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Author Topic: unplaned microfracture  (Read 1517 times)

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Offline missing my bike

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unplaned microfracture
« on: August 09, 2010, 07:17:21 PM »
hi  ;D
im a new member ive looked around and think this is an excellent site i have had a unplaned microfracture about two and a half wks ago i say unplaned as i went in for my third arthroscopy on my left knee, and did not expect to wake up and find out my surgeon had taking a drill to my bone.
I am not due to see my consultant now for another 5wks and do not feel i have had anything explained to me properly he did explain some things but this was the moment i had opened my eyes from the anisthetic and to be honest took very little if anything of what he said in.
i have been told to be non WB for 6 wks is this right? as my leg feels great and i feel like i could walk on it no problem.
i have had a copy of the letter sent to my g.p and although some of it i can understand its very much two doctors talking to one another and dosen't explain what it means for me in the long term all i remember my os saying when i came around was i would need a knee replacment  :'( wich im sure you can apriciate at 32yrs old was a bit worring and i understand they are very reluctant to do this until i am much nearer 60.
heres the break down of the leter if anyone could shed more light on it i would be very gratfull


PFPjoint cartlidge degenergration 2-3on patellar side and on femoral groove,normal trekking,free flaps shaved

MEDIAL COMPARTMENT
femoral cartlidge degeneration gr 2
tidial gr2
medial meniscus - norm stable
ACL partilally lost - knee 1 stable, PCL norm
LATERAL COMPARTMENT
femoral catlidge gr3 small area gr4 free flaps shaved
tibial degenaration gr4
lateral meniscus torn of anterior and middle third stable - big free flap resected
microfracturing of tibial plateau and fem,condyle
chriocane 20mls to tissues and knee joint

dont get me wrong i understand some of it i know the grading system 4 being the worst and the chicocane is pain relief what i dont know is things like my over all recovery time as being off wrk is costing me a small fortune and im finding it really hard to stay positive  :-\
so i surpose the main queistions are when can i wieght bare?
how long off wrk i do a high impact job?
is this a servere op? and how many of my bones have had a drill taken to them?
on the plus side im droping the pain killers and my leg feels prety good

oh the back ground to my injury is i feel off a mini digger when i was 19 this is were the ACL tear came from and why my knee has deterated in this way
thanks for reading and hopefully posting
oh and i do really miss my bike lol

Offline Teacher2Many

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Re: unplaned microfracture
« Reply #1 on: August 09, 2010, 08:57:16 PM »
Hi,

Sorry to hear of your unplanned surgery-nothing worse than going in thinking one thing is going to be done and then waking up and finding out much more was done.  But sometimes that's just how things go, as they don't know the extent of the damange and/or how to fix it until they go in and it's best to have it fixed in one operation then to have them tell you what's wrong and then you have to go back again to have it repaired (at least in my mind that is-I always tell my surgeons to fix whatever is broken, even if it's not something we discussed as I don't want to have to have yet another surgery).

Non weight bearing for six weeks is the norm after microfracture as you don't want to put all your weight throw that joint while the cartilage is trying to heal-it won't work if you do.  There should be a protocol that you follow re: a weight-bearing schedule, such as when you can increase the weight and by how much, and you should be up and about in PT as well.  I went in for a cartilage biopsy in 1/09 and my surgeon's PA wanted my okay to go ahead and do a microfracture if they found it to be necessary (plan was to do a biopsy and then follow-up with doing an ACI so this wasn't anything previously discussed).  I refused as I knew 6 weeks off of work wasn't an option, as I teach 3-5 yr. olds w/severe disabilities, and that for me, it probably wouldn't work due to having such large chondral defects.

For some people, this surgery (or ACI) works great, for others, not so much.  But the key to helping it work great is to do exactly what your doc says-don't try to put weight through it if you haven't gotten the clearance, make sure you're following up w/the exercises they prescribe, and even after you get the clearance to bear weight, be careful.  Don't go running or doing high-impact sports until your doc gives the okay.  If you are one of the ones where it works great, knee replacement won't be necessary for a while.  But if this doesn't work, they'd probably go ahead and try an ACI first before even talking about knee replacement.  And I know it's not the norm for someone your age-they were considering doing a patellafemoral joint replacement on me this past summer due to persistent knee pain after bilateral ACI in 6/09 and I am only 28.  Luckily, we found out what the true issue of the problem was and have gone the route to fix that first but am sure that somewhere down the road, my knees will need to be replaced-the damage is too extensive to assume otherwise.

The point of microfracture is to drill holes in the bones surrounding your chondral defects with the notion that the healthy marrow will seep out of the holes (for lack of a better term) and fill the chondral defects.  This is why it's extremely important to be cautious with weight bearing, as you want to ensure that those holes can be filled w/out the pressure of the bones rubbing, etc.

Compile a list of questions and concerns that you have and e-mail them to your surgeon.  If you don't hear back within 48 hrs. or so, follow-up with a phone call to his office.  Waiting 5 weeks for a follow-up is a bit much, all things considering, esp. if you have unanswered questions.  Inquire about getting into PT if you aren't in already, as that will definitely help w/the recovery.  Did they give you a brace for your operative leg as well or just the crutches?

Happy healing!

