, and support. I feel much more informed, and look forward to getting to know you.  Hopefully I'll have some answers from my OS next week.

Offline PieceDesigner

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Re: TruFit Plug Surgery 8 days ago
« Reply #1 on: July 08, 2009, 12:16:45 AM »
Went to my OS today for post op followup.  Knee feels good, only occasionally swelling, and stiffness is better every day.  He was pleased with everything. He said I could start putting a little bit of weight on my knee, while using the crutches.  I took the first step and about died! Rest of the day I gingerly put my toes down, but did not put much weight on it. I am sitting here with it elevated and iced. Even took a pain pill. First one since a couple days after surgery. 

He told me that he did the microfracture and TruFit plug in the planned area, but he also saw a large area of exposed bone in another area, so he did microfracture on that.  It was a line formation. Explains why I had pain in other area, besides the pain I expected on the medial femoral condyle.

He does not want to start PT until I return in 3 weeks. I'm to do the same gentle exercises I have been. He said I should be able to be completely off my crutches at that time (5 weeks post op).

It's been a long, tiring day. My husband had a motorcyle spill this morning, so also visited my Ortho. Bruised and scraped, but he's OK. We're sharing ice packs tonight.  ::)

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #2 on: July 18, 2009, 03:32:42 AM »
This is day #23.  I am still on 2 crutches, but able to get around better. I am using the crutches, but trying to walk as normal as possible without putting full weight on the knee.  Too much weight and my knee screams!  Swelling is still an issue, expecially if I am standing or walking for more than 15 minutes.

I woke up this morning and found I could not fully straighten my leg. When I try to force it I get sharp pain under and around my patella. I'm hoping I just slept on it wrong, and it's not related to the trochlea MFX.  (Which by the way I found out is the 2nd spot he did the MFX. I found this info from a copy of the surgery report. My OS mentioned the second MFX, but did not indicate where). 

Has anyone else had MFX in 2 different areas at once?

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #3 on: July 29, 2009, 12:57:05 AM »
Today was my 5 week check up. I am having a lot of swelling, and expressed my concerns to my OS. He told me that it is normal, and with all he had to do in surgery that it was expected. Keep icing...   

I also told him I was concerned with not being able to straighten my knee.  While I was laying on the table he gently pushed my knee down, and told me that PT should help with it. Again he wasn't overly concerned at this stage. 

I asked him to show me exactly where he did the surgical work by feeling my knee.  I have so many areas of pain in and around my knee, it was hard for me to sort out what is arthroscopic pain, incision pain,  and what is MFX and plug work.   The MFX/TruFit plug work is on my medial femoral condryl, and the other MFX is on my lateral trochlea groove. He said he had to do a lot of trimming on the underside of my patella, so that is most likely why my patella is so sore.  So.... I have legitimate pain on the medial, lateral, and middle of my knee.   ::)

I have my PT evaluation Friday, and then 4 weeks of PT x 3day/week. I go back to OS in 4 weeks.  I am still mostly using both crutches, as I am pretty unsteady and have a lot of pain and swelling if I don't use crutches. Occasionally I use one crutch around the house in the mornings, but by afternoon/eve I have to use both crutches, as the pain and swelling gets worse the more I'm on it. Hopefully a few PT sessions and I can ditch the crutches.

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #4 on: August 11, 2009, 05:30:22 PM »
I'm at 7 weeks post op. I feel I'm doing pretty well, although swelling is still a major issue. I have been using a cane for about a week and half. I tried just one crutch, but was too clumsy and awkward. When I switched to a cane, I could manuever much better.  The last couple of days I have carried the cane more than using it to steady me. I have nearly fallen many times, so I have the cane ready to help steady me. My knee tries to buckle or hyper extend a lot. My PT says more quad conditioning will help this. I'm keeping the cane handy just in case.  ;D

I have had 5 sessions of PT (4 sessions and an initial eval).  I've made leaps and bounds! I feel my quads waking up. He's spending a lot of time on my quads, hamstring, and calf muscles. Before the first session I could not make a complete revolution on my exercise bike, and now I'm doing 20-30 minutes 4 times a day - on lowest resistance. I was concerned about my leg not extending right, but it turns out my extension is only a degree or two off. It was my weak quads not allowing my leg to raise up (imagine sitting on a bench and trying to raise both legs out straight in front of you. My bad leg would only raise up a little).  My flex is 110, so it's getting there.

