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Author Topic: Archie's Meniscal Allograft  (Read 9251 times)

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Offline cliffoa

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Archie's Meniscal Allograft
« on: November 29, 2010, 03:56:30 PM »
Hi

I had a meniscal allograft about six weeks ago. Prior to the operation I’d gotten a lot of information and help from reading other people’s posts on this site, so I thought I’d post my own experience on here, in case it’s of any use to anyone else.

First thing I should say is I’m 55. Me and my knee go back a long way, to an old footballing injury over 35 years ago, a life changing day I can still remember vividly. So I’ve posted a short history of my knee below.

Following that I’ll post a transcription of the notes from my latest op, the meniscus transplant.

Then I’ll post updates of any progress since the operation, and hope to continue doing that into 2011 and beyond, for good or bad. Feel free to skip any boring bits.


History of knee/injury.

1974 - aged 19, injured my knee playing football. Got a bad tackle, hit and twisted round while all my weight was on that knee. Suffered complete rupture of ACL and bucket handle tear of medial meniscus.

1974 - had partial menisectomy to tidy up meniscus. ACL grafts weren’t then available so I was forced to give up serious contact sports. Anything that involved twisting or cutting would risk the knee giving way.  Got on with life, lived with unstable knee with no ACL for 25 years.

1999 - had missing ACL replaced with a graft. It felt like getting a new knee again. For the next 7 years my quality of life improved greatly (hiking, cycling, mountain climbing). It also coincided with my son growing up, from the age of 6 to 13, so I was able to give him my best years being ‘active dad’ kicking a ball around in the garden, games on the beach, piggy back rides etc.





2006 - August, injured knee while playing rounders on the beach. Seemed innocuous – hit the ball and began to run on the sand, pushing off on my left leg. I felt a dull sensation somewhere in my knee, but nothing particularly paintful. However it swelled up badly that night, and wouldn’t settle over the following week.  Walking even small distances (1/2 mile) would suddenly make it hot, angry and swollen.

2006 - November, arthroscopy, orthopaedic surgeon removed damaged chondral flaps from the articular cartilage, general debridement, said it should be fine to get back to all my normal activities in the New Year.

2007 - January – taking OS at his word I began serious rehab physio and was doing sprints on grass when I got a searing pain through the knee joint. 

2007 - January – went back to OS who did another arthroscopy, further debridement, cleaning up damaged meniscus and articular cartilage.

Still the knee refused to settle. Since the beach injury in August 2006 I had been unable to run, jump, or do anything vigorous on that leg. Anything  that required me to brace my weight on it, even  throwing a ball, would set it off.  So I spent the following 3 years ‘walking on eggshells’, having to ice the leg several times a week, when the least thing would aggravate it – stubbing my toe, stepping off the kerb in the wrong way, sneezing too vigorously! (I joke not).  At times the leg about as useful as a crutch. My sporting activities were drastically curtailed to basically cycling and swimming, which I could tolerate, and upper body work in the gym. But I could no longer run at all, even across the road, nor could I walk long distances without pain and swelling. A mile was about my limit.

My orthopaedic surgeon said I was too young for a knee replacement at 55, probably 5 years away, so the only option he offered was an osteotomy, to counter-balance the narrowing of the knee joint on medial side, as I had a good lateral compartment.  However, I didn’t relish the prospect of having my leg sawn in half, so I said I’d wait and get by with the pain for a while, and see if any other procedures became available.

2009 - I noticed my ‘good’ knee was starting to ache quite a bit, as I had been favouring it for over 30 years, and for the last 3 years it had basically been doing the job of 2 knees.  I didn’t want to risk ruining that knee also, so I looked into alternative treatments for my bad knee. I researched, and found a surgeon who did Meniscal Allografts in the UK, Angus Strover.  I told him my case history, he did MRI and xrays, and said I’d be a good candidate for a Meniscal Transplant (MT). Although the joint space was narrower on the medial side where the cartilage was lost, he confirmed there was insufficient mal-alignment to necessitate an osteotomy, which was a relief. When asked what my post-op goals were, I said it would be great if I could get back to playing golf, which I was learning before the latest problems curtailed that, and maybe even a little doubles tennis with family and friends. Really, just to be able to walk for any distance without pain and swelling would be nice, and to run across the road if I needed to. I cycle a lot, every day, and had been able to do that even when the knee was bad, so I assumed I’d be able to continue that at least to the same level, hopefully even more so. But I wasn’t looking to return to any contact sports or anything vigorous. At 55, with my knee history, those days are sadly behind me. 









1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #1 on: November 29, 2010, 04:17:52 PM »
For anyone who is remotely interested, here is a summary of the surgeon’s report of meniscal allograft I had on 9 October 2010. It's a bit technical I'm afraid as I've simply copied it from the surgeon's letter to my doctor, so not sure I'll be able to answer any questions if anyone has any.


2010 – 9 October –Meniscal Allograft done by Angus Strover at London Bridge Hospital.

