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Author Topic: TruFit Plug Surgery 8 days ago  (Read 20011 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

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Re: TruFit Plug Surgery 8 days ago
« Reply #15 on: September 23, 2009, 06:57:53 AM »
13 weeks and Plug is doing pretty well.  I'm having more pain at end of the day if I've been on my feet too much, but it's still just an achey kind of pain.  Days I'm off the knee there's hardly any achiness. Had OS appt this morning, and he's still pleased with the Plug progress, and I am too.

I asked him about the warm spot I have over the Plug area, and he was not concerned. He feels the whole knee is pretty much inflamed from the patella cartilage problems. 

Although he thinks it's too early to call the MFX a failure, he doesn't hold much hope that it helped any, either. He feels my patella cartilage is too far gone, and I'm just bone on bone there and the groove.   After cleaning up all the fraying under the patella, he said there just isn't enough cartilage left. He gave me a cortisone (Kenalog) injection, and wants to see if that will settle the knee down. I asked him if the anti-inflammatory benefits of the injection would be counter productive to the MFX, and he said since it has been 3 months, he didn't feel it would hurt the MFX at this point, and he was more concerned about getting the inflammation and pain from the patella arthritis under control.  (I feel that statement confirmed his suspicion the MFX wasn't going to help).  He attributed increased pain I'm having radiate from top of tibia down my shin as inflammation, also. He didn't elaborate, so I'm not sure if it's bone pain or tendon pain I'm feeling. I'm also having a little bursa inflammation on upper top area of my patella, too. Feels like a quarter sized gel mass under the skin that slides around a little. More of a bruise type pain. Hope shot helps that too.

The patella / groove pain has steadily gotten worse. I'm in more pain now than post surgery. Absolutely miserable at night. I am taking Benedryl just to get 3-4 hours of sleep, then dragging through the day, trying to catch a quick catnap when I can, but most days can't.  I wanted something for the night pain, but after asking me if I had any drug allergies, I told him I can't take codeine. He just shrugged and said, "let's see what the shot does for you for now".  I stopped on the way home and picked up more Benedry.   ::)   This OS is definitely stingy on pain meds.

I like the benefits of a steroid shot, but usually have a miserable 24 hours after one. This one is no exception. Tightness in the joint and sharp broken glass in the joint feeling is the norm for me. I spent the afternoon and evening on crutches hoping tomorrow I'll start feeling the benefits of the shot.

I went to the appt with a lot of questions ready. My OS seems very reluctant about giving out much information (an understatement!), and doesn't offer much, unless asked specific questions. Even then it's hard to get answers from him. I persisted today, and kept asking questions and/or rephrasing them until I got an answer. My sister is a doctor, and even though orthopedics is definitely not her specialty (PhD and specializes in cancer/virology DNA research), she gave me some insight into how to get past layman's questions and get him talking. Besides stepping out of the room to get the injection stuff, and I'm sure to pop into another exam room and then back to mine, he actually spent 40 minutes with me.  :)

Justin.... how's it going?

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #16 on: October 12, 2009, 07:25:42 PM »
16 weeks now.  A couple days after the cortisone shot my whole knee felt so much better. I could feel the slight pain from my Plug site more, but I think it was because the other inflammation pain was basically gone, and it wasn't over powering the pain signals.  It aches a little, but over all the Plug site is still doing great.

I had almost 2 weeks of pain relief from the arthritis and MFX. Very little swelling, and I've only had to ice once a day, or not at all if it was an easy day. I even got lots of sleep at night, too.  My knee 'almost' felt normal again. I only tried climbing stairs the proper way once. My quads aren't quite strong enough yet, and I didn't want to ruin my good day.  :D 

This last week I've felt the MFX and arthritis pain gradually start to come back. I've had to ice a couple times a day, and long bouts of standing seems to aggravate it.  Deja vu.  :'(
It's not as bad as it was a month ago, but DANG! I was hoping to get more relief than a couple weeks.

I have an OS appt on the 20th. Hope he has another backup plan.

