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Author Topic: Advice following Microfracture  (Read 2271 times)

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Offline cjtkd

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Advice following Microfracture
« on: March 16, 2010, 02:30:30 PM »
Hi,
Firstly I want to say 'Hi' to everyone, I've a feeling I might be popping on here quite often in the coming months so I'll explain my situation if that's a good starting point. Basically I am really quite concerned for my career, I'm only 30 and work full-time teaching kids Martial Arts as well as building up what has been up to now a successful career in film making. Here's whats happened.
I went in for day surgery this past weekend, on what was suspected to be a torn Meniscus only I awoke to be told two areas of my articular cartilage and been trimmed right back and that I'd had Micro-Fracture surgery. At the time I was as high as a kite following a heft dose of Morphine so I didn't fully take on-board the long term implications. A couple of hours the specialist (without really holding back) suggested to me that my days 'jumping around' were really quite numbered and that running and high impact activities were to be avoided.
Whereas I fully respect his opinion is it really that bleak or is there a chance I could go back to 'jumping around' and performing as normal? Has anyone else been through a similar situation and could you share any advice?

Ive put on a brave face at home as to not upset my wife and kids, but honestly I'm really not sure what to do with myself if it turns out that there really is no way to return to sports. Im due back in the clinic in 3 weeks time so up until then its a waiting game I guess!  :-[

Offline mmrocker13

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Re: Advice following Microfracture
« Reply #1 on: March 16, 2010, 03:23:58 PM »
The microfracture recovery period is a bit longer than you were planning on--it can take months for the fibrocartilage to "set". I'd avoid running and jumping for 6-8 months...but after that, you can certainly try again. Many people return to sports following a MFX, triathletes, runners, etc. You may have to cut back a little, or use common sense, but if you follow your rehab protocol, take care of yourself, etc., you have a good chance of resuming sports.
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline cjtkd

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Re: Advice following Microfracture
« Reply #2 on: March 16, 2010, 03:38:42 PM »
Thanks for your prompt reply.  :)

I did get the feeling that he was a little 'doom and gloom' and maybe wasn't in the best of moods that morning. Ive also found that people in the medical profession (not all, so please if you are don't take offense) can take a rather dim light on Martial Arts as a whole. Many see it as simply violence and don't see past all the kicking and punching. He referred to what I do as 'all that Karate stuff' so I did get the feeling he had already type cast me as some kinda MMA cage fighter, bar room brawler type :-P.

Some of the higher level movements I performed could be classed as acrobatic in nature, would it be a case if seeing how rehab goes and trying them a step at a time, or would they probably be out of question?

When I return to see the specialist in 3 weeks I do plan to stress how important my training/teaching is to me and that its not simply a case of finding a new profession. Its something ive done since an early age, its all I know and more to the point, all I'm qualified in!

Further along the path to recovery are there any specific braces or training aids I could turn to? By regular standards I already have very strong legs as I train a large range of plyometric and resistance drills (or should I say did :-P) so I am hoping this will be of use when I hopefully return to work.

Offline jt801

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Re: Advice following Microfracture
« Reply #3 on: March 16, 2010, 03:53:10 PM »
Hi and let me welcome you to the "mfx club". How big was your defect and where was it located? That plays a big part in how your recovery will play out. The best advice i can give you is to be patient. I am 13.5 months out from my mfx and only in the last couple of months have gotten back to the sports activities i was doing before i got hurt. There seem to be many different opinions as to whether one can run and do high impact activities after mfx-case in point: my OS' assistant told me that i would never want to try to run again, but when i asked the OS about this he said that wasnt the case and that it would be okay to return to sports. He did say to avoid running long distances for exercise. So i went ahead and started playing again when i felt ready and so far my knee is holding up. With that being said, it took nearly a year before i felt ready to try and i'm glad i didnt rush back into it too quickly. My other advice is to religously put in the time on the CPM and keep your weight off the injured leg at all times. If you can start doing some light pedaling on a stationary bike in a couple of weeks that seems to help. Just take it easy because its a long road back and you want to give yourself the best opportunity to heal properly. I think your age is in your favor (i was 35 when mine was done) so you should have a successful recovery. Good Luck!
                                                                                           Joel
12/99 left knee lateral release and plica removal
1/09 right knee chondroplasty and microfracture LFC

Offline kscope09

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Re: Advice following Microfracture
« Reply #4 on: March 16, 2010, 04:05:35 PM »
Is your mfx on a weighbtearing area, if not you'll have a better chance of being able to return.

