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Author Topic: Symptoms from cartilage defect(s)  (Read 3748 times)

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Offline Lottiefox

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Re: Symptoms from cartilage defect(s)
« Reply #15 on: October 13, 2010, 05:44:01 PM »
Surgeons are more fickle than a teenager and a boxed set of Twilight......they go for whatever their research interests lie in a lot of the time, especially if they are pioneers in a particular field.....and Vicks has your chap specifically talked about mosaicplasty or OATS? There is a difference. If he is thinking of one plug, then the success may be low. As Andrew says, using mosaicplasty allows them to replicate the curvature.....I remember seeing a research paper with pics of this in it, and the fit of them was amazing. All down to skill though, its not like tiling a bathroom I guess.  :P

I'd be seeking yet another view too.......there is no right solution to fixing cartilage holes. Its a case of weighing up what, when, how, who and the risks of success versus the risk of worsening or no improvement....

Andrew - who did your mosaicplasty out of interest? Vicks - might be worth chatting to whoever it is....I agree with Andrew that I would want someone doing the repair who had confidence it could help.

I would also urge trying a visco shot. It is painless, and has helped my lesions. I have less catching, less pain on direct pinching. Mine are just off WB so I am able to adapt a bit, but the Euflexxa has certainly assisted. Nowt to lose. If it stops the knee getting irritated then its a win. Not a long term fix, but whats to lose??

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 Catsmum

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Re: Symptoms from cartilage defect(s)
« Reply #16 on: October 13, 2010, 06:24:42 PM »
Vickster

Sorry to hear about your problems with the insurance company. You're right that I have been referred to Stanmore on the NHS. Is this a route that is open to you?

I am sure that your OS is right in warning you about the drawbacks of (M)ACI in terms of prolonged recovery etc. I've been quite daunted by some of the stories I've read on this site. I guess at the end of the day you've got to decide what symptoms you're prepared to accept. For me, although the pain is not too severe it is at a level where I am taking increasing amounts of painkiller to make it managable. I also would not enjoy the prospect of never being able to run again although I realise this is still a possibility even with MACI. It sounds as if your symptoms are not at a level that you would put up with forever. I'm sure it is the right thing to speak to your OS in the new year if it hasn't improved.

 

Offline Lottiefox

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Re: Symptoms from cartilage defect(s)
« Reply #17 on: October 13, 2010, 06:43:14 PM »
Catsmum (great name BTW  ;D)

Not wishing to hijack Vicks' thread but check out threads on here by JulianUK - he had MACI through Stanmore some 6 years ago and is a big success. Similarly member called thevoice had MACI about 8 months back and is now doing well. Cricket is another success story with ACI and has her own blog on her experience. Its detailed, graphic and not for the feinthearted but it illustrates the process and rehab very well. Serach for her posts and it will link to her blog too if you want to know more. Its a fine line I think with knowledge and having some trust in the process that is recommended. However I'd always recommend being advocate for your own knee/health. Good luck with the RNOH appt.

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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #18 on: October 13, 2010, 07:07:02 PM »
Lottie - Mosaicplasty ... I quote from last letter from OS to GP in mid August... Should she have difficulty with this (trial etc), then I would be happy to perform a mosaicplasty to the area  :)

I could try the shots - again, I don't know whether the insurance will cover (not asked).  The lesion mostly burns simply when sitting, it is not linked to movement specifically

Andrew is in Scotland - I looked at his profile (I am not a crazy stalker, honest  ;D I was going to PM you to ask, then noticed Scotland in the profile :)  Frankly, Stanmore / Bushey was pushing the realms of practicality at a 2 hour journey each way, Scotland would be a complete no no lol I don't feel the need to seek a third opinion (reasons discussed before), especially given the restrictions imposed by the insurance company (they will pay for MFX and I think mosaicplasty under sufferance)

catsmum - indeed, I would put up with it if there was nothing that could be done.  I don't need to take painkillers, as much as I could, because they are also not without problems.  The pain comes and goes, it is unpredictable, so not the easiest to control I guess

Running is not my thing, but it would be nice to be able to for a train etc, rather than a rather weird hobble-skip-run as at present lol

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 #19 on: October 13, 2010, 07:42:56 PM »
I am indeed based in Scotland. My surgeon is Sanjeev Chitnis. He leads the ACTIVE trial in this area but I had my op done privately (lucky enough to have work insurance).

Vickster - I too waited before rushing into this surgery. I was told I was being redundant just under a year ago so wanted to wait until I had a new job lined up before jumping in. It also allowed me the time to really see if the microfracture had any chance of success. I also had my brother's wedding in the summer so wanted to get that out the way and also didn't want to start a new job then tell them I needed time off straight away for a knee op! I actually took 3 weeks holiday rather than take time off sick.