Nan

Offline rockchalkhawk00

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Re: TruFit Plug Surgery 8 days ago
« Reply #17 on: October 18, 2009, 09:57:12 PM »
Hi Nan,

We have finally figured out the problem, which is a relief...I was starting to think the pain was in my head!  Work comp has been a pain in my ass and I regret that they are involved with my knee.  The low quality MRI they called for showed nothing in the knee and we proceeded with therapy and treatment with that information.  The OS at the Steadman-Hawkins recognized the crappy MRI and ordered a new MRI, which showed the blown out MFX still holding on by a thread and flapping in the fluid...under it is exposed bone which is starting to spur.  The OS in Denver is ready to go with an MFX in the groove and a minor Lateral Release.  I guess the after care of the MFX is biggest factor in success and my Doc then, my PT then (no experience), and myself failed to make the best of it.  I was back to work when I should have just started full weight bearing or phase 2 of post MFX PT.  I was also told that the OS needs to make a "bed" for the new cartilage to form and that was not done either.  The example I think works best is gluing something back together...for the glue to adhere correctly it is best to rough up the surface a bit. 

What really sucks is that now we know what is wrong and what needs to happen, work comp does not want to have it done in Denver (although they have worked with them before?).  My work comp OS 's (3 so far) seem intimidated by the S-H brand and want me to be seen in Denver, but Work Comp insists to have it done somewhere else...alll the while I have not been able to work (the longer I am out the less I get paid).  So my next appointment is at KU med on Nov. 2nd, so we will see what he says armed with the new information from the S-H clinic.  I guess the most frustrating part was not only a misdiagnosis based on bad evidence, but I am not even allowed to pay out of pocket to get this done (or they have threatened to take away all of my work benefits!) with a doctor that I trust will get the job done.

Sorry for the rant, I am just getting tired of the BS that is involved with an injury that occured in March.  I feel bad that your are having issues post surgery, but you are still in the Rehab portion of the MFX process.... http://www.steadman-hawkins.com/knee_microfracture/recov.asp ...and should be very careful until you are 6 months out.  Maybe you need to review the rehab protocols again with your PT?  Have you and your doc discussed the protein injections yet?  Even with the damage I have, I was still feeling great for almost 2 months once we started the shot process...

Have a great weekend!

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 #18 on: October 19, 2009, 04:08:30 AM »
Oh Justin! What a hassle you're dealing with.  Can your S-H doctors write letters on your behalf to worker's comp? Can you go up the chain at Worker's Comp and get someone to listen to you? Have you checked with your OS office, or S-H and see if there's a patient advocate that can get something happening?  What a bunch of crap you're having to deal with!

I go back to my OS Tuesday. My knee is still a little better than it was a month ago, but is still very painful, especially at night - and more so if I've been on it all day.  I'm taking the max doseage of Motrin or Tylenol during the day, and it helps take the edge off, but I need to resolve the problem - if there's a fix out there.    I'm sure he was hoping for the off chance that the cortisone shot would work, and since it didn't do much, I'm hoping he'll have another option when I see him Tuesday.   I'll post again after I see him.

Hang in there - stay strong.

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #19 on: October 21, 2009, 05:47:49 AM »
Hi Nan,

Fortunately I am a 15 yr exp manager at a major retailer, they have a ton of training $$$ in me.  I am supposed to be hitting the most productive years now and I am only 32.  Therefore my company supposedly has a strong interest in my return, so I called our HR dept and they are helping me wade through the BS...because our work comp is outsourced. My S-H OS also agreed to be paid from my work comp, so if they further deny him, we know it is about my case manager's ego at that point. The OS I see on Nov 2nd is versed on all of the latest and greatest when it comes to cartilage regeneration...so we will see.

How did your appt go?  The Docs at S-H go with Protein injections at a certain phase of the rehab of MFX.  They also fit you with a special brace to keep the load off the groove, along with orthodics as standard operating procedure.  Did/do you have or have to do those things as part of your rehab?  If you have the time you might look at the Jan 2009 sports medicine journal...it has some very interesting articles about MFX vs other procedures.

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 #20 on: October 21, 2009, 07:43:45 AM »
Hi Justin. I'm glad your employer and OS are working with you (& for you!) to get through that WC mess.  Hopefully it will all work out for you soon.

