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Author Topic: Symptoms from cartilage defect(s)  (Read 3569 times)

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Offline Vickster

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Symptoms from cartilage defect(s)
« on: October 12, 2010, 02:02:28 PM »
I have now been dealing with my gammy left knee for 13 months and am getting more and more frustrated with lack of change, progress, recovery, whatever you want to call it :)

I came off my bike (  ::) ) at a reasonable speed onto concrete and tore the lateral meniscus (partial meniscectomy in Feb which resolved the locking and buckling), bruised the bone of the lateral femoral condyle and knocked a chunk of cartilage off the LFC on a WB bit (I also have a grade II defect of the tibia opposite, assume caused by accident), I also have grade III wear & tear to the patella (shaved during February scope).  I never had a great deal of pain even at the time and hobbled around without crutches or anything else.  The scope was primarily to sort the meniscus but there was also a possibility of microfracture depending on the state of the osterochondral defect.  However, this wasn't done as the defect has already naturally filled with fibrocartilage. 

So where am I now? I realise that scopes can take months to get over, but it was 8 months ago and I have the same level of swelling and soreness I had after about 4-6 weeks.  Sometimes better on the soreness front - can get a burning from the defect area and it is puffy around there and if I push against or twist on it, I get a sharp pain.  It also starts to ache laterally with walking - after say 10-15 minutes not miles by any means!  It can also burn or be sore just lying in bed.  The whole knee also gets really stiff when I sit for any length of time (maybe 30 minutes plus) which does ease off with a bit of a hobble!

The kneecap also pops and grinds when I bend and straighten, not usually uncomformatble.  The OS said this wasn't unusual after the shaving as suction can occur!

I am able to walk fairly quickly (but any sort of running / jogging is a no no) and I can use the gym - static bike with some resistance, stepper, XT, walk on treadmill.  With rowing, it feels ok at the time as long as I don't over bend or over straighten but the knee seems to react quite badly the next day (may just be a coincidence).

I take minimal painkillers - it is uncomfortable rather than downright painful and I think I have just got used to it feeling 'off' the whole time, sometimes with sharp pains which pass.

My OS firmly believes all of the swelling and discomfort is the result of the scar tissue over the defect.

I was going to have AMIC but my insurance company wouldn't cover it.  My OS suggested I see another OS at the RNOH in Stanmore about the possibility of cartilage / repair on a clinical trial which I did.  He however, was not of the opinion that my functions and symptoms really warranted such major surgery and said I should decide what level of restriction I could live with.  He did say he would be happy to scope the knee again and have a look (fresh MRI showed improvement versus the one done about a month post injury).

I am 38, probably 6 kg overweight (I have lost 16 already this year) and have an office job that does require travelling / visiting clients from from time to time.  Try to go to the gym 3 x a week and do around 30-45 minutes of cario leg stuff - not painful per se, but none of it feels smooth and comfortable. I can't do any sort of medium-deep squat (pain through kneecap), nor can I kneel on it.

I saw the physio again yesterday but I think he is at a bit of a loss as to why the pain and especially swelling persists - something in there is angry and irritable it seems.  he says that if I wasn't doing any sort of exercise then the stiffness could be explained perhaps and he doesn;t think I am overdoing it given the amount of time that has passed since injury and op.

The knee had been more settled for around a month but has flared again recently - I don't think I have been doing anything more or unusual (perhaps more walking as have been carless, but again only 10-15 minutes at a time really to stations etc)

I think I am at a bit of a loss as to what to do as nothing I do or don't do seems to maike any difference for a sustained period of time :(  I know lots of you have cartilage defects and I was wondering what sort of (level of) pain you have, qwhat level of function impairment and how you deal with it and what you can do that doesn't upset your knees? 

Maybe this is just now 'normality' for me and my knee, but it would be great to know how to deal with this new reality and not feel so damned frustated and fed up all the time!  >:(

Thanks in advance and apologies for the ramble!

« Last Edit: October 12, 2010, 02:07:20 PM by Vickster »
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 AndrewH

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Re: Symptoms from cartilage defect(s)
« Reply #1 on: October 12, 2010, 03:21:12 PM »
You say that the insurance company won't cover ACI? Who is your insurance company? Are you in the UK? As far as I am aware, AXA, BUPA & Prudential all cover ACI.

I considered ACI but the hospital wasn't licenced. The only option was to try another hospital or go on the clinical trial you mentioned (which would have meant getting randomised to either ACI or mosaicplasty - and would have been done by the very same surgeon!)