However after 13 months there was no real improvement in the microfracture and my surgeon advised that what was important was to get the defect attended to sooner rather than later.

I considered ACI but the problem was that with some new transplant rules or other (I did research it at the time), my surgeon's private hospital was not licensed. He told me I could get a referral back to him on the NHS to go on the ACTIVE trial and the op would ironically be done at a hospital just round the corner from my house. However I would be randomised to either mosaicplasty or ACI and go on a waiting list for a number of months. It didn't seem logical to me to do that when there was a 50% chance I would have mosaicplasty anyway and I wasn't sure which option would be best anyway.

I also considered going to see a surgeon in Oxford who specialises in ACI. I even phoned up and made an appointment. However my wife didn't think it was very practical if I had an op down there. Personally I thought it was doable and wanted the best for my knee. But again, I wasn't convinced that ACI would be better than mosaicplasty.

As I mentioned, there is only one study that came out in favour of ACI over mosaicplasty and, as I mentioned, the average defect size was twice mine and they didn't place the plugs flush. I also noted that the authors were being paid by a medical equipment company. I made my own conclusions on that. All other studies on mosaicplasty that I have read had had very good success rates and either been as good or better than ACI. They have also been better than microfracture. Indeed, from the studies I have read there is some controversy whether ACI is better than microfracture. If you look at the ACI section of this forum there are plenty of examples of ACI not working. However as Lottie points out there are many success stories. I know that former Manchestr United footballer Ole Gunnar Solskjaer had ACI and he made a comeback. I also note that Andrew Flintoff the cricketer has had to retire after having microfracture last year. The Dundee goalkeeper Rab Douglas had microfracture on 2 lesions this year and he is on the road to recovery.

I will state however that its still early days for me. I cannot say for certain yet whether mosaicplasty will work for me. I have also had work done to 2 lesions on the patella. I am not counting my chickens yet.

Re your point about the burning pain at the lesion just sitting down - I know that feeling very well. If its burning when just sitting then its far from okay! Since having mosaicplasty I have not really had that sensation. I keep waiting for it but its not happened yet. It doesn't feel 100% but I am confident. I went for a 1 mile walk this afternoon and it felt incredibly normal and there has been no burning sensation that has hit me yet.







« Last Edit: October 13, 2010, 07:50:53 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 Catsmum

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Re: Symptoms from cartilage defect(s)
« Reply #20 on: October 13, 2010, 07:56:25 PM »
Vickster - ha ha- yes I know all about the hobble-skip-run for the train have done that one myself on a few occasions! :-\

Lottie - thanks for the advice, will check out the threads you mentioned.

Catsmum :)



Offline knee always hurts

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Re: Symptoms from cartilage defect(s)
« Reply #21 on: October 13, 2010, 08:46:34 PM »
"...it suffers if I sit for 30+ minutes in a meeting, but I have to be able to do this for my job!"

That could be your answer right there. That's the conundrum with these sorts of problems with the knees. Everyday life intervenes, and you are simply unable to do what is necessary to properly rest the knees. In my case, I'm able to do anything necessary to rehab the knee, and I'm still having problems with it. Physical therapy helped a bit, but made some other problems worse, and I've found through experimentation that my knee's level of tolerance is very low. Perhaps there is a procedure that your surgeon will be able to perform that will allow you to achieve a higher level of tolerance to loads and ultimately allow your knee to heal, but remember that all injuries need a period of real rest without irritation to heal.

Offline Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #22 on: October 13, 2010, 09:16:16 PM »

I will state however that its still early days for me. I cannot say for certain yet whether mosaicplasty will work for me. I have also had work done to 2 lesions on the patella. I am not counting my chickens yet.

Re your point about the burning pain at the lesion just sitting down - I know that feeling very well. If its burning when just sitting then its far from okay! Since having mosaicplasty I have not really had that sensation. I keep waiting for it but its not happened yet. It doesn't feel 100% but I am confident. I went for a 1 mile walk this afternoon and it felt incredibly normal and there has been no burning sensation that has hit me yet.



Hi Andrew
Good to hear the burning symptoms are relieving, what other improvements have you felt since the op 3 months ago?
I can't walk a mile comfortably, in fact pretty much all the time I can feel the knee after 5 minutes of walking - normally a tightness which feels like the knee is being squeezed - uncomfortable rather than painful. Any distance and I get a tugging laterally and sometimes the burning. Not normal I guess :-\
It is so damn hard to know what to do ultimately, there is no perfect cure, no doctor can give me a guarantee, not even how long the fibro will hold - pretty much the first thing the OS said when I came round from the scope was that it is anyone's guess! All complicated a little bit more by the insurance situation - of course, I am lucky to have had everything covered to date.
I just think the whole taking cartilage from a 'good' bit of knee and that the donor site will heal over with fibro again does not fill me with joy given how the knee is reacting to the fibro over the defect. Also, do I want a major open surgery to do something that may not help or even make the knee worse...tough tough tough decision! Wish I'd never fallen off the damn bike ::)

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 Lottiefox

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Re: Symptoms from cartilage defect(s)
« Reply #23 on: October 13, 2010, 10:57:48 PM »
I'd just add in a couple of things...