I had a horrible 2nd PT session. Everything was going fine until he wanted me to sit on the bench with my knee at 90 degrees, then slowly straighten it, then slowly lower it back to 90 degrees. There's one spot where my knee wants to catch and the pain is horrendous, especially on the down movement. 2 x 20 just about did me in. I have a pretty high pain tolerance, but tears were running down my cheeks with that one!  He held my knee and felt the joint as I did a couple more. He could feel (& hear) the grinding/popping when it hit that tender spot.  My knee started swelling big time then. Even Game Ready icing didn't help much. I spent the next 48 hours elevating and icing, and reaching for the pain meds again.  I took 1/2 a pain pill before my next PT session 2 days later, and told him I just couldn't handle that exercise, and he agreed. Had a much easier workout, and after resting my knee over the weekend, it was much better. Yesterday's PT was vigorous, but I didn't have any problem (We agreed not to do the torture exercise). 

I feel a little pain where the TruFit Plug was installed, but it's more of an ache. Not the ferocious pain I had there prior to surgery. If I spend too much time on my knee, it aches a little more, but overall the pain is minimal.  The really awful pain I experience when doing that torture exercise is on the lateral side of my kneecap. I believe it's where the trochlear groove MFX site is, but not certain.  When walking I don't feel the sharp, awful pain there, unless I step wrong, or have any sideways or twisting movement. Then I see stars!

I wish I didn't have so much swelling. Seems like I have to have an ice pack ready all the time. If I go anywhere I pack one in a cooler in the car, as I know I'll need it if I'm out shopping, etc.  It's getting old!

I'm self employed, and part of my job is physical. I have not been able to stand on my feet for very long, so haven't been able to go back to work, except to do computer type work. I have to climb outside deck stairs up to my office. I can manage that ok. Not great, and defintely not very fast, but using my good knee and handrails I make it. I tried to take one step with my bad knee yesterday, just to see what I could do. I very nearly had splinters in my chin! Nope, quads aren't strong enough to support me yet.

Overall, I'm pleased with the TruFit Plug surgery so far.  Not at all happy that my OS did MFX on the trochlear groove while he was in there, as I wasn't having any pain there before.   :(

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #5 on: August 17, 2009, 09:52:37 PM »
I'm having a pretty good day. I have not used the cane in a couple of days, except for first few minutes when I get out of bed. A little stiff and unsteady until I get going.

Still icing... a lot.

I had PT today, and things are going great. My ROM is 124 and 0.  !!!!   I am up to level 4 on the stationary bike, and level 5 on the treadmill. We're still staying away from the "torture" exercise where I am still having a lot of pain. My PT worked on that area with massage. Not sure it helped much, but it felt good at the time.   :D

I am concentrating on my gait, and consciously trying to put full weight on the bad knee and not limp.  It's a little hard to do when I get up from a sitting position, but after I get going I'm able to somewhat loose that 'penquin' waddle.  I don't have a lot of pain when weight bearing, so it seems to be more of a learned gait that I need to correct. 

The plug site is tender and achey, but not terribly painful. I occasionally get the shocking lightning bolt pains, but they seem to less frequent and not as intense (or else I'm getting used to them).   My patella is still very sore, and a concern I plan on talking with my OS about next week.

My quads are really coming along. I have a long ways to go, but amazing how far I've come in less than 3 weeks of PT.  If on my back, I can do leg lifts immediately, and 90 degrees off the table. I couldn't even budge my heel off the table at my first PT eval.  Today's PT focused a lot on my hamstrings.  Will probably be sore tomorrow, but that's ok!

So far, so good......

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #6 on: August 25, 2009, 10:53:59 PM »
Week 9 and today was OS followup visit. 

He is very pleased with the TruFit plug site. It's aches some, but overall not painful. Just enough pain to let me know I had work done there, but not the awful pain I had there before surgery. He told me it would be several months before the achey feeling completely went away, but I should see steady improvement.