There is also the option of mosaicplasty which I had 3 months ago after a failed microfracture last June. So far I am happy with the results of the mosaicplasty on 2 lesions plus microfracture on the patella. It seems to be working.

My surgeon said to me that the most important thing with articular cartilage defects is to get them treated as soon as possible. I also wouldn't say that the mosaicplasty surgery I had was *that* major. If you can cope on crutches then 6 weeks non weight bearing is really not too bad. I was back at work after 3 weeks (sedentary job) but could have been back much quicker. I've already got my full ROM movement back as well - and I had full open knee surgery with a massive incision down my knee and work done on 3 different lesions.

If I were you I'd find a surgeon who will get you sorted.
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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #2 on: October 12, 2010, 03:48:38 PM »
Andrew, thanks for your reply

It is one of the three companies mentioned (and they do not cover, not going to say which one it is) - their stance is that as (M)ACI is not approved by NICE, they won't cover unless part of the trial.

My OS doesn't like mosaicoplasty, an old procedure and he doesn't think the success rate is high enough.  Also, the defect is on a curved surface and given the size (1.5cm2) would be very difficult to plug successfully.  He said he would do it as a last resort - I dk if I am there yet, this is my quandary.   He did say none of this stuff really works for the patella.  i assume when you say the MFX failed your defect was through to bone.  I guess mine is currently similar to a successful MFX as it is well filled with fibrocartilage, but is just tender - so fixed, just not settled. I do trust his judgement, have no problem with any course of action followed thus far and cartilage repair is one of his special interests and has experience.

The issue is it is not easy to get sorted due to the insurance being buggers (they do have a rep for querying claims and being difficult, corporate policy so no choice).  I have never been in the NHS system for the knee.  I have seen 2 surgeons, one would operate but can't due to the funding, the other could possibly operate but not able to recommend it based on what he has seen (but he hasn't seen me 10+ times in 9 months, nor the inside of my knee).

Was your op very painful, everyone say (M)ACI is but not sure precisely which bit cause the pain and issues?  I had major back surgery when I was 20, 6 inch incision on lower back, hurt like h*** for a few days (try sleeping!) but then not too bad.  Can it be worse than that (it would seem so reading the ACI section and diaries).

All highly frustrating!
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 k66yla

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Re: Symptoms from cartilage defect(s)
« Reply #3 on: October 12, 2010, 06:34:21 PM »
Hi Vickster
I don't know anything about knees but I can understand how you are feeling regarding the burning pain & swelling. I've had the burning pain since my fall back in Jan 2009. Everytime I attended physio they done ultrasound massage on it but that did'nt relieve it. The only thing that did relieve the pain for a couple of weeks was an injection in that area. Do you think you could of torn your meniscus again?
I'm still waiting for my lateral meniscus op, next 4 weeks hopefully. You have me worried now if after 8 months you have'nt recovered.
April 83 - Right Knee Trauma
             2 Broken Wrists
1999    - Lateral Release Left Knee
Nov 10 - Anterior HornTear & Parameniscal Cyst Athroscopy Left Knee

Offline Lottiefox

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Re: Symptoms from cartilage defect(s)
« Reply #4 on: October 12, 2010, 07:21:06 PM »
I'm just going to chime in...playing devil's advocate there is no guarantee that the current knee issues are due to the defect/fibrocartilage per se. It may simply be an unhappy knee due to the traumas of accident and surgery. Undertaking a cartilage repair is no guarantee that the knee will become happy. If the lesion were down to the bone, you had severe issues with weight bearing or when the patella catches on it, then I would definitely say that a repair is in your future...but.......

Transient issues that may be down to the defect, may be down to a joint that won't settle, may be down to a menisectomy, may be down to constantly irritated synovium........that is a harder one to call and is basically what the RNOH doc was saying in my view.

I also think that one OS's views are not always gospel and not always right for your knee. Mosaicplasty isn't outdated, under the right circumstances. It has gained a reputation for failure when used in LARGE defects (and yours isn't clinically large) without adequate structure around them. Not dissing your OS, but they all have their bibles and views. My London OS says don't even bother trying to darn my multiple defects with any form of fix. (I know my knee is different in aetiology to yours) Mr Shetty however thinks that Cartifill would work. Who do I believe??! At the end of the day - it isn't their knee and future mobility!!!