My situation is similar since i'm a Karateka, I trained for 15 years and had newly gained my 3rd Dan when I tore my acl along with some cartliage on the non-weightbearing part of the medial femoral cordyle.  The acl tear was only tiny and the OS said I could return, but the rehab has been incredibly hard.  I only had a chrondoplasty, which is not as inense as mfx and I'm constantly worried with every little bit of pain in that area, that it might have failed even though I had an mri that confirmed it hadn't, I worry it has failed sicne then.  Assuming everything is alright I should be alright for the basics but I'll lose my former kicking ability.  In Karate you can get away with not beinga great kicker but I know in TKD it's your bread and butter, so I would say; go through the pt and talk with as many people as you can who've had similar surgery and got back into MMA (especially TKD) and see if you can find a pt who does MA.
When I return to training which I hope will be later this year, I will be consulting a biomechanist who is also a 5th Dan Karate instructor who should be able to adise me as to the best ways to  safely return and get as much of my former ability back as possible.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline cjtkd

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Re: Advice following Microfracture
« Reply #5 on: March 16, 2010, 04:12:13 PM »
Hi and let me welcome you to the "mfx club". How big was your defect and where was it located? That plays a big part in how your recovery will play out. The best advice i can give you is to be patient. I am 13.5 months out from my mfx and only in the last couple of months have gotten back to the sports activities i was doing before i got hurt. There seem to be many different opinions as to whether one can run and do high impact activities after mfx-case in point: my OS' assistant told me that i would never want to try to run again, but when i asked the OS about this he said that wasnt the case and that it would be okay to return to sports. He did say to avoid running long distances for exercise. So i went ahead and started playing again when i felt ready and so far my knee is holding up. With that being said, it took nearly a year before i felt ready to try and i'm glad i didnt rush back into it too quickly. My other advice is to religously put in the time on the CPM and keep your weight off the injured leg at all times. If you can start doing some light pedaling on a stationary bike in a couple of weeks that seems to help. Just take it easy because its a long road back and you want to give yourself the best opportunity to heal properly. I think your age is in your favor (i was 35 when mine was done) so you should have a successful recovery. Good Luck!
                                                                                           Joel

Forgive my newness to all this, but could you explain what CPM is? With regards to weight off my leg, all ive done since Saturday is gently walk about with crutches, I did try without them today and whilst not painful I wasn't at all confident so I returned back to a single crutch.

Kscope09 - I'm sorry to say that I wasn't told the specific position of the defect. The painful area is on the inside lower area of my knee, I could touch the painful area so it wasn't between the joint if that makes sense? It was more to the front it seems. Prior to the op I could run ok, train ok but occasionally I would get the most awful stabbing pains and then nothing again for several weeks. Does that suggest that it might only be a small area?

Offline kscope09

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Re: Advice following Microfracture
« Reply #6 on: March 16, 2010, 04:31:46 PM »
With me I had the lesion on the medial side but most of the pain on the lateral side.  After the injury in Feb 08 I kept training for 6 months before my injury got the better of me and I realised it wasn't going to go away.  In that time I actually seemed to get better around April/May and thought I'd be back to normal soon, and my training didn't seem to aggrivate things that much.  I could still do most kicks, though they started to get a bit awkward.  When i went to pt the therapist was barking right up the wrong tree and said I had an mcl sprain because of tenderness when she pressed it.  She said 3 months of rest and I could go back with no restriction, but 3 months later I didn't feel better because I lost so much muslce mass but at the time I thought it was the smelling oging down, that made my knee feel so much bonier.  After that I trained when i felt upto it but it was always on my own and havn't been in a regualr class line-up since August 08.  I kept up my kata and basics but some things were just getting harder to do and it was getting harder to put power into the techniques.  I reckon that you didn't suffer that much pre-op because your muscles were still strong.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline jt801

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Re: Advice following Microfracture
« Reply #7 on: March 16, 2010, 06:31:14 PM »
CPM stands for continous passive motion. Its a machine that moves your leg slowly back and forth making your knee joint flex. It helps to restore range of motion after surgery and in the case of mfx it smooths off the scar tissue and the motion is supposed to stimulate the new cartilage to develop. Its prescribed after most microfractures-in my case i had to do 6-8 hrs a day on it for 6 weeks. My defect was in a weight bearing area; it sounds from what you are describing that yours possibly is non-weight bearing area. Weight bearing area microfractures require 4-8 weeks on crutches-if yours is not weight bearing area than thats another thing in your favor.
12/99 left knee lateral release and plica removal
1/09 right knee chondroplasty and microfracture LFC

Offline cjtkd

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Re: Advice following Microfracture
« Reply #8 on: March 16, 2010, 06:36:42 PM »
With me I had the lesion on the medial side but most of the pain on the lateral side.  After the injury in Feb 08 I kept training for 6 months before my injury got the better of me and I realised it wasn't going to go away.  In that time I actually seemed to get better around April/May and thought I'd be back to normal soon, and my training didn't seem to aggrivate things that much.  I could still do most kicks, though they started to get a bit awkward.  When i went to pt the therapist was barking right up the wrong tree and said I had an mcl sprain because of tenderness when she pressed it.  She said 3 months of rest and I could go back with no restriction, but 3 months later I didn't feel better because I lost so much muslce mass but at the time I thought it was the smelling oging down, that made my knee feel so much bonier.  After that I trained when i felt upto it but it was always on my own and havn't been in a regualr class line-up since August 08.  I kept up my kata and basics but some things were just getting harder to do and it was getting harder to put power into the techniques.  I reckon that you didn't suffer that much pre-op because your muscles were still strong.