We discussed the pain I'm having with the patella and trochlear groove.  He took my knee through the motions and felt the grinding area. He thinks it is the arthritis and bone spurring I had before the surgery. He did the MFX in that area because I was bone on bone, and said he did a lot of clean up on it. The cartilage is very far gone there. He's hoping that I might find some relief from the inflammatoin if I rest my knee a couple of weeks. He wants me to continue the home muscle exercises and stationary bike, but hold off on PT. If I'm not better in 2 weeks we'll discuss cortisone shot.  He and my sports doc had told me that a knee replacement might be in my future, and he brought that up again today.  I was really hoping the MFX might delay it several years. 

With the Plug doing so well, I'm really bummed about the other issues I'm having with my knee.  :'(

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #7 on: September 03, 2009, 02:34:47 AM »
10 weeks out and doing very well.  Some days more pain than others, but overall just a mild achey kind of pain at the Plug site.  Some days I don't even notice it.  ;D  The tender patella is another story...

Overall my knee feels much better this week. Easing off the PT has helped. I am faithfully doing the home exercises and stationary bike. I've been avoiding over using my knee, but keeping it moving.  I am able to walk without a limp (from the Plug work, anyway. Sometimes the patella pain will make me limp).  I no longer have any Plug site pain when first getting out of bed in the morning, and usually don't start feeling achey until late in the day.  Some mild achey pain at night, but not bad.

Today I looked out my window and saw the postman start to drive away. I had been waiting on a delivery for a couple days. Without thinking about it, I ran out the door to flag him down. Probably ran about 30 yards.  I amazed myself! Didn't even give it a second thought to start running! It didn't hurt! Nice to know I could move that fast, but don't think I'll push my luck and try running again anytime soon.

I am not having much swelling this week, either.  I am still icing my knee when I feel it getting stiff, or if I've been on my feet too long. I also ice after my exercises.  This is the first week I haven't felt permanently attached to the ice pack!

So far, so good. Still pluggin' away (pun intended)  ;D

Nan


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Re: TruFit Plug Surgery 8 days ago
« Reply #8 on: September 10, 2009, 05:11:46 PM »
11 weeks. The Plug site is doing great. Only slight achey feeling, but very mild. I climbed stairs yesterday, one foot over the other. I did use my arms on both railings for support, but my knees did most of the work. No trouble with the plug site. Had pain in the trochlear groove microfracture site, and it hurt the rest of the day, along with patella pain. 

I've noticed for a few weeks now that the Plug area feels slightly warm to the touch, but not red or swollen, and no pain other than a very mild ache.  Not sure what's going on there. Hope it's just healing going on. ???

Still doing my home exercises and riding the stationary bike. Although quads don't seem to be getting significantly stronger in leaps and bounds like they were while going to PT, I think they are not backsliding.

I was shopping and on my feet about 6 hours yesterday. My knee began to get very stiff and a little swollen, but I didn't stop. I iced it down afterwards and it felt better. Did not have pain in the medial Plug area, just the patella and lateral groove mfx.

I am not taking anything for pain. Took Tylenol for the first few weeks, but nothing now. I have a lot of pain (patella and lateral groove mfx) at night, and very hard to get comfortable and sleep. I sometimes take Benedryl just to get a few hours sleep. I'm going to ask my OS for something for night time when I see him in 2 weeks. 

Over all, very happy with Plug.  Not so happy with the rest of my knee.   :(

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #9 on: September 14, 2009, 01:35:36 AM »
Hi Nan,

I went to the steadman-hawkins clinic for a second opinion last week.  WOW! That group is awesome! I drove 18 hours round trip and they made it worth every penny.  I had a 3:15p appointment and was there until after 6pm!  I did not think surgeons worked after 4p?  I have never seen doctors that are so thorough and meticulous in my life...and I work in a pharmacy.  After examination, they put me on a 6 week pt program to strengthen my stabilizer muscles and scheduled a new MRI (higher res) and appointment in early October.  I have damage in two places, lateral femoral condyle and trochlear groove so I am still getting a solid click or snap sound 2-3 times every step.  I guess it depends on how much damage that there is, but since I seen the inventors of the microfracture procedure, that is what they proposed to do in October...8 weeks non-weight bearing???  The good/bad is that the doctor said there is an 80% chance they can make me 100% (by 2011) if I follow their strict regain and program.  The bad is that I am 32 and there is a 20% chance I will be permanently disabled...that is scary.

I see my local OS on Thursday and then my general doc on Monday so he can help me make a decision between the two surgeons.  Logistically Denver is a pain, but having one of the best surgeon groups working on my knee is comforting.  They said my Physical Therapist will work, but follow up visits would have to be in Denver...


Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

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Re: TruFit Plug Surgery 8 days ago
« Reply #10 on: September 14, 2009, 02:58:15 AM »
Wow, talk about a thorough exam! My Sports Doc has spent as much as 45 min with me concerning my knee, but my OS has never spent more than 10 min with me. (Sometimes I've felt that he really didn't even want to spend 10 min).  ::)  I go back to see him on the 22nd, and I'm going to request my records go back to my Sports Doc (they are in the same practice, just different branch offices).  If I'm in a 'maintenance' phase now, I'd rather see my Sports Doctor, whom I've known for a long time.

What is your local OS wanting to do, or will Thursday's visit be your first with him? Does he do MFX? How much experience with MFX?  Your situation is very similar to mine, with the 2 different locations. I'm glad I was able to have the plug in the medial fem condyle but wish he had not done the MFX in the trochlear groove.  But.... nothing to do about it now, but continue on and hope for the best.

18 hours round trip! That's a drive, but sounds like you made a good decision to see the pros. How often are follow-up visits?  Getting those stabilizer muscles ready will surely help a lot.

Keep me posted. Hope your doc visits go well this week, and you have lots of info to make your decision.

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #11 on: September 15, 2009, 12:29:55 AM »
Hi Nan,

My local OS is the same as yours, if you ask 20 questions, you might make a 5 min visit as he is nudging toward the door...I understand that many OS are like this in general, so do not hold it against my OS.  My OS is very experienced, so he knows the ropes, but he is very, very conservative.  I think he will do the MFX, but my first experience was very similar to yours via pain, movement, etc.  Two years post MFX we had to go in and clean up the scar tissue, which is what I believe the real concern is in my case, because it has started forming again.  I am almost at the max age my office will do MFX, they do not give you the option after 35.  I was curious about your plugs...why plugs and MFX?  Did you have the option?

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

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Re: TruFit Plug Surgery 8 days ago
« Reply #12 on: September 15, 2009, 02:28:38 AM »
Justin,
  My Sports Med doc did not think I would be a candidate for the plug because of my age (48), but my OS did not have a problem with that. The lesion was still within Plug size, so he opted for that.  The area in my T-groove was larger, and more linear shaped, so he did MFX there. That spot did not show up on the MRI, so neither of us anticipated it. He decided to do MFX on it while he was in there installing the plug.  Even though he found this bone on bone area, I was not having any symptoms.  Now it's the area that is giving me trouble.  ::)

  What options does your OS give you if you're older than 35?  So this will be the 2nd MFX in the same site for you? Or is this the 2nd area?

Nan


Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #13 on: September 15, 2009, 02:49:13 AM »
Nan,

I am not sure exactly what they do after 35 except a cleanup and/or a replacement.  I know this has came up a couple of times with determined individuals, so they go somewhere else.  My groove had a minor MFX, only a couple of holes where made after the damage was "discovered" during a lateral release.  Sounds familiar? That area (groove) gave me issues for 6 months and finally became tolerable (late 06).  After my OS went in again and cleaned out a ton of scar tissue (early 2008), I finally felt 95% after rehab in that knee.  So do not get too upset about the MFX progress, it is very, very slow...if I have it done, I have been told I would not be fully rehabbed until 2011.

Justin
2006 - Lateral Release, MFX (Troc Groove), Debridement (Left)
2007 - Lateral Release, Debridement (Right)
2008 - Scope for arthrofibrosis, Debridement (L)
2009 - MFX (Troc Groove), Lateral Release, plica cleanout (L)
2010 - Autologous chondrocyte implantation (L)

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Re: TruFit Plug Surgery 8 days ago
« Reply #14 on: September 15, 2009, 03:00:45 AM »
Both my Sports Doc and OS think TKR is in my future, but OS thought he could buy me some time by doing the Plug.

Overall my cartilage in this knee is pretty bad due to arthritis, but only had the one really bad spot I injured in April when I tore the articulate cartilage to the bone.  I know I'm just under 3 months and have to give it time, but I have a dreadful feeling about the arthritis and t-groove MFX. I hope one area wasn't sacrificed when saving the other.  But.... I'm going to try to be PATIENT and wait and see.   ;D

Nan