Left knee arthroscopy with general debridement and removal of adhesions, proceeded to medial meniscus transplant using allograft

Arthroscopic findings
1.   The suprapatellar pouch showed a number of flimsy adhesions, but the patellofemoral joint itself appeared to be in good order. There was no maltracking and no damage to the joint surfaces of the PFJ.
2.   The medial compartment showed early osteoarthritis of the medial femoral condyle and a meniscus, which appeared to be in reasonable condition in the middle part, but the posterior part of the meniscus was very flimsy. This was probably responsible for the grade III osteoarthritic changes on the medial femoral condyle.
3.   The intercondylar region showed a alightly small intercondylar notch. The anterior cruciate ligament was intact. The medial tibial spine, however, was enlarged.
4.   The posterior medial compartment was entered and o loose bodies were found. The posterior cruciate ligament and anterior cruciate ligament were both intact.
5.   The lateral compartment showed good appearances throughout with a healthy looking joint surface and a normal lateral meniscus.
Arthroscopic procedures
1.   The adhesions in the suprapatellar pouch were removed.
2.   A moderate notchplasty was performed in order to access the posterior horn of the medial meniscus.
3.   The existing meniscus was trimmed to gain a healthy bleeding remnant, particularly in the posterior and mid region of the meniscus.
Graft preparation
•   The meniscal allograft was measured and it did agree with the size of the medial compartment.
•   The posterior horn of the meniscal allograft was finished with a stay suture of Fiberwire.
•   An additional stay suture was placed in the posterior third of the meniscus. This was Ethibond 2/0.
•   A third stay suture was placed in the anterior horn and once again this was Ethibond 2/0.
•   The graft was marked with a blue marker pen and in particular several small dots 5mm apart were placed on the superior surface. The posterior horn and the anterior horn were also marked.
•   Guide wire was placed from the anterior medial aspect of the left tibia into the posterior medial part of the tibial plateau, in the area of the posterior horn of the medial meniscus.
•   This guide wire was followed by a cannulated 4.5mm drill and the stay suture on the posterior horn of the meniscal transplant was railroaded through this tunnel.
•   An additional guide suture placed in the posterior third of the transplant was taken through the appropriate area of the recipient meniscus, and by manoeuvring these two sutures the meniscus was pulled into the knee and held firmly using rubber shod forceps.
•   The posterior horn suture was then stabilised by the use of a suture anchor, passed through a small incision over the exit of the drill hole in the tibia.
•   The stay suture was held fast while a new suture was passed using the zone specific cannulae and size 20 Ethibond stitches.
•   The old scar on the medial side of the left was used to create a 2.5cm incision through which the inside-out sutures were captured and tied.
•   An additional 4 sutures were placed by the same method to hold the meniscus tightly to the capsule.
•   2 meniscal arrows were passed through the posterior horn of the donor meniscus, into the recipient, creating a firm attachment of the posterior part of the meniscal allograft.
•   Finally, the anterior horn of the meniscus was tightened at the end by taking it through the subcutaneous tissues of the medial porthole.
•   The final appearance of the meniscal allograft was good.


1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #2 on: November 29, 2010, 04:29:55 PM »
And here's how I got on for the first six weeks after the op.


2 hours post op - after I came out of theatre they strapped me into a CPM for 24 hours, with ROM to 30%. I was a bit surprised by that so soon after op, but assumed they knew what they're doing.  Since I was still pumped full of anaesthetic, this moderated the pain somewhat. 

1 day post op - they had me out of bed walking on crutches, partial weight bearing, wearing no brace at all, which again surprised me a bit as I'd read of other people undergoing similar op being braced up with no weightbearing for some weeks.  But I had faith my surgeon knew his business.  I went home the same day. Before discharge the hospital Physio gave me a range of exercises to do at home, including straight leg lifts, and flexing knee as pain permitted, to max of 90%.

1 week post op – first week was pretty grim. Knee constantly ached with a mixture of sharp burning pains and deeper throbbing ones, so I was fairly popping the painkillers, but they only helped a little. The nights were worst, I didn’t know where to put my leg. Every position I lay in, it hurt. The most relief was had by propping a pillow under the knee. But it’s hard to lay in one position, flat on your back, all night long. I kept wanting to turn onto my side, but it was too painful. Most nights I’d go to bed around 11pm, and be tossing and turning all night, sweating and in pain. Often I wouldn’t fall asleep until almost daybreak, around 5 or 6am, when I would nod off from sheer exhaustion. That first week the knee swelled so much I had to knock off the exercises and contact the surgeon to arrange an additional course of anti-biotics, as we were concerned about potential infection.  I didn’t ice it much as even the application of an ice pack felt uncomfortable on the knee.

2 weeks post op – thankfully due to curtailing the exercises, complete rest, additional antibiotics and copious painkillers, the knee seemed to stabilise and the worst of the pain began to recede. I’m a great believer in listening to your own body. It tells you when something is right or wrong, and when you are doing too much.

27 October 2010 – 2 weeks post op - I saw my OS again and he said he was pleased with progress. Said I was to continue with minimal weight bearing on crutches, progressing to partial weight bearing, and resume with exercises as pain tolerated. But likely to be on crutches up until Christmas, and unlikely to be able to drive before then.

NB. Should perhaps say a word here about the love/hate relationship I am developing with my crutches, who have been my constant companion this last fortnight, and probably will be for several weeks to come. On the one hand they are incredibly helpful, letting me hop around the house without putting too much weight on my bad leg, on the other hand they seem to delight in getting in the way in almost everything I do, from opening the fridge to getting on the loo, to trying to get a cup of tea from room A to room B.  At times they seem to almost wilfully delight in snagging on things as you walk across a room, caterpulting you forward, or no matter where you lean them when not in use, they have a built in countdown after which they will always, but always, slide down and topple over in a clatter onto the floor.  I spend a great deal of my time shouting at my crutches, calling them names and having long conversations with them. So for anyone considering similar surgery, unless you are living with family members who can wait on you hand and foot, make sure everything is set up with military precision before you come home after the operation. A kingfisher trolley is essential for transporting meals and cups of tea between rooms.  If you don’t have one, most local council social services will normally lend you one for your rehab.