Any form of cartilage repair is an unknown. Its still very new apart from the MFX which is the OS's first line of attack as it has fewer risks, is easier to recover from and might just work.

Fundamental question is how bad does the knee have to be that the risk of a more in depth repair is worth it? If this is your knee for good now can you deal with it?

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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #5 on: October 12, 2010, 07:53:01 PM »
k66yla - I don't believe the menisectomy is the cause of the problem - as I said it has removed the meniscus related pathology in my case - locking and buckling from walking.  There are no guarantees with any surgery, but if you do have symptoms that aren't going away that the doctor thinks is due to a meniscus tear, then in my view, time to get it fixed.  I followed a conservative course for 5 months and it didn't get better, if anything the tear got worse and I ground away a bit of the mensicus.  I could never straighten the knee but the buckling was a late addition to the party!  I don't think the meniscus is re-torn as I have had an MRI since the scope and nothing mentioned (not seen the report)

I don't regret having the scope, it's certainly not made anything worse.  I would just have hoped to see more improvement, nearing normality after so long.

Stuff to think about Lottie, thanks as ever :)  I could see 10 doctors and get a different answer from each!  I could have mosaicoplasty, the insurance would pay for it, but the OS has not seen good results especially in defects on the curved bit of the condyle which are harder to patch.  I already have 3 areas of cartilage damage to my knee already, do I want to have a 4th from the donor site with more lovely fibrocartilage even if it in an NWB area?  The lateral area is tender if I press it gently and it's also swollen.

I am really looking for some sort of feedback from folks with similar issues to assess whether the swelling and pain is just a normal consequence of the pathology or more unusual.  Ultimately, I am just at a complete loss what, if anything I should do  ???  If nothing can be done, then so be it!

My right kneecap (which the 2nd OS observed to have crepitus) was grinding on the leg press at the gym too today, marvellous  ::)
« Last Edit: October 12, 2010, 08:17:38 PM by Vickster »
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 AndrewH

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Re: Symptoms from cartilage defect(s)
« Reply #6 on: October 12, 2010, 10:12:33 PM »
Vickster, I am suprised that you say that one of those 3 companies don't approve ACI. I have seen ACI named as an available op for 2 of them on their procedure lists for certain.

My original defect was on the medial femoral condyle on a weight bearing surface. It was around 1.5cm2. I had microfracture last June. The pain never went away and I went in for mosaicplasty this July. The surgeon said that when he went into my knee, the original defect had completely covered over with fibrocartilage. Unfortunately it just wasn't doing the business.

He performed mosaicplasty on the defect this time and used 4 plugs. The gaps should fill in with fibrocartilage. Unfortunately he found 2 new defects on my patella this time around as well. I was suprised as I wasn't really having any issues with my patella. They are both small lesions. He filled one with 1 plug (mosaicplasty) and did microfracture on the other.

« Last Edit: October 12, 2010, 10:26:39 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 AndrewH

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Re: Symptoms from cartilage defect(s)
« Reply #7 on: October 12, 2010, 10:21:39 PM »
Sorry for the 2 posts Vickster.

To continue, I have done extensive research on mosaicplasty and would disagree that the success rates are not high. There is only one study where the researchers came out in favour of ACI instead of mosaicplasty and they stated that the continued use of mosaicplasty was of dubious value. There were several issues to notre with this study though. The study was small, the average defect was very large (over 4cm2) and the plugs were placed prominently. If you look at other studies, particularly Handgody's studies, the average defect is around 1.5cm2 and the plugs are placed flush.

Handgody's study (over 800 surgeries) gave a success rate of 92% on the medial femoral condyle. Mosaicplasty on the patella is more unusual. Nonetheless, he has a success rate of 79% on the patella. My own surgeon has done loads of mosaicplasties and says he has only ever had one where the patient had continued problems.

I am still at a very early stage (3 months) but feel that mine is working. I should know better at the 6 month mark, although improvements may continue up to a year.
I would advise you do some research on the many studies out there. Mosaicplasty has a very good success rate. My surgeon hinted to me that he expects the ACTIVE trial to show that ACI is superior.... but that goes back to the issue again of the type and size of defect. Mosaicplasty may not work very well with larger defects.

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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #8 on: October 12, 2010, 11:08:20 PM »
Hi Andrew,

Thanks for taking the time to post again.