Beth
6/07-L TTT & LR
6/08-R TTT & LR
6/09-Bilateral ACI
7/10-R derotational femoral & tibial osteotomies, LPFL reconstruction
6/11-L derotational femoral & tibial osteotomies, R hardware removal
1/12-L tibial hardware removed, R scapulectomy
4/12-L femoral hardware removed
7/12-L & R MPFL reconstruction

Offline missing my bike

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Re: unplaned microfracture
« Reply #2 on: August 10, 2010, 10:50:50 AM »
hi beth

Thakyou for replying so quickly i have just got off the phone to the clinic and asked for a follow up appoitment asap they said they would send me one out so fingers crossed its not to far away. (didnt have a email address for my os) I was just sent home with crutches there is no bracing on my knee there was just a surpport bandage which was removed after 5 days i am hopeful that the knee is healing well.
I do think that its v.poor theres no follow up with a pt as i think this is v.important to the healing process. All i can think is theres not a lot i can do untill the wieght bearing begins other than the few basic exercises i was given. straight leg raises. tensing quads. and high chair leg bending..
I am pretty sure that ACI hasnt received aproval here in the u.k, but hopefully it wont be long as i think this is the best route to go down to delay a TKR
how did you find the ACI?
thanks again for your replay take care and i hope they manage to sort your knee soon
Andy

p.s can any one shed any more light on ACI  and if it has been or will soon be aproved by N.I.C.E in the u.k??

and i am still missing my bike!!!!

Offline Vickster

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Re: unplaned microfracture
« Reply #3 on: August 10, 2010, 11:10:35 AM »
ACI does not have NICE approval in the UK.  There are ways to get it on the NHS and there is a 28 centre trial ongoing.  Google Active trial.  But patients aren't eligible if they have extensive OA, and especially on the tibia I think (details on the website).  I am seeing an OS about the trial next week as my private insurance company won't cover either - I have one traumabtic defect on lateral femoral condyle!  Microfracture has been discounted as I already have fibrocartilage filling the hole, but the knee won't settle with it  :(
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline missing my bike

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Re: unplaned microfracture
« Reply #4 on: August 10, 2010, 02:04:24 PM »
thanks vickster

thankyou for the info ive had a look at the trial page you surgested not sure if they would except me. have to wait and see how the microfracture heals first..
good news as i was looking at it the clinic rang and i've got a appoitment nxt wk :) so hopefully i willl get some answers on my op although my os has now left  :(
i wish you all the best with the trial and hope that you get a positive outcome  :)

Offline ajparis

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Re: unplaned microfracture
« Reply #5 on: August 10, 2010, 02:18:47 PM »
Hi there--

you may not get to hop on your own bike, but pt means a recumbent bike for "long rides."

I too had an unplanned mfx at age 63. After 6 weeks have almost full rom. But I can tell when I've done too much as I have shin/ankle pain that curtails me or some limping. My pt said i will probably need a knee replacement, but with continued good healing and following all the exercises, I can hold off for 10 years. I don't know if that means someone your age would only get 10 years, but at 63, that sounds good to me.

Good advice from this board--including "don't put pillows or cushions under your knee as it prevents straightening your  knee. Support the ankle and continue to do heel pumps and quad sets."

Best of luck for speedy healing and clear communication between  you and your medical staff.

aj retired

Offline missing my bike

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Re: unplaned microfracture
« Reply #6 on: August 10, 2010, 02:43:06 PM »
hi

thanks for posting and really nice to hear someone with a positive outcome.. :)
my knee feels really gd even at this early stage less pain than before the op might be due to the fact i have been resting were as before i was working right up to the day before..
this is the third time they have been into my knee for arthscopy and the only time ive not had physio with in a wk of the op so am a bit shocked??
hopefully i will get more answers nxt wk
the other thing thats buging me is the lack of consistancy in my care guess thats the joys of the nhs never see the same consultant twice (well thats how it feels anyway)
who knows what the future will bring and i need to put the TKR off for as long as poss and ten years is a start i've had 6yrs between my last arthroscpy its just alarming how much my knee has deteriarated in that time  :(
I just cant belive how much ive been kept in the dark this time just feels like no ones telling me anything
ive just found out the clinic were i had my op has just changed hands aswell maybe the old staff gave up caring  :-\

thanks again take care and  good luck with your continued recovery
Andy

p.s i know i need to get on a static bike but wont untill ive spoke to a physio or consultant just to be safe


and i still miss my bike!!!!!!!

Offline Vickster

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Re: unplaned microfracture
« Reply #7 on: August 10, 2010, 02:46:24 PM »
I know that the outcomes for ACI are less good if the area has been previously microfractured.  One of the reasons my surgeon isn't considering it for me (even though it would be covered) - he did explain, damage to the subchoncral bone or some such means poorer outcomes for subsequent repair.  Also, my knee evidently is averse to fibrocartilage in that area, hence wanting to try for a better surface!  I can ride a bike - although not very far without it being sore and expecially on hills, but there is no reason why you won't be able to do once healed assuming the pain is tolerable :) Just don't fall off like I did!  ::)

Good luck for your appointment - make a list of questions before you go :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline missing my bike

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Re: unplaned microfracture
« Reply #8 on: August 10, 2010, 03:33:47 PM »
thanks im sure i will be back on my bike soon as all i need to do is bend my knee far enough and be able to climb off as the bike im missing has a motor to get me around lol... i will defenatly take the the advice on a list other wise i will forgot some of the things i was going to ask..
thanks again and gd luck
take care
Andy
p.s im a motorcycle instructor part time and falling off isnt an option  ;)















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