3 weeks post op – pain and swelling easing a little, but still need pillow under knee some nights, and painkillers, mostly at night, occasionally during the day. Most nights sleep is broken, doze off for a couple of hours, wake for a couple of hours,etc.

4 weeks post op – progression seems a bit ‘stuck’.  Knee still moderately swollen, only real exercises I’m doing are straight leg lifts, tightening of quad muscles, and using a rolled towel as a fulcrum under the knee, plus flexing leg to 70 or 80 degrees.  Knee aches quite a bit afterwards, so icing quite regularly.  Some nights still need pillow under knee to get comfortable, others not.  Usually still popping painkillers before I go to bed, but no longer taking them during the daytime.  Mostly I’m sitting around with my leg up.  It's interesting how there seem to be almost as many variations in post-op rehab as there are surgeons. Some immobilise you in a brace, others don't, some allow weight bearing and ROM, others don't, some use CPM early doors, others don't.  On one level it's worrying, because ultimately they can't all be right, and you would assume that if one surgeon's post-allograft recovery advice seems diametrically opposed to another surgeon performing exactly the same procedure, then one of them could conceivably be COUNTER productive. But I guess all you can do is follow the advice of the surgeon who operated on you, because if things don't work out, then at least it's down to them. 

5 weeks post op – seemed to be a definite improvement this week. It seems to happen in very small degrees, getting a tiny bit better each day.  But now can flex knee to full 90 degrees. Still can’t extend it fully however. It goes almost horizontal, but not quite (and my good knee goes 2-5 degrees past the horizontal). Still being quite conservative with my exercises, cautious about risking any damage to graft before I get the definite all-clear form OS that it’s completely healed and knitted together. Mainly stepping up frequency of exercises a little, as they cause less discomfort now.  If I overdo it a little, I ice it afterwards. Small but definite improvements. Steady as she goes.  Due to have 6 week post op meeting with OS next week, will aim to get more reassurance and specific advice on physio and exercises to follow from there on in.  At the end of this week I had my first ho bath in six weeks, a long hot glorious soak.  Finally the knee had  just enough bend to fit in the bath.

6 weeks post op – went to see OS who was pleased with continuing progress.  Said the knee appeared to be healing fine, and said I was ready to go on to phase 2 – restoring full Range of Motion to the knee.   I’m to work on a combination of stretching and massaging the joint several times daily, to break up scar tissue and get it to go a little further each day, just a degree or two, with the aim of having a similar ROM to my good knee, at 3 months.  Then at 3 months he said I should be ready to move on to phase 3 - strength building work (cycling, cross-trainer, rowing, swimming), but not before.  Knee currently bends to 90-95° and extends to about 178°, so my goal is to get it bending to circa 35-45° and extending to at least 180° and hopefully minus 2-5° below the horizontal. To demonstrate the kind of pain level I should be aiming at to progress, the doc made me sweat by bending the knee as far back as it would go. I’m sure the underside of his examination table still bears the indent of my fingers. 

Also, since I’ve been using two crutches for 6 weeks, Doc said I should now start trying to get around with one crutch indoors, but keeping to two if I go outside, to prevent slippage/accidents until full ROM and strength is restored.  He had me walk on one crutch during the appointment which felt weird as I had not put that much weight on the leg since the operation.  Over 30 years of ops on the knee, and many setbacks along the way, has made me naturally cautious in my rehab, but he said it was okay now to start putting more weight on it as the cartilage graft should have healed similarly on the inside, to the scar on the outside. He said it would probably take an accident now to damage it. That was quite reassuring, so my other aim is now to wean myself off one crutch, then eventually off both crutches, to full weight bearing at 3 months, when I should be ready to drive and go back to work.  Some people progress quicker than this, others take longer, but one thing reading other people’s knee rehab stories tells you is that every person is different, from their whole medical and injury history, the condition of the knee, the exact procedure they’ve had done, their age, weight and everything else, so all you can do is be guided by the experience and wisdom of the surgeon, which I’m happy to do.  My operation was 9 October and I’m provisionally aiming for 9 January as my back to work and driving date.  In between now and then I’m going to work diligently as my stretching and massaging exercises every day, to continue the daily improvement.
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #3 on: December 10, 2010, 09:37:12 AM »
Okay, this post covers week 7 post op.

The knee extension exercises went well, and I was managing to get the leg pretty straight.  The increase in weight bearing also seemed to go well, getting about on one crutch around the house, and for brief spells without no crutch at all, though still a bit unsteadily.

However, the knee flexion (bending) exercises had the opposite effect. Having had an ACL graft and other knee ops in the past, I was familiar with the ‘no pain no gain’ rehab regime required to restore ROM to a stiff knee post-op. However, this felt like something completely different. It felt like there was a real physical block at around 95-100 degrees, which if the pain allowed me to push beyond, something would snap or tear. However much I persevered using my good foot to try and bend the affected leg back as far as it would go while massaging to break up swelling/scar tissues as my OS instructed, no matter how much I forced it, I couldn’t get it back any further than about 95-100 degrees. This was very painful to do, and the knee felt very tight, with specific pain developing at the back of the knee on the medial side, just above and below the knee. As though the hamstring were getting tendonitis. It was a burning, sharp pain, that grew in intensity as the week progressed. Doing standing leg raises (flexing the knee behind me, while standing) were most painful of all, and seemed to inflame it most. 

