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Author Topic: Mosaicplasty on MFC and Patella plus microfracture on 9th July!  (Read 11815 times)

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Offline AndrewH

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Afetr having a failed microfracture on the MFC last June I'm going in for mosaicplasty next week on 9th July.

Defect was about 1.5cm2 - hopefully it won't be much bigger, we will see.

Background is that I am 40 and began getting into running in my mid 30s after putting on some weight after giving up smoking. It turned out I was quite good at it - 35.15 10k, 1.22 half marathon my last 2 race times before injury in Oct 2008. Was training with some like minded runners and was probably over training. Was averaging around 70 miles per week when I got injured.

I never really felt at any time that the microfracture had worked. I landed heavinly on my affected leg the very night after the surgery as I almost slipped coming down the stairs. I also landed heavily on the affected leg twice while hoovering on crutches (well, I used the hoover as a crutch and hopped about - before turning and tripping over the wire!) This time around I will be taking things very very easy.

I have 3 weeks booked off work for recovery and will have the wife and kids to help me and keep me amused. I slowly started smoking again during the past 12 months as I knew the microfracture hadn't worked and also had the stress of finding a new job after being made redundant. I have now stopped smoking for the past 2 weeks in preparation for the surgery. I've also been going to the gym more regularly to get in some cycling and keep my upper body strength up for the crutches.

Hopefully this surgery will be a lot more successful. My surgeon says he's never done a mosaicplasty that has failed.
« Last Edit: September 12, 2010, 04:24:34 PM by AndrewH »
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline mike40

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #1 on: July 06, 2010, 04:47:30 PM »
Hi andrew,

I have a similar story to you. I was a dedicated runner which overdid it everyday. a sports injury led me to have a bad knee which i later found out I had a crater in my medial femoral condyle and an acl tear, this restricted me from doing everything - from walking to even riding a bike (sucked big time). I decided to have both the acl repair(hamstring) and OATS procedure done at the same time and I could say recovery has npot been as bad as expected. It was a 6 week non weight bearing with constant bending and icing of the knee. at 6 weeks i began partial weight bearing which was weird at first but slowly got easier. swelling by this point, at 8 weeks,  is almost gone and the knee feels very good. The only downside is the crutches which are dangerous at times and the loss of leg muscule. I hope all goes well on your procedure and if you have any questions feel free to contact me. I begin full weight bearing next week. which is the defining moment of this experiance so i will keep ou posted. good luck

Offline AndrewH

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #2 on: July 07, 2010, 08:43:44 PM »
Hi Mike

Good to hear from you.

Did you tear the ACL and damage the cartilage at the same time? How big was the cartilage defect? I presume it was also on the medial fermoral condyle?

Please keep me updated with your progress - I'll try and give regular updates as to how I am doing.

Less than 2 days to go now for me. Dreading it and looking forward to it at the same time! I was 6 weeks non weight bearing last year and lost a lot of muscle. My right leg still looks a lot more skinny than my left leg over a year later - although the fact that the microfracture hasn't worked hasn't helped me with trying to regain muscle. I've tried various exercises whilst trying not to aggravate my knee. Cycling in the gym seems to be the best for it. I did a lot of cycling in the gym in the first 6 months after I started weight bearing again but it tailed off in the last 6 months for various reasons, one being me losing my motivation.

I really hope this surgery works. I would love to try and take up cycling and see if I can attain the same levels as I did with running.

BTW - are you based in the UK? Did you get a CPM machine after surgery? How many nights were you in the hospital?
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline Lottiefox

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #3 on: July 07, 2010, 10:19:29 PM »
Good luck for Friday Andrew, I remember you posting about your failed MFX and that you were hoping to do something else this summer.

Sounds like the mosaicplasty has a better outcome rate overall and hopefully will get your knee back to better strength.  ;D

Let us know how things go. Is this done via scope or is it an open surgery?