Today's OS visit was good/bad.  We are both pleased with the Plug. Pain is almost non-existent there now.  He feels the groove MFX is probably not good, and the almost non-existent patella cartilage is his main concern.  He showed me the photos he took during my surgery, showing the awful condition of the cartilage.The groove damage was pretty large, and he told me he really didn't hold out much hope since it was grade IV, but he did the MFX hoping it would work. He discovered it while in there for the Plug surgery.   We discussed my options.  He is recommending trying Orthovisc injections to delay TKR, although he has no guarantees that it will help.  Am waiting on insurance to approve the injections.

I'm 48 (for another 24 hours anyway  ;D ), and am not a candidate for ACI or any other cartilage repair procedures.  If I was younger, and the rest of my cartilage was in better shape, I'd be estatic about the Plug success.   Kind of bummed now.....

Hang in there.
Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #21 on: October 22, 2009, 01:45:10 AM »
Hi Nan,

If my cartilage was not good everywhere other than just the two spots I have, I would have definately pushed for a full or partial knee replacement.  Every one I have talked to and my family member (I got my crappy knees from somewhere) has LOVED their new knees.  I rehabbed a lateral release next to a 40 year-old TKR and he rehabbed as fast or faster than my then 28 yr old self. So do not dread them...think of them as a possible solution that can last up to 15 yrs!

I really think you will like the orthovisc shots, except when they are administered...ouch! I talked to the orthovisc drug rep in my area and she recommend that I stay off my feet for 24-48 hours. It is also recommended on the website and in the instructions that come with the shots, so if you can relax post-shot and let them set up in the joint.

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 #22 on: October 22, 2009, 02:44:19 AM »
Thanks for the tip, Justin.

I agree with you about just getting on with it, and getting the TKR.  I know it's the right thing to do. The timing is just awful, though.  And the expense I'll have with a huge deductible and co-pays.  :o   Just now getting this last surgery paid for. 

So do not dread them...think of them as a possible solution     It is a solution.  Although I haven't had years of knee pain like a lot of people on this board, I have had 6 months of misery, and it's not giong to get any better.  That's the reality of it.

Tomorrow is my birthday, and my family is taking me out to celebrate (the demise of my 40's, lol!).

Keep me posted on your knee and surgery.  Hang in there...

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #23 on: November 04, 2009, 12:28:42 AM »
Hi Nan,

Unfortunately I am one of those who have been dealing with these issues for the better part of 4 years.  Pre-surgery in 2006, I was a runner, working toward a brown belt in Tae Kwon Do and I also playing inline hockey several times a week....it is amazing how things change as quickly as my 45 minute surgery in 2006. 

Well in seen the "approved" OS on Monday and without much examination, he decided that the S-H doc was right on the money.  I am being scheduled for a MFX of the groove (again!), a lateral release (again!!) and possibly a MFX of the lateral femoral condyle or Trufit plugs.  I asked about the Trufit in the groove, based on your experience and my previous failure of the MFX.  He said that the first thing is that once you do plugs, you do not go back...so much cartilage is removed to place them, if they fail, there are very few options.  Second, plugs in the groove have not been met with great success, so the MFX is a higher % success.  I think the scariest thing we talked about was the bone spurring that was starting to occur in no less than 3 spots...I know with my mom's struggle with spurring in her feet, that this is something that will dog me for the rest of my life.

The approved OS's office and staff were quite the step down from the quality of the S-H clinic, basically on extreme to another.  I hope that the quality of care does not reflect that difference, I mean I have already had one bad experience and never fully recovered.  Also the work-comp direction has been so poor and inefficient to this point (injury was in March!), I really do not trust their judgment...but although this is my body, they seem to have the keys to the car, so I do not think I have much of a choice without foregoing my benefits.......frustrating, very frustrating....

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 #24 on: November 04, 2009, 01:02:59 AM »
Oh Justin! I'm sorry to hear you are still dealing with so much frustration with worker's comp.  >:(

I had the Tru-Fit plug on my medial fem condryl. It's the only part of my knee that is doing well. I had MFX on my groove. My OS doesn't do plugs in the groove, and even if he did, it couldn't be done because the defect was a fairly large linear defect.  The groove MFX pain and the awful arthritis under my patella is causing a lot of problems.  I also think I may have blown out another chunk of cartilage in the area near the plug. Not at the same spot, but on that condryl.  I went from a sitting position and quickly got up and pivoted (this was when the cortisone shot was falsely making me feel like Superwoman). I heard a loud grinding pop and immediate pain. My knee popped with every step for several days.  Exactly what happened when I originally hurt my knee this spring. I didn't have nearly as much swelling as before, but again the cortisone shot was probably helping that.   