At first I only got the pain when I was doing the stretching exercises, but after a few days the area at the back of my knee above and below it seemed to inflame, making it painful even to lift and bend my leg.  Plus the knee in general puffed up and stiffened, and got hot.  After a week of going backwards I finally listened to my body and stopped the stretching, which had actually decreased my flexion ROM  from the 90 degrees of a fortnight ago to 80. 

I wondered if it was anything to do with the sutures or anchors, where the graft was stitched into my knee tissue? Or simply scar tissue/arthrofibrosis from the op? Whatever it was, it didn’t feel like something I would be able to grit my teeth and break through, as I had in past knee ops.

I wrote to my OS, Angus Strover, asking his advice on what to do for the best.  He said that the problems may be  due to the suture anchors at the back of the knee, as they are inserted quite deep into the tissue during the graft, so in this case it would probably wise not to obey the ‘no  pain no gain’ rule and keep strictly within the pain free range of movement. He assured me range of movement would improve during the year, but we would have to let it come back naturally through activities of daily living, rather than trying to force it early doors and risk doing damage.  Meanwhile ice and elevation to get the inflammation back down.


This post covers week 8 post op.

Having backed off the aggressive flexion exercises, the knee settled down again this week, during which I was able to work on extension exercising and quad strengthening exercises, mainly by repeated sets of straight leg raises and simple quadriceps tightening, held from anything from 10 seconds to a full minute.

Then an interesting development. Toward the end of the week my knee developed a strange, intermittent, and what I can only describe as a 'squishing' sensation.   Hard to describe exactly. As though something very soft was being squished between the centre of the knee joint. 

It has only happened twice (so far, at the time of writing). Once, after I'd been wearing an ice wrap sitting down, when I stood up and extended the knee fully, it started happening.   When I stood up and locked back the knee, that's when I got the sensation. It stayed with me for about a minute as I walked around, and I found I could repeat it by flexing the knee slightly then locking it back again in extension, that's when I got the strange squishing sensation. I assumed it might have been something to do with either the cold or tightness of the ice wrap  I'd had around the knee, affecting the joint fluid in some way, although to be honest I've used ice wraps for years and never had it before.

Then this morning, on waking, when I got out of bed and stood up, it happened again briefly. When standing and extending the knee fully, I could just feel the dull squishing sensation inside. So, it couldn't have been the ice wrap. After a minute or so it disappeared again.  It wasn’t in the least painful, but quite disconcerting as I'd not experienced it before in 35 years of knee troubles. 

It didn’t feel like normal crepitus, which I've experienced many times when injury/swelling occurred in the past. In fact the knee isn't that swollen or hot at the moment, just the usual slight puffiness you might expect 2 months post op, so I'm not sure why it should start happening now, or what it is. 

The oddest thing  is why it should start doing it now, two months post op.  I can't think of anything recently that would have precipitated it. There was aggressive ROM stretching from a week ago which I had to stop. Plus I did have a very minor stumble a couple of days ago when tripping over a crutch with my good leg, so had to put my bad foot down a tad harder than normal, but it was nothing to speak of, and I didn't feel any great pain or anything, just the usual slight discomfort you get during any rehab when doing something you haven't done for a couple of months. Didn't twist on it or anything, just had to lean on it a bit harder than normal.

Generally I'm not in increased pain, just the usual the occasional twinges you get when you get up or walk around after sitting down for any length of time, but nothing that I haven't been getting since day one after the op - twinges that have been diminishing in frequency and intensity with every week that passes. 
As to the location of the 'squishing' sensation, it doesn't feel particularly localised, somewhere in the middle of the joint, but probably more to the front than the back, is all I can say. But feels like it's in the 'core' of the joint.  Hope it's not an untoward development with the graft.

Wrote to my OS Angus Strover, updating him on this development, but said not to bother replying if it was nothing to worry about.   While you don’t want to become a complete wuss, crying to the OS over every ache and twinge, you do worry that the one thing you might decide not to tell him, may be the thing he needed to know. So my policy is better safe than sorry. I only have one life, and I need to get this knee right.

Will post again if I hear back from him.
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #4 on: December 10, 2010, 10:42:00 AM »
My OS Angus Strover got back straightaway to reassure me. He said "if this strange feeling is not painful it is not harmful. I guess it is due to a bit of fluid or blood clots that need movement within the painfree range to help them dissolve." Which has put my mind at rest considerably. 

I must say, I've had a few surgeons over the years and have found Angus to be one of the best. His expertise and experience in the field of cartiilage transplantation is pretty much second to none in the UK, but unlike a lot of surgeons I've known he's also incredibly approachable, takes the time to explain everything, answer all your questions, and encouragges patients to keep in touch with him about any worries or developments, and he always makes a point of getting straight backwith helpful and reassuring words of advice.  Such a shame he's retiring next March, I consider myself been lucky to have been one of his last orthopaedic patients.
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #5 on: December 19, 2010, 04:30:13 PM »
This post covers weeks  9 – 10 post op.