One of the three companies definitely turned me down for the AMIC repair that my OS recommended (who as I said has been treating the knee for a year now on and off), despite it being disputed at a corporate level by HR and the OS writing to explain his reasoning at their request.  They were adamant - no AMIC, MACI or ACI unless part of a trial which is in line withe NICE guidelines (I even trawled through the 50+ page PDF)!  They basically expected the OS to produce long-term data.  Unfortunately, my OS was invoved in the Genzyme trial (SUMMIT?) but that has finished and is in the analysis and reporting phase or I would have been ok.  Mosaicoplasty isn't approved by NICE either but they seemed more willing to cover (assuming the OS wrote again - believe me this was all a royal pita), I guess because it take spare parts from the patient's knee, no need for costly membranes and cell culture (not that they ever said cost was a reason of course).

What sort of symptoms did you have from the defect that led to the MFX and then the mosaicoplasty?  Was the defect from an injury or wear and tear?  Sharp pain, ache, specific things set it off, were you able to walk ok - how far? What are you able to do now, 3  months post op? Sorry for all the questions, but I am trying to measure my own experience :)

I think that, for whatever reason, the lateral side is more problematic than the medial?  Ref the lack of success for mosaicoplasty, the OS said that he has been doing for 7+ years and had seen 50% success in his patients, certainly nowhere near 90% and the curved surface where the defect is located is problematic.  he said if it was a small punched hole, no problem.  My defect is around ~1.5cm2 too, for him, 2cm2 is about the max (I guess surgeons may try on larger if major symptoms no other options).

Nothing I do seems to make any sort of consistent positive impact, nor does anything obvious cause more issues than anything else.

Sorry for the wiffle!

This stuff is all really confusing, I think ultimately I am looking for a solution but I don't know what that is.  The physio even said that there is no magic bullet - he's as frustrated as I am!  We have a family friend who is a retired Consultant OS (and knows me as he operated on my back all those years ago), maybe I'll give him a buzz (he is aware of my knee woes from my mum lol).  He will definitely be on the conservative end of the spectrum, and was a general OS rather than a knee spec, but he will have some insight :)

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 Catsmum

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Re: Symptoms from cartilage defect(s)
« Reply #9 on: October 12, 2010, 11:27:01 PM »
Hi Vickster,

First time posting on this site so here goes....

I too have a cartilage defect in LFC on my L knee and was struck when reading your post how similar my symptoms are to yours. Constant swelling in knee, burning pain not too severe but definately uncomfortable. I am also getting some burning at night and stiffness in the morning. I too can walk reasonably fast but with a slight limp when I get tired but would struggle to run ( & I love running). So, yes, I guess your issues may well be caused by the cartilage defect rather than some residual inflammation from your meniscectomy.

I had no knee problems at all until an injury in May this year. My MRI showed a complete ACL rupture & meniscal tear. I  had ACLr & meniscectomy and the cartilage defect was picked up during the surgery. My OS offered me  microfracture, OATS or referral for ACI and after a lot of deliberation  I have  been referred to Stanmore for possible (M)ACI.

 I am now 3 months following ACLr & have not seen much improvement over the last 6 weeks in terms of swelling & pain. So I am now hoping for some joy when I go to RNOH next week!  

Offline Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #10 on: October 12, 2010, 11:58:22 PM »
Hi Catsmum
Thanks for posting (especially your first time)!
I didn't damage any ligaments (fortunately) - the meniscus tear and damage to the bone.  The pain is manageable, I could take more painkillers but I tend to be someone who takes them for acute pain only and am not happy taking long term for chronic.  I did discuss with the physio perhaps seeing my GP for a course of a prescription NSAID to see if that helps settle the knee but I don't think it is a long-term solution.  My surgeon also suggested hyaluronic acid injections as a possible help to lubricate the joint, but again he seemed less than convinced of their worth in my case (although people with OA do get immense benefit from them, and won't do any harm so might be my next course of action)

It will be interesting to know how you get on at Stanmore (presumably an NHS referral) and that they can offer you a solution. I actually saw the surgeon from there privately for the second opinion and his view was that MACI would send me way backwards from where I am now (a few nights in hospital, pain, brace, crutches) and that it would be a year to return to meaningful activity and 2+ years to clear benefit.  He did say it was very much my choice however and for me to decide what level of restriction I could live with.  I am not the most decisive, so am obviously still agonising over this.  If I was 68 or even 58, I would just live with it, but at 38 it is a tougher decision clearly especially with no guarantees :( 

I can't even fly comfortably - recent 2 hour flight to Berlin, bulkhead seat in business but both ways it was decidely uncomfortable for much of the flight and the knee was a s stiff as ever.  The physio said it should be better now - I don't know if it's the yomping around the airport that is the issue or the cabin pressure, the sitting or what! I'd like to fly long haul for holiday next year but economy would be impossible if I am where I am at now still.