All the best

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 AndrewH

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #4 on: July 08, 2010, 08:51:54 AM »
Hi Lottie

My surgeon told me that it will be open surgery.

Iíve been worrying like mad whether Iíve made the right choice to go with mosaicplasty rather than ACI. There were were a few considerations. First up, the local private hospital where I will have this op does not have a licence to ACI (needs authorisation from transplantation authority or something like that Ė I did look into it and so did my surgeon as he used to do ACI at this hospital until the new regs came in). I then enquired about going down to see a surgeon in Oxford (I live in the Glasgow area) and booked an appointment. However I eventually decided to cancel that and go with the mosaicplasty.

My surgeon is leading the Active trial in his area to see whether ACI or mosaicplasty is better. He thinks (although he wonít say it outright!) that ACI will turn out to be better. However he does think that both are much better than microfracture and heís never had a failure with either. I could have gone onto this Active trial via the NHS and had the op at a hospital right across the road from my house. However it would have meant more months on the waiting list and then being randomised to either surgeryÖ. I could have waited months and ended up with mosaicplasty anyway!

Iíve done a lot of research of my own however.

Handgody, based in Hungary, has published details of his study of over 1,000 surgeries and has had a 92% success rate with mosaicplasty on the MFC. He didnít use a control group in his study and his success rate is boosted by self selecation of patients who he thinks will be a success Ė but that is what should happen anyway, isnít it?

A study by Saris concluded that ACI was no better than microfracture while a study by Knutsen concluded that microfracture was better than ACI. A study by Gandas concluded that mosaicplasty was better than microfracture while a study by Dozin concluded that the results of ACI and mosaicplasty were equal. There have been a few other studies into mosaicplasty / OATS which have also given good results. In a study by Horas, it was found that the clinical outcome of mosaicplasty v ACI was the same but that the recovery for mosaicplasty was quicker and that there was a greater % of hyaline cartilage.

The one study that has gone against mosaicplasty / OATS was one by Bentley et al which concluded that ACI was better than mosaicplasty and that the continued use of mosaicplasty was dubious. Reading further into this study however raised concerns for me. The average lesion size was 4.66cm2 which is very large for mosaicplasty and favours ACI. In addition, the moasicplasty results were dragged down by patellar failures plus the study also stated that the plugs were placed slightly prominently Ė while all other protocols state that they should be positioned flush. The sample size was also just 100 compared with over 1,000 by Handgody. Yet, despite this, mosaicplasy still had a 74% success rate in this study.

I've also read a lot on this website!!† ;D

It seems to me that all alternatives have pros and cons and risks. Iíll just need to follow the rehab protocol to the letter, be very cautious with non weight bearing for at least 6 weeks before gradually moving to weight bearing (I tripped 3 times last year when non weight bearing and then started weight bearing before the 6 weeks were up and virtually dumped the crutches after only a day of partial weight bearing Ė I regret that now).

Iíll post as much as I can through my rehab. I know there are people who read these things without necessarily replying themselves.
« Last Edit: July 08, 2010, 09:22:05 AM by AndrewH »
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline AndrewH

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #5 on: July 08, 2010, 08:54:10 AM »
By the way Lottie Ė how are things going with you? What is the latest?
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline lis1

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #6 on: July 08, 2010, 02:04:43 PM »
Good Luck tomorrow Andrew

BTW i had this procedure (open) 2 years ago and my cartildge looks good, no more OA and i too was nervous as predominantly i am not an ideal candidate (overweight and previous failed surgery, MFX and ACL)

I had 12 plugs covering quite a vast area, and after last years ACL revision from a new surgeon i actually took the dvd of the op to the guy that did the mosaicplasty to show him because it was such a good job.

Be prepared for the 1st week or so to hurt........quite a lot, but it does get quite a lot easier after that.