Now the cortisone shot has completely worn off, and I'm still waiting to hear from the insurance company. 

I'm not that familiar with lateral releases, but... it is it common to have to repeat it?

You're right about the Plug being a "no going back if it fails" procedure. For me it was my only option left. I'm really frustrated, because it seems to be a great success, while the rest of my knee has taken a dive.  Lot of good a successful plug is doing me now.  ::)

Do you have a surgery date yet?

Hang in there....

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #25 on: November 11, 2009, 04:49:23 AM »
Hi Nan,

I am still waiting for the surgery approval, but it seems to be eminent.  I was doing some research about your lateral release question and I found nothing really conclusive either way.  I did find a large research study involving long term results with microfracture.... http://www.eorthopod.com/public/patient_education/11922/does_the_microfracture_technique_for_articular_cartilage_repair_hold_up.html ....The great quote from the article is: "The final analysis suggests that microfracture helps improve knee function in the early months to year following surgery. But many patients experience deterioration over time. In other words, the benefit of the procedure doesn't seem to last so the durability of microfracture is questionable."

I also found good article that I used to help my family and friends understand what is going on in my knee without getting into specifics.  http://www.denverpost.com/nuggets/ci_4675594?source=email . The name of the article is "Micro surgery is risky business" and it contains some good information.

My only guess why I need another lateral release is due to scar tissue bounding the knee cap again (I scar something fierce!) and I really did not have a good rehab post MFX and lateral release in 2006.  I am sure since we were very aggressive with physical therapy after my injury in March 2009(bad MRI that did not show anything) that I traumatized the joint more than usual, since "there was nothing wrong" with the joint.  Another lateral release will hopefully take more load off my MFX repaired groove and decrease the friction that would have otherwise been on it. (at least that is what I am told)

Are you going to get a TKR soon?  Or will you wait for several more months to see if there is some improvement?  Were you going to try the Protein shots first?

Take Care,

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 #26 on: November 11, 2009, 05:29:03 AM »
Hi Justin, thanks for the interesting articles.

I am pretty aggravated today. I have waited 3 weeks to find out if I'm getting insurance authorization for the Orthovisc shots. I finally called my OS office today to check on it. After talking with a couple people, I was finally able to speak with the person handling it. (It's a very large practice with 14 Ortho docs, and they see hundreds of patients a day). The lady I spoke with had no record - literally NO medical record for me.  She put me on hold and when she finally came back online, she said she had found my records.  She had taken over the job from the previous employee who quit. When she quit, she had a stack of records to get authorized, and she "misplaced" the whole stack. Of course... luck would have it I was one of them.   ::)   

So now I am back at square one.... waiting for authorization. The gal said she would mark the file STAT and try to get an answer for me within a day or two at most.   

I have decided to go ahead with the shots, and give it 1 try (of a series of 3 shots).  Because of a big work project I can't even consider a tkr until the project is complete, and it won't be until mid-December.  That leaves me 2 weeks to try to get one scheduled. I dont think the stars are going to align to get it done according to my schedule, lol.   I have a $5K deductible that I've met this year, so delaying it until 2010 really bites, but.... hey it's only money, right.   :( 

MFX sure seems to be a "maybe" fix, doesn't it? I wonder how long the "long term" benefits of MFX really is.  OSs seem to be quick to do it.  It's hard to get a good picture of its success rate and long term outcomes based on postings on this forum. The majority of posts are from patients who are having trouble post-MFX.  Kind of skewers any data.

 Hopefully science will continue to have breakthroughs, and something more long term is coming soon.  You are young, so hopefully whatever it is will benefit you. 

How long until you have approval and a surgery date set?

Hang in there,
Nan


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Re: TruFit Plug Surgery 8 days ago
« Reply #27 on: November 15, 2009, 09:22:28 PM »
Finally got the authorization to get the Orthovisc shots.   First one is Tuesday.  Will keep you posted......