I plan to run through basics as soon as I can walk ok, by basics I mean extremely slow, think Tai Chi, as I am worried if I go from training 6 days a week (upto 4 hours a day) to zero I'm going to end up with more than just a sore knee! Obviously for the time being all Im doing is hobbling about ever hour or so to avoid DVT setting in.
Im guessing slow leg movements with no knee locking or impact (jumps etc) should be ok as I practiced this most days to improve leg control and improve leg strength. Im talking VERY slow movement... ok would you think?

Offline cjtkd

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Re: Advice following Microfracture
« Reply #9 on: March 16, 2010, 06:38:52 PM »
CPM stands for continous passive motion. Its a machine that moves your leg slowly back and forth making your knee joint flex. It helps to restore range of motion after surgery and in the case of mfx it smooths off the scar tissue and the motion is supposed to stimulate the new cartilage to develop. Its prescribed after most microfractures-in my case i had to do 6-8 hrs a day on it for 6 weeks. My defect was in a weight bearing area; it sounds from what you are describing that yours possibly is non-weight bearing area. Weight bearing area microfractures require 4-8 weeks on crutches-if yours is not weight bearing area than thats another thing in your favor.

I was told by the nurse I only had to use the crutches till I found I could walk ok on my own so Im guessing its not a weight bearing location? I was not at any time told to use the crutches for 4 weeks so maybe that again is a good sign, that or the gave me rubbish advice.

Offline jt801

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Re: Advice following Microfracture
« Reply #10 on: March 16, 2010, 08:24:48 PM »
If i were you i would consult with your specialist before you try anything exercise related. At this stage the marrow clot that will become your new cartilage is very fragile-one wrong step or jump and you could undo the whole procedure. I've read that it takes about 8 weeks for the clot to turn to fibrous tissue. Even if your defect is in a non-weight bearing area you have to do your utmost to protect that area until it is fully healed. My advice is to hit the stationary bike or get in the pool at this stage if you're worried about keeping your fitness level up. Just my thoughts.
12/99 left knee lateral release and plica removal
1/09 right knee chondroplasty and microfracture LFC

Offline Lottiefox

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Re: Advice following Microfracture
« Reply #11 on: March 16, 2010, 08:53:04 PM »
Ditto to other advice - weight bearing or not be VERY careful with anything involving impact or jumping for a good while. I would also check exactly WHERE the defect was, how big it was, and make absolutely sure of the weight bearing/crutch advice. Do you have any PT referral?

After MFX you want to focus on dull dull leg exercises to get back ROM and allow the site to bed in and heal. Straight leg lifts, quad sets, heel slides...yada yada......especially within the first few days to weeks. When ready - the staitionary bike and pool are good options to start off with. It doesn't matter how fit you are, you've GOT to treat a MFX site carefully.

good luck and keep us posted

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline kscope09

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Re: Advice following Microfracture
« Reply #12 on: March 16, 2010, 09:48:40 PM »
That's right, except I wasn't told 8 weeks, I was told 12 before you had the fibrocartliage and then another couple of months before it settles down, and I only had a chrondoplasty.  One of the questions I asked my pt in September was, "will I be OK to do my Xmas shopping in Leeds and York" and I expected a Yes, but he said, "no way, you can't be going around spending all day walking around on ahrd surfaces until after Xmas."  He wouldn't even let me go up stairs with that leg until after 12 weeks.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline cjtkd

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Re: Advice following Microfracture
« Reply #13 on: March 16, 2010, 10:29:00 PM »
Ditto to other advice - weight bearing or not be VERY careful with anything involving impact or jumping for a good while. I would also check exactly WHERE the defect was, how big it was, and make absolutely sure of the weight bearing/crutch advice. Do you have any PT referral?

After MFX you want to focus on dull dull leg exercises to get back ROM and allow the site to bed in and heal. Straight leg lifts, quad sets, heel slides...yada yada......especially within the first few days to weeks. When ready - the staitionary bike and pool are good options to start off with. It doesn't matter how fit you are, you've GOT to treat a MFX site carefully.

good luck and keep us posted


I've been asked to return in 3 to 4 weeks and need to wait for an app to arrive via the post

Lottie  :)

Offline mmrocker13

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Re: Advice following Microfracture
« Reply #14 on: March 16, 2010, 11:59:59 PM »
Depending on where your lesion was--medial, lateral, tibial, femoral, or patellar... the amount of time you need to spend on crutches will differ, as will the length of your rehab and when you can return to activity.

I had a very large lesion on my lateral femoral condyle (too large, really, for a successful mfx). NWB for about 6 weeks, and on the crutches until about 8 weeks. I didn't get back on a bike or elliptical trainer until around 6 months. I also was allowed to resume "fitness walking" at that point. I started a run/walk mix at about a year post op, and resumed "full" running at about 18 months.

The absolute BEST thing you can do is take your return to activity slowly. I know it is painful, but giving the fibrocartilage time to form and set up is your best bet.
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty















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