Lisa
remidial meniscemtomy 1994
scope and tidy up july 2006
acl reconstruction and microfractures oct 2006 (failed on both counts)
oats june 2008 - very successful
acl revision patella tendon - oct 09

Offline AndrewH

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Re: Having Mosaicplasty on MFC on 9th July
« Reply #7 on: July 11, 2010, 03:30:43 PM »
Thanks for those words Lisa!† :)

12 plugs! I've had 5 plugs in total - 4 on one leasion and 1 in another. Yours sounds horrendous compared to mine! That gives me some confidence that this will work. My weight shouldn't be an issue as I'm well within the normal weight range BMI. In fact, I've put on about a stone in weight since I injured myself and now no longer look too skinny. I'm probably at my ideal weight just now appearances wise. My wife hated my skinny look - in fact no-one liked it! However being the ideal weight didn't stop the microfracture from failing.  :(

Just back home. Had to spend 2 nights in the hospital. The surgeon wanted me to reach 90 degrees on the CPM before he would discharge me. I actually reached it last night but it was too late by then to leave.

Well, the news was mixed. The original dameg last year was a 1.5cm x 1cm defect on the MFC. I was worried that it would have got bigger. However the surgeon told me that it it was now 1.4cm x 1.2cm and was filled by 4 plugs. He said that the defect had actually filled with fibrocartilage from the MFX op last year but was still soft and obviously hadn't given me pain relief. He therefore cleared it and did the plugs (makes me wonder would I have been better leaving it a few months more???)

That was kinda the good news - ie the damage hadn't extended.

The bad news is that I had further damage on the patellar which wasn't there last year - 2 lesions. That was a nasty suprise as I haven't really been doing anything that could have caused more damage. The surgeon reckoned it might have been there before or was soft and its just progressed.

There was one lesion on the medial side of the patellar, 8mm x 6mm, in a sort of v shape he said. He inserted 1 plug into that. There was also a slightly larger area of damage at the margin of the patellar he said and he microfractured that area.

So that's me now on the rehab. I am going to hire a CPM tomorrow so that I can keep doing it at home.

The pain was much worse that MFX alone. I can't really move the leg myself and the pain has been really bad at times. Not too bad just now though. Got a big line of staples up the middle of my knee. The surgeon explained that they now cut you up the middle of the knee as that is what will happen if they need to do a knee replacement in future.....† nice to plan ahead!† :D

I've been given paracetamol and also a morphine based painkiller which I get for a couple of days only. I've also been given dicolfenac but am not taking it was NSAID's can impair bone healing.

I'll continue with updates. Please feel free anyone to givce me any hints, tips or anything else. Any stories about recoveries, etc welcome.


« Last Edit: July 11, 2010, 04:09:01 PM by AndrewH »
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline lis1

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Re: Mosaicplaty on MFC and Patellar plus microfracture on 9th July!
« Reply #8 on: July 11, 2010, 07:10:59 PM »
Andrew welcome to this side of the horrendous mosaicplasty, but please be assured that it gets better.  At times you may get frustrated, i know i did but all in all i have to say that being arthiritis free right now means that there are definately no regrets, and now i have had that beautiful open scar down the middle opened twice!!

Hints...................mmmmmmmmmmmmmm do as you are told basically.  Dont try and rush the recovery, they say a year to get over it totally and thats a real year too, but as time goes on you get stronger all the time.  Get the swelling down if you can, that will help the healing and get plenty of rest.

My microfractures didnt work either and the surgeon who did them basically said i was too big to help further, go away you have arthritis learn to live with it and i will see you when you are old enough for a new knee.  I was fortunate to find another surgeon who although was honest in saying that my weight was not a good factor, was willing to weigh that against how fit i was and give me a chance.  Thank goodness he did because it was a success.  Are you on facebook?  i have some knee pics on there?