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #28 on: November 18, 2009, 04:47:49 AM »
Had the Orthovisc shot today.  So far, so good. I wrote about it in another post:
http://www.kneeguru.co.uk/KNEEtalk/index.php?action=post;topic=49272.0;num_replies=5

I've been feeling a bit more pain in the medial femoral chondyl area lately. I don't think it's the plug site, but can't really tell.  Just more of a deep ache going on.  It might be from the area nearby that i suspect I damaged some more cartilage a few weeks ago when I stood up and pivoted too quickly.  Just not sure......   

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #29 on: December 30, 2009, 02:36:38 AM »
Hi Nan,

I am glad that the shots are working for you, I just hope that the effects last longer for you than it did for me.  I think my OS has those shots as part of the rehab program for MFX. 

FYI, I am 14 days post-op right now and I no longer feel like I was ran over by a large vehicle.  What a great Christmas Present!  I had a MFX of the trochlear groove (again), lateral retinacular release (again), debridement and general clean out of large amounts of scar tissue and loose cartilage (again).  Rehab has been going well, but I guess I will not really know much until this summer. 

Have a Great New Year!

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 #30 on: December 30, 2009, 03:06:14 AM »
Hi Justin!  So glad to hear you're post surgery and mending. I did have to cringe when I read your post. Sure brought back those awful memories of the first days post surgery.  :o  Hope you're feeling better with each new day. 

Have you started PT already?

Up until the last few days my knee has felt pretty good. I'm 6 months post surgery, and since the shots the knee has had great improvement. It's been more achy, especially at night, but it could be due to the weather. We had an unusual big snowstorm Christmas eve, frigid temps, and another snow expected tonight. We usually don't have winter weather like this, so maybe my knee is revolting.  ;)  I don't want to even think about the possibility that the shots are wearing off!

Best wishes for a speedy recovery, and a wonderful 2010!

Keep me posted.

Nan

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Re: TruFit Plug Surgery 8 days ago
« Reply #31 on: June 18, 2010, 08:39:55 AM »
Hi Nan,

I am not sure if you check this post much, but I just wanted to let you know I had the same results for the MFX...failure.  We tried the protein shots, tons of PT, restrictions, etc, but my knee did not repair itself.  The wound was much larger this time around, over 2 cm, so my ortho only gave it a 50/50.  I did have a small miracle happen though in the last couple weeks, I had read a post about someone with the same issues as me (I now have "kissing" lesions on the back of my kneecap and it locks with the wound in the groove.) and the use of leukotape.  My PT rarely used it and my Ortho looked at me like I had lost it, but they let me try it and suddenly I could walk without dragging my leg!  I even did a whole day at seaworld with minimal issues, but the tape has to be place just right or I rub against the damaged edge of the wound.  It also helps me stand for more than 5 mins with out the rush of pain.  Anyway, I have explored all my options and it looks like I have only 2 options left, knee replacement with cadavor tissue (Fresh Osteochondral Allografting) or a knee replacement with standard metal and plastic.  I will shoot for the allograft, but their are only a few surgeons in the country who do it and you have to find a matching (deceased) partner.

How are you doing?  Are the trufit plugs still beneficial ?

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 #32 on: June 18, 2010, 03:35:10 PM »
Hi Justin,
 
I haven't been on this forum in months, but was glad to see your post!  I'm sorry your knee is still giving you so much grief.   :(  I hope the leukotape continues to help you, and lets you hold off on any surgery... but if you have to have it, may all the planets line up correctly, and you find that surgeon and match! 

 My knee started showing a little improvement after the shots, but then seemed to get worse, but.......  I can report now that the last 3+ months my knee is doing great!  I have trouble going down stairs, but can do it, although I don't try to push myself, but I'm climbing stairs, and walking without a limp.  The pain is negligible, and only if I have a very active day or stand on concrete all day do I get any swelling, but it's not enough to make me grab ice.  I have forced myself to stay active and make my knee stronger.  The area of the TruFit Plug has no pain and no problems.  The area under the kneecap that had just the MFX is where I still have the troubles, but I can definitely live with it now.

Next week will be one year since surgery. After so many rough months, I never thought I'd report that my knee feels about 95%+ recovered.  (Mind you, I won't be running or rock climbing in this lifetime, lol).

My doctor still thinks knee replacement is in my future, but I'm being optimistic that it won't be anytime soon. (Hope I haven't just jinxed myself!)  ;D

Best wishes, Justin. Keep me posted.

Nan















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