Slow improvements in knee.  Can now get about house without crutches, bearing full weight on knee, albeit quite gingerly.  There is still residual swelling from the operation, it’s almost gone but not quite, and if I spend too long on the knee it gets a bit hot and bothered, and will puff up a bit, requiring me to ice it and self-medicate with ibuprofen.  I have been continuing housebound straight knee exercises (lifts and muscle contractions), and just generally trying to spend a little more time on my feet each day, walking around, waking up all those little muscles and tendon movements that have been lying dormant for several weeks since the operation.  I’m hoping to build up strength gradually in this way at home over Christmas, then when I go back to work in the New Year, to see if I am up to gym strengthening work at that time (stationery cycle, row machine, x-trainer and swimming). However, my knee flexion remains stuck at about 90-95 degrees, confirming my fears that it will either take several months to regain anything like a normal range of movement, or if it remains stuck at 90-95 degrees (which right at this moment, it feels like it will do), I may require a subsequent operation to address that. 

Weight bearing on the knee generally no longer gives me pain, although oddly enough when I am lying down, if I bend or straighten the knee or cross my legs in a particular way, I can get a quite sharp pain, usually round the side and back on the medial side. Once again, I attribute this to the sutures/anchors that were used to fix the cartilage graft, which are probably the reason behind my limited ROM, but I will check this with the surgeon when I see him again in February.  I will also ask him about occasional ‘clicks’ I get in the knee, and that familiar slightly painful ‘nipping’ sensation which the surgeon said was probably due to my knee adjusting to the mechanics of the knee with the grafted meniscus, and probably a few rough edges here and there.  So, in summary, some improvement over the last fortnight, but it still doesn’t feel strong or supple enough yet for me not to be aware of every step I’m taking, and when I walk without crutches it is quite gingerly, and with a bit of a limp. I would appear to be still some way off from walking comfortably with a ‘normal’ gait. Having said all that, it feels stronger than it was two weeks ago, and I am able to do more on it than I could two weeks ago. It’s just that the progress is so small it’s quite hard to quantify.  Probably one or two percent a week, or five percent better over the fortnight.  Will update with progress in a week or two’s time. 
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #6 on: January 08, 2011, 06:14:47 PM »
 :)
This post covers weeks 11-13 post op.

Didn’t do much over the Christmas period. The rest seemed to help the knee settle down again. In the first week in January I began taking walks outside, starting with ¼ mile, then ½ mile, ¾ mile, and by the end of the week I  was able to walk just over a mile without getting any significant reaction from the knee. Minor swelling on a couple of days was quickly relieved by icing. A single crutch was taken with me for security but not required. Was able to walk with fairly normal, if a little cautious, gait, albeit at a very pedestrian 1mph. 

My ROM also seems to have freed up a bit, and am now able to bend the knee to approx 110 degrees.

 ???
At the end of the first week in January (week 13, 3 months post op), a bit of a setback. While getting up from sofa one evening, felt a twinge in the knee. However it didn’t swell up, and next morning it felt okay.  That day I spent a couple of hours on my feet taking down the Christmas tree/decorations. After a couple of hours standing I began getting sharp shooting pains through the knee when I stood or walked on it. I’ve never had a trapped nerve, but it felt like I imagine a trapped nerve might feel like, a very short intense electric shock of pain going right across the back of the knee, which really made me wince.  It wasn’t constant, and sometimes I could walk on it pain free, other times I’d take a step and the pain would shoot across again.  I’ve spent the last 24 hours since then walking on eggshells, and have had to ice it quite a bit.  Really disappointing after the good progress I thought I was making walking.  It’s really knocked my confidence back, so I’m walking much more tentatively again, bracing myself every step in case the horrible shooting pain recurs. I’m due to return to work next week, and had been confident I wouldn’t need crutches or support of any kind, however I’m now likely to take a crutch just for security. Because if the shooting pain occurs more frequently, and persists, it will be difficult to walk on the leg or bear much weight without a crutch.  It’s similar to the twinges I’d often get in the knee before I had the cartilage graft, so hopefully that’s not an omen that it’s failed.  Due to see my OS again mid February, will see what he says.  In the meantime, back to work next week, pain or no pain. Hoping the intense shooting pains were some kind of transition that won’t recur, but they felt more serious than that. 

 :'(
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline Meniscus LOVER

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Re: Archie's Meniscal Allograft
« Reply #7 on: January 09, 2011, 06:48:44 PM »
Thanks so much for posting your experience.  I just had a medial meniscus transplant on December 7th and it has been really helpful to read about your experiences.  I am 5 weeks out and my ROM is only 0 to 81 (with force).  My surgeon said if I do not gain more ROM, he might have to do another surgery to clean out scar tissue at the 3 month point.  He wants me to be 0 to 120 by the 6 week point, so I am bit behind.

Since you seem like you have struggled a bit to get ROM and you mentioned your surgeon talking about additional surgery, are you having to have another surgery?  How far has your ROM gotten since your last post?  Thanks!

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #8 on: January 20, 2011, 12:25:10 PM »
Hi Meniscus LOVER
Not gotten much further with my ROM, it's gradually eased maybe another 5 or 10 degrees, so bends to about 100 degrees in total now, but I'm over 3 months post op, so it should be way past that. 

There's definitely something blocking it. I can't even get on a static bike because my knee can't do a full revolution.  It's okay at the bottom of the stroke, but as the knee bends near the top of the stroke, it jams sharply, a not pleasent feeling, so I'm unable to turn the pedal all the way round.  I'm reduced to doing single pedal strokes with the one leg, raising it as far as it will go, then pushing it back down again. Rubbish really. 

Don't think it's scar tissue, I've worked through that kind of thing after previous ops.  This definitely feels like something was sewn up during the operation that maybe shouldn't  have been. I'm due to see my OS some time in the next month, so I'll report back after that. Can't see what else he can do but go back in and have a look, see if something needs freeing.