Lisa
remidial meniscemtomy 1994
scope and tidy up july 2006
acl reconstruction and microfractures oct 2006 (failed on both counts)
oats june 2008 - very successful
acl revision patella tendon - oct 09

Offline Lottiefox

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Re: Mosaicplaty on MFC and Patellar plus microfracture on 9th July!
« Reply #9 on: July 11, 2010, 07:17:06 PM »
Hi Andrew

Great to hear that you're through and home and recovering. Bit of a bummer about the patella damage but it sounds like perhaps addressing it at this stage will stop anything further happening. Keep us posted on the recovery, are you completely NWB or can you toe touch?

You asked about me - I've been lucky enough to see some progress with religious PT but the lesions obviously remain. I am limited from running or impact work but otherwise the pain is pretty well controlled apart from the odd PFS type of flare on the kneecap. I am still favouring the Cartifill option and waiting for that to be available via scope next year and for further results to be made known about the initial patients going through it with Mr Shetty in Kent and around the globe. The bad news is that my foot gave up the ghost this year - big toe problems and I am in for foot surgery this week - eeek! Typical! Joints are a nightmare. †::) :o

Good luck with the next few days and I hope the pain comes under control,

Take care

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 AndrewH

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Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
« Reply #10 on: July 11, 2010, 11:37:49 PM »
Thanks for the replies guys!

I'll keep giving updates.

Lisa - I almost can't believe I'm having to go through another year of rehab! I'm at the stage now where I can't imagine what it would be like to have a normal knee again....  :-\

Going to give it all my all to get better though. Just resting just now though. Going to hire that CPM machine tomorrow morning though.

Lottie - I'm NWB but physio and surgeon have said I can touch toe down in order to keep balance, eg going up stairs or where necessary. Better to keep balance and avoid falling.  Pain is not too bad just now - although I did take an oxycodone tablet 4 hours ago and its been helping! I've got a supply for 3 days so I'm hoping the worst will be over by then.

I'm at least now able to get up and down from seats and into bed myself. That was really bad yesterday.

I'm actualy quite optimistic now that I've had the op> I now at least feel as though I'm heading in the right direction.  :)
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline AndrewH

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Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
« Reply #11 on: July 13, 2010, 07:50:21 PM »
4 days post op now.

Pain is okay, well below 5 on a scale of 1-10. I'm only taking paracetamol now a couple of times a day. The CPM machine arrived today and I've done a couple of hours on it so far. Got the flexion up to 90 degrees so far.

Strength in my quads has disappeared though. I'm totally unable to lift my leg at the moment!

June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline AndrewH

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Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
« Reply #12 on: July 16, 2010, 10:26:07 PM »
That's one week post op today. Pain levels have been up and down this week. Today has certainly been the best in terms of pain.

Had my first visit back to the surgeon today. Nothing really happened, had a quick chat, got the dressing changed and he stressed how important it was that I did static quad exercises.

I cannot do straight leg raises with my affected leg at the moment. My quads just do not have the strength at the moment.Surgeon reckons its because I have work done on the patella, which was also my thoughts. I'll need to keep working away at those static quad exercises then.............
June 09 - Microfracture to MFC right knee 1.5 x 1cm
July 10 - Mosaicplasty to MFC right knee 1.4 x 1.2cm (4 plugs) plus mosaicplasty to small lesion on patella (1 plug) and microfrcature to another small lesion, also on patella

Offline ski-bum

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Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
« Reply #13 on: July 28, 2010, 04:19:23 AM »
Glad to hear that you are doing well.  I've been following your threads closely and really happy that you have moved forward and making progress by the day.  I may be close behind you with regard to OATS and have been quite impressed with many positive results discussed on this board.  Good Luck!!!!  Keep up the good work.  Post often and if/when you get down ask for support!
Marc
1995-ACL Repair Left Knee
2007-Partial Meniscectomy Left Knee
2009 (April)- Microfracture Medial Femoral Condyle Left Knee

Offline Lottiefox

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Re: Mosaicplaty on MFC and Patella plus microfracture on 9th July!
« Reply #14 on: July 28, 2010, 12:56:44 PM »
Hi Andrew

How are things going? Hope progress is smooth!  :D

Let us know how you are,

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....