Hope it all goes well for you

Vickster
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 knee always hurts

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Re: Symptoms from cartilage defect(s)
« Reply #11 on: October 13, 2010, 01:23:43 AM »
Hey Vickster,

If you are feeling poorly the day after doing an exercise, perhaps there is a connection between the two. If you are overdoing exercises at the gym on a regular basis, that could definitely prevent your knee from recovering. It may be a bit unconventional, but take a look at this post here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=53006.0

This individual had severe patellofemoral pain as well as significant chondromalacia defects, and yet ultimately made a complete recovery. I'd strongly recommend reading the blog linked in the first post.

If you don't mind wading into the abyss of medical research papers, these three might cast an interesting and novel light on your condition:

http://docs.google.com/viewer?a=v&q=cache:sIxlKJaiqGYJ:rehabeducation.com/main/wp-content/uploads/Therapeutic%2520implications%2520of%2520tissue%2520homeostasis.pdf+synovium+irritation&hl=en&gl=us&pid=bl&srcid=ADGEESiMFOXRVhxrNp-vyd2N412erMdLYT51ZxagCtws0q--x1BuKdZhvDaCJzzNAvqpjcUGZ6zJEMCf60Yg4McSC8qyqJswR9Yv4SvprHm0UDbt3e-W1MSLtb4nHXQiwt47Nx3sCd5a&sig=AHIEtbTwvpWG6Zql7FWhLn0MInvJsws4Ng

http://docs.google.com/viewer?a=v&q=cache:w42Ub7Mx5UYJ:rehabeducation.com/main/wp-content/uploads/Patellofemoral%2520Pain%2520-%2520Current%2520concepts.pdf+role+of+synovium+in+patellofemoral+pain&hl=en&gl=us&pid=bl&srcid=ADGEESiaF03W7rL6sHTpe32GnYPBQAMLDeDDd65xw95lieCutrCa3-E5p-CdgsisjCmBshwwO3lx_cPk-STSseTcMJ6u-D-lkHWoZ0ZMlhe4jaQra7YrZAZUXxFE90dII0ydmboKuHJx&sig=AHIEtbTtD9pPn0RwGicAjcPFm1nzDR2LhQ

http://docs.google.com/viewer?a=v&q=cache:4msKEpZCA24J:prdupl02.ynet.co.il/ForumFiles_2/19447772.pdf+The+Pathophysiology+of+Patellofemoral+Pain&hl=en&gl=us&pid=bl&srcid=ADGEESgGIVZMNaVoTwM0D9wAvqt3-f2aEHuIF0hnWOdEYXFiLlGFVJnjfQmbs4FsQ7VbWO_OiUmt_jxBwg1wHu5bY24AhdW6X80qJx4w2S-iEiDd8zoQPXkWnPg1c5484uLbMXHdnzTC&sig=AHIEtbRuEhbHlhgdwVnugn-_0eOiBdncTQ

Offline Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #12 on: October 13, 2010, 08:14:28 AM »
Thanks KAH :)

I should have added that, on the advice of my OS, I had around 12 weeks away from any exercise other than swimming in the summer after returning to the gym post scope (on the OS's advice to keep the muscles strong to reduce the load on the patella especially).  No gym, no bike, no physio exercises, just lots of very unstylish front crawl  ;D  made no real difference.  The knee did settle (less discomfort, but no less swelling) for a few weeks (around the time I saw the second surgeon) but has since flared again.  Although I actually don't like swimming, I did give it a go and when I went back to the gym I took it pretty easy.  The thing is, although I am not an exercise fiend like some, it is not acceptable to me to not be able to use the gym - both from a fitness but more importantly weight control point of view.  Indeed, the 2nd OS also encouraged me to carry on doing all the 'right things' in the gym - cycling, stepper, XT, rower 9although this does annoy the knee, not so much at the time but the next day) and walking on treadmill. Also, to get back out on the roads on the bike - not had much opportunity due to the weather recently!  I am caught a bit between the devil and the deep blue sea on this.  Certainly, the physio is encouraging exercise for flexibility (cycling etc) and strength (leg press) - finding the balance between too much for the knee and too little for the rest of me is tough!