I've also had one or two more episodes of the pain twinges on walking/standing, which I'm hoping may all be connected to the same ROM problem, rather than a problem with the graft. That's the biggest drag of all, not knowing. Will see what OS says.

Good luck with your own rehab, hope you're progressing more problem free.  If you're posting regular, send me a link and I'll keep checking your posts.

Cheers
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline BECKZ_oo7

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Re: Archie's Meniscal Allograft
« Reply #9 on: January 21, 2011, 06:25:06 PM »
Not that i dont need a good healthy medial meniscus right now and i dunno why but laughed real hard when i read the line "Hi meniscus Lover"...

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #10 on: February 20, 2011, 01:05:03 PM »
This post covers the period from 3 to 4 months post op (mid Jan to mid Feb 2011).  Nothing much really exciting has happened. Progress is so slow it’s impossible to measure on a daily or weekly basis, yet over the month it does feel like the knee has improved slightly, if only by about 5%.

I went back to work the second week in January. I work in an office so it’s sedentary work behind a desk. Physical work would have been a complete no-no, as I’m still having to use one crutch for stability outside the home, and still walking gingerly with a limp around the house. The main problem at work was sitting in the same position for too long caused the knee to stiffen, but periodic trips to the printer and photocopier helped combat that.

Also, driving in proved challenging for the first 2 weeks, as my knee barely flexed enough to fit on the clutch pedal. With the leg still quite weak, depressing the clutch often gave me a twinge in the knee, but after a fortnight, this seemed to ease up, and now at 4 months post op I’m able to drive pain free. Oddly enough, because driving is now more pain-free than walking or standing, I have started to look forward to my drive to work and back each day. I guess it’s a psychological thing. For that half hour I feel in control, able to do something useful, pain free. I don’t feel quite the invalid that I feel when doing practically anything else. May seem like a small victory to some, but not to me.

Another small victory has been, during my lunch breaks at work, I started going down the pool at the local Holiday Inn, where I was able to swim up and down gently for 10, 15, then 20 minutes at a time, alternating between crawl and breast stroke.  I couldn’t kick my knee much on the breast stroke, nor paddle my feet too vigorously on the front crawl, but just getting my body moving again, pumping some air through my lungs, I felt like a butterfly emerging from a 3 month chrysalis.  Hey, I even managed to overtake some of the pensioners in the pool! They were like a hundred years old, but it’s a start.  I’m not sure it’s helped the knee much, but in terms of my overall conditioning and sense of wellbeing, it’s given me a much needed tonic. 

There’s also a gym at the hotel, so I’ve been able to use some of the equipment to get some life back into my upper torso.  At first I was unable to use any of the stationary bikes as my knee still wouldn’t bend enough to get the pedal all the way round. I could manage 5 or 10 minutes on the rowing machine with slight discomfort and occasional twinges at the back of the knee. My OS had told me to use the cross-trainer (elliptical to some), but because I’ve very little strength in the quads, the knee still felt a bit loose and unstable, so it didn’t like the cross-trainer much. Generally, if I stuck to swimming in my lunch hour, the knee would barely swell during the afternoon. But if I did rowing or cross-trainer, I’d have to sit with my leg raised under the desk, with an ice pack on my knee all afternoon.  I keep a big bag of peas in the freezer downstairs in the company canteen for that purpose.

As well as the swelling, when I irritate the knee, I still get those disconcerting clicks and clunking sensations walking around that you get when you’ve got fluid on the knee, plus those occasional sharp shooting pains across the back of the knee, that felt like a nerve trapping in something. Those shooting pains puzzled me, as if anything they were on the lateral side, whereas my allograft had been on the medial side.

On 12 Feb, exactly 4 months post op, I went to see my OS again, Angus Strover.  In my mind progress has been negligible, with all the problems I mention above, so I had expected him to want to schedule another arthroscopy, to go back inside and see what’s up. But at the consultation he counselled a more conservative approach for the time being. He took another MRI, and pointed out the allograft, which he said must have knitted together fine to show up on the MRI.  Okay, so I told him I have 3 main problems.

•   ROM, still stuck at around 100 degrees (110 is a real drumskin stretch, painful, feels like it comes up against a hard stop). 
•   Chronic heat, swelling, and resultant feeling of instability. My knee doesn’t balloon up, but at the end of most days it ends up a little red and puffy.
•   Sharp shooting pains I often get across the back of my knee.

On 1. the OS said he was fairly sure the stuck ROM was due to scar tissue from the operation, and from previous ops too, although thinking about that now, I’m not sure how it could have been from previous ops as he said he’d cleared that out during the allograft op. 

On 2. he said that the limited ROM was probably irritating the knee, causing heat/fluid. He said the knee needed nearer full ROM to operate at its most efficient mechanically. Because it was coming up against a stop around 100-110% every time I bent it, that would account for the mild swelling and heat building up during the day. Solve the ROM and it should go away.

On 3. he seemed uncertain, his best guestimate was something called the popliteus muscle, which apparently runs at an angle across the back of the knee. He said when the knee joint wasn’t working as bio-mechanically as it was supposed to, this sets up stresses and strains on various tendons, one of which is the popliteus muscle (tendon?), which may be irritated and spasming as a result.  As to the accuracy of that diagnosis, only time will tell. It seems plausible because it would account for the spasms being mainly in the lateral side (non-op) at the back of my knee. My mind wants to believe that, rather than anything more sinister, so I’ll go with that for the time being. 