Cartilage itself has no nerve endings, so cannot actually be the source of the pain. Something around the cartilage is inflammed and this is causing the pain. Clearly if you have a defect with NO covering and weight is transferred through it then the result will be pain as the bone does have nerve endings. For a "defect" to be creating pain at rest something else is irritated/inflammed - quite probably because of the pathology in the knee but not necessarily...the knee may just not be setling after surgery......the menisectomy site may be troublesome.......yada yada...knees have a mind of their own.....I have 3 areas of grade 3-4 cartilage loss (I've seen my MRI, there is bald bits!!!) but no pain at rest now my inflammation is reduced through a combination of the right exercises, the right avoidance of impact but the right use of exercise (and I still train hard 4-5 times a week...but within the parameters of my knees), the right medication and probably the final thing of the Euflexxa. I haven't covered my defects with anything (although the London OS said it isn't inconceivable I may have something protecting the holes - I suspect not!) but my pain at rest/burning is dramatically reduced, to a level that I can accept. There are times now the knee feels normal. I was sitting with my knes bent up and criss crossing them, etc and chatting to a friend at the gym and she said "Blimey - you weren't doing that 3 months ago...." I can bike 30k without a break and feel fine after. How long will it last - who knows!

All I'm saying is that try anything you can to reduce this inflamed knee before a repair. I am the world's most surgically averse person, I know, but had I chosen in February to have a MFX and shaving and possible lateral release I feel I'd be far worse than I am now. Seek out anything you can to try and resolve things. Regardless of insurance a visco injection is around 300. It might just let the knee start settling....

BTW - are you icing after the gym sessions? I never miss my ice sessions..... ;)
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 #24 on: October 13, 2010, 11:01:38 PM »
You know me...never been much of one for the ice...except in cocktails  ;D  Never seems to have any effect on the swelling

I shall think about next steps if any

Cheers :)
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 #25 on: October 15, 2010, 06:07:03 PM »
Vickster - I am having improvements daily. I went for a family day out yesterday and did a lot of walking about - totally pain free. I never ever managed to do that after microfracture. What I have now is a small area of numbness on the skin next to the scar but that's getting better and its not really an issue. My knee does feel "weak" but its not painful. I presume it will feel stronger with time.

I've not had any donor site issues so far. Bit of clicking for the first couple of months but that has now stopped.

Now considering I've had mosaicplasty to 2 seperate lesions plus microfracture on another plus have 5 plugs from a donor site and a huge great scar down by knee, I am absolutely amazed at the progress so far. I am not counting my chickens yet - in fact I'm just waiting for something to go wrong - but so far so good.

I wish I'd had this op a year ago!
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 #26 on: October 15, 2010, 08:49:23 PM »
Good to read, Andrew

Looking back at the comms from the insurers when I was planning on AMIC, they did say they won't necessarily cover mosaicplasty either due to a lack of long-term data (which seems to be in line with the NICE guidance, that they company seems to hang its hat on)

I am going to have the hyaluronic acid injections if the OS still thinks it's a good idea.  Wretched insurers won't cover that either (well they will a consultation, and strangely an x-ray) but that is much more manageable to self fund.  Hope to see the OS next Thur say for the first jab all being well.

I'll have a chat about possible next steps if the injections don't work

Vicks :)
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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #27 on: October 21, 2010, 01:17:15 PM »
Seeing the OS about the HA injections later today.  If he thinks they are worth a try, then will be done over three consecutive weeks (presumably first one next Thursday assuming the stuff is available as has to be especially ordered by the hospital).

Knee has been stiff, burny, sore on stairs and generally grouchy this week.  In the last week, I have just done 2 short lunchtime gym sessions (mainly cycling) so not overdone I think, but who knows!?  That is the frustrating thing with my knee, it is never right, but it is incredibly unpredictable.  I had to resort to paracetamol to sleep one day which is unusual  :(  Going to give the road bike a go this afternoon as I have the day off and, although chilly, the sun is shining  :)
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 Vickster

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Re: Symptoms from cartilage defect(s)
« Reply #28 on: October 22, 2010, 10:45:38 PM »
Well, it transpires from my latest MRI that I have subchondral bone damage under the scar tissue on a full-on WB surface of the femur - explains the pain I guess.  I have been advised by the OS to pursue MACI as part of the Active trial (thanks to my lovely insurers) as the best option with the most likely favourable outcome.  Left, the damage could be as likely to get worse as better.  Pah...  :(
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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