I think my frustration really stems from the fact that whatever ever I do or don't do, I see and feel no change in the knee - it suffers if I sit for 30+ minutes in a meeting, but I have to be able to do this for my job!  13 months ago I was 16kg heavier (the weight loss has been for both the knee and the rest of me) but my knee was fine!  >:(
« Last Edit: October 13, 2010, 09:46:19 AM by Vickster »
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 AndrewH

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Re: Symptoms from cartilage defect(s)
« Reply #13 on: October 13, 2010, 01:40:04 PM »

What sort of symptoms did you have from the defect that led to the MFX and then the mosaicoplasty?  Was the defect from an injury or wear and tear?  Sharp pain, ache, specific things set it off, were you able to walk ok - how far? What are you able to do now, 3  months post op? Sorry for all the questions, but I am trying to measure my own experience :)

To give you the background, I am now 41 and I gave up smoking 6 years ago. For a year I was putting on weight and doing little exercise apart from playing 5s once a week. I then decided to get fit. I went running, joined a gym, etc then did a couple of 10ks and then a half marathon. I discovered that I really liked running and my times were quite good despite not training seriously.

I then entered a marathon for April 2007 and started training seriously with some group of serious runners at my work. Over the course of the next 2 years I became totally addicted and very competitive. By the time I got injured I'd got my 10k time down to just over 35 mins and my half marathon time down to 1.22. I was finding myself lining up at the front of big races with hundreds or even thousands of runners behind me. It was a big rush because I didn't believe I belonged there and everyone around me looked like *real* runners and fitness fanatics - yet I was beating them and posting faster and faster times. I wastraining around 70 miles a week. The beauty of it was that I could run to or from work (or both), which was 6-9 miles depending io if I drove part of the way and did 2/3 lunchtime sessions. I could run to work quicker than any other method of transport. It mean I had this great hobby that took up virtually no family time whatsoever. My wife had no problems with ity, apart from the fact that I'd become very skinny (despite eating around twice what I do now!)

Anyway, something went wrong in November 2008 and progessively got worse from there. I went to physios, etc but it wasn't until I saw my surgeon in April 2009 that I was finally diagnosed. Ity took the surgeon off of 5 mins to diagnose my problem!

My sysmptoms were very like yours. Sharp, burning pain that got progressivly worse. I was able to still run until Jan 2009 and then it just got worse from that point on. Before the microfracture I could hardly walk. Despite the microfracture, the pain never went away and that is what led to mosaicplasty.

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I think that, for whatever reason, the lateral side is more problematic than the medial?  Ref the lack of success for mosaicoplasty, the OS said that he has been doing for 7+ years and had seen 50% success in his patients, certainly nowhere near 90% and the curved surface where the defect is located is problematic.  he said if it was a small punched hole, no problem.  My defect is around ~1.5cm2 too, for him, 2cm2 is about the max (I guess surgeons may try on larger if major symptoms no other options).

I suppose all surgeons will have their own experience. My defect is around 1.5cm2 on the weight bearing curved part of my condyle. That is the area which actually has the highest success rate according to studies. My own surgeon reckons its the most successful area. The use of mosaic plugs is what allows the surgeon to replicate the curviture.

I think my surgeon actually enjoys doing these types of surgery. He described my surgery as "beautiful"! Each to their own!

If your surgeon doesn't have a great success rate and isn't keen doing it then I'd be wary. My surgeon was very confident and, as I said, he reckons he's only had 1 person with continued problems. One of the keys to success for this surgery is technical ability. That is one big reason why I am confident that my surgery is working. My surgeon is confident and had no qualms about going ahead with it.

Whether my surgery has actually worked, time will tell, I'll find out over the next few months. I might end up needing a TKR.

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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #14 on: October 13, 2010, 02:59:45 PM »
Thanks Andrew.

I don't think it is a lack of confidence on the part of my surgeon, he is very experienced, specialises in knees and is one of the UK based cartilage repair pioneers.  I just got the impression, that in my case, he favours a MACI /AMIC type of repair (it may be that it is newer and funkier  ;D ) - mosaicplasty is one of the options he put forward, just not the preferred.  However, given the situation with the insurance company, if I am still struggling like this in the new year, I will talk to him again and possibly go down the mosaicplasty route.  I have not seen him again since seeing the other OS, because until the last few weeks the knee had been feeling a bit more settled.  Work is also utterly manic so there is no chance of me basically taking 6+ weeks off.  February will possibly be better!
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















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