On those painful spasms at the back of the knee, I’ve learned to live with them. When they first started occurring they’d take my breath away, I’d freeze mid-stride and let out a curse. The pain was sharp and intense, like a badly trapped nerve or cramp spasm. But it’s amazing how the body and mind adapts.  Not sure whether it’s the pains growing less, or me tuning them out, but now I just walk through them. They don’t happen all day, some days not at all. But usually if I’ve irritated the knee and it’s a bit puffy, they will strike at random points during the day, when I’m getting up from a chair, or just walking somewhere. My hope is that, when I eventually get better ROM back into the knee, and strength in the quads, and the knee generally operating like it’s supposed, then these rear knee spasms will fizzle out, if it is the inflamed popliteus as the OS suspects.

In previous posts I have also described a strange anomaly, what I can only describe as a ‘squishy, squeaky’ sensation, that usually occurs when the knee is a bit swollen, or, oddly enough, when I have been icing the knee.  When I get up and walk around there’s a definite sensation of something slimy squeaking through the centre of the knee joint. In my mind’s eye, I picture it as a piece of thick, lubricated string being passed through the rollers of a mangle, as the knee joint flexes and extends. When it’s doing it, if I’m in a quiet place, you can clearly hear it squeaking, like the hinge on a rusty door. It’s not in the least painful, but feels quite disconcerting as it’s obviously something that’s not meant to happen, and my OS can’t seem to account for it.  When I mentioned it to him at the last consultation, he muttered something about it possibly being ‘a bit of bone’ moving about in there, then quickly changed the subject. A BIT OF BONE! WTF! Like hello! I should have pressed him further on this point, but you go to these consultations with so many questions, and the conversation ebbs and flows, so if you don’t actually sit there with a tick list crossing everything off, you always come away having forgotten something you meant to get a satisfactory answer on. If it’s still happening at my next consultation in two months, I’m going to press for a more considered diagnosis.

For now, my OS has counselled conservative treatment.  He says 4 months post op is still early days for an allograft, and it may take a year or more to get as good as it’s going to. He wants me to give it another couple of months continuing to try and gently stretch the knee to increase ROM, combined with getting a physio to massage and break up the scar tissue.  Because my OS is in London and I’m in Norfolk, it was impossible to visit his normal physio, so I’ve got by without so far. But he now thinks it’s vital I get a physio to try and help me break through this barrier. So I’m going to scout out the best local physio I can find with experience of working through scar tissue. Can’t say I’m hopeful of finding anyone in the wilds of Norfolk with experience of meniscal allografts, but you never know.

If the conservative option doesn’t get things moving, my OS said the other two options were manipulation under general anaesthetic, or an arthroscopy to go in and clear out scar tissue.  I said I’d heard some good stories, and also some horrific ones, about what can result from a MUA, so if it comes to that, I’d rather have an arthroscopy than a straight out MUA.  At least with an arthroscopy if they’ve got a camera in the knee, they can see what they’re pulling apart.  But we’ll cross that bridge if we get to it. In the meantime I’m now trying to step up the flexing exercises, and will investigate some local physios next week to get some help. 

My next OS consultation is scheduled 2 months from now, in early April.  However, I am being handed over to a new OS, Ian McDermott, as the OS who did my allograft, Angus Strover, is retiring in March.  I could have done without that complication, but Ian McDermott works at the same clinic and is experienced in the same procedure, so I’m hopeful the handover won’t cause problems.

Apologies again for my rambling, long posts, I just wanted to tell it like it is, so anyone else contemplating this treatment can read this as a reference of one individual’s personal rehab. But always remember to look around at other people’s experiences on this site, as no two people seem to have exactly the same journey.
So in summary , my progress and daily life at about 4 months post-op is this:

•   Walking (gingerly and slowly) about the house without crutches.
•   Outside the house, and at the office, use one crutch to aid mobility, stability, and speed.
•   Driving comfortably without pain.
•   Swimming 20 mins lunchtime, 5 mins rowing machine, occasional 5 mins recumbent cycle if knee will bend that far.
•   Try to flex and stretch knee at various points in day, as far as it will go.
•   At weekends, try to get out for a 20-30 minute walk (between half a mile and three quarters) around the local village.
•   Most evenings knee a puffy and red, some days a bit more than others. Requires ice.
•   I’m a long way off from anything that remotely feels like normality. 
•   Do I notice any improvements on a daily or weekly basis? No. Does it feel better than it did a month ago? Yes, but only by about 5%.
•   Must spend next 2 months working on ROM stretching, helped by physio massage to break up scar tissue.
•   Next scheduled to see OS in 2 months (early April).

 :-\
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline Jill M

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Re: Archie's Meniscal Allograft
« Reply #11 on: March 18, 2011, 01:04:34 AM »
Archie,
I wanted to see how you were progressing since your surgery. Sorry to hear you have had such a difficult journey. I can sure relate to many of your experiences.
It is so frustrating when you know that you are not progressing as expected. It sounds like the knee definatley has some scar tissue issues along with possibly issues with the graft. Keep icing and elevating as much as possible when it is red/swollen.
Even if you OS cleaned out scar tissue when he put the graft the scar tissue can reoccur.
I hope the transfer to the new OS goes well  and your work with Physio will give you some progress.
Jill
8/07 Right subtotal meniscectomy
4/08 Chronic meniscus tear, grade 4 changes
10/08- R distal femoral osteotomy, lateral meniscal transplant, tibia microfracture, osteochondral allograft femur
12/08- AF noted, LOA
2/09- MUA
8/09- extensive LOA, patella baja
1/20/11- TKR

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #12 on: April 08, 2011, 04:14:50 PM »
This post is being written at 6 months post-op, and covers the period from 4 to 6 months.

Two months ago (at 4mths post op) my ROM was stuck at 90/100.  Physio sessions in the last two months have helped me improve that to 120/130 degrees.  This in turn enabled me to get back on my road bike for the first time in five months, and increase my bike work in the gym. That has enabled me to start building up the muscles, particularly the quadriceps, which have been very weak since post-op.  The physio also gave me some exercises to build up the abductors/adductors, and some tips for restoring my proprioception reflexes in the knee.  The overall result is the knee is starting to feel stronger and more stable than at any time since the op, and at 6 months post op I am now able to cycle up to 10 miles, and walk just over a mile without much reaction. 

I still get some redness, heat and swelling some days, but it’s growing less frequent and severe with each month. Usually it coincides with if I’ve overdone some activity, or turned or jarred the knee in some way that irritated it, just going about normal activities of daily living.

Just had my 6 months appointment with my new OS, Ian McDermott, on 6 April 2011 at the London Sports Ortho clinic.  At my 4 month check up, my previous OS Angus Strover had said that if my ROM didn’t improve, he was considering MUA or scoping the knee.  But my new OS said he was happy with the increase in ROM I’d achieved over the last 2 months, and counselled me to continue with the physio, massage and other exercises, and see if it continued to improve.  Then to review the knee again in 3 months time (9 months post op).  At that stage, if ROM hasn’t improved much, there is always the option to scope it later.  But he said he definitely wouldn’t do an MUA without also having a scope in the knee at the same time (phew!) as that would risk damaging the graft, and anyway his preference is always not to go in unless necessary.  Because the main constriction of movement is tightness across the front of the knee, my OS thinks it is more likely to be scar tissue.  If the pressure was more across the centre or back of the knee, he said that would indicate a mechanical problem (eg cartilage not sitting right, need trimming, etc). 

So for the time being, I’m to continue stretching and getting massages to break up that scar tissue and increase ROM.  He further reminded me, if I didn’t know already, that 6 months is still ‘fairly early days’ in terms of rehabilitation from a meniscal allograft.  Although the graft would have already knitted together with my remaining meniscus and formed a blood supply between them, that process can take a year or more until it is complete. So he still advised against any ‘impact based’ exercise in the meantime. I’m to stick to cycling, x-trainer etc, steady as she goes. He was very much into managing my expectations, which was cool, as I’d rather have honesty than unrealistic hopes. 

So in summary, my progress and daily life at 6 months post-op are as follows:

•   Walking fairly normally indoors and outdoors (crutches discarded 6 weeks ago).
•   Have walked up to 1.5 miles without significant reaction.
•   Walking upstairs/steps normally, without handrail.
•   Still need handrail to walk downstairs/steps, or have to go very slowly when flexing affected knee.
•   Physio once a fortnight – massage and working on ROM and strength building exercises.
•   Gym most lunchtimes – bike, rowing, x-trainer, abductor/adductor, swimming.
•   Cycling outdoors, usually between 5 and 10 miles a day.  Still not completely comfortable getting out the saddle on hills yet, tend to knock it down into lowest gear instead.  Aim to build back that ‘out the saddle’ confidence in coming weeks/months.
•   Still need to ice knee most days, mostly after significant exercise/activity.  If I have a ‘light’ day, I often don’t need to ice it at all.

NB. My 'good' knee is showing signs of wear

In the first appointment with my new OS I also took the opportunity to ask him about some irritation I’ve had in my RH (good) knee for the last year or so.  I had mentioned this to my previous OS, who had done an MRI on it but said he could see nothing untoward.  My new OS Ian McDermott reviewed that MRI and immediately spotted a small tear of the medial meniscus, which my previous OS had either missed, or decided not to tell me about.  Great.

It was a bit of a bummer finding out I’d got a tear in my ‘good’ knee.  That’s something I’ve been dreading ever happening, as it’s been like a crutch to me all throughout the years of my left knee playing up.  However, I know exactly when it  happened, about 18 months ago, when I was stepping up onto a sauna bench which the local swimming pool had conveniently raised to about 2 foot high.  Because my bad knee had no power to push off, I remember  I had to pull my self up just on my good knee, and I remember an uncomfortable feeling, as though I’d done something to it, but there was no tear or pop or anything, no twisting movement at all.  Just that it felt weird.  Well, now I know what it was.  And it’s never settled down since.  My OS reckons that at my age (55), it was probably as much a degenerative tear as to do with the activity per se.  The older you get, the less flexible and more friable your cartilages become, so it takes less to injure them. 

“As people get older, the meniscal cartilages become worn and begin to lose their elasticity, and degenerate meniscal cartilage tears can occur with just minor trauma, or sometimes even spontaneously.” http://www.kneeguru.co.uk/KNEEnotes/node/1831

What a bummer, but there’s nothing I can do about it.  Age is catching up with me. Maybe I should just be thankful it didn't happen sooner, or I've have been completely screwed.

Since the knee causes me no actual pain to speak of, more a feeling of mild irritation at the back of the knee. It doesn’t lock or catch or anything, so my OS said there wasn’t much point in scoping and trimming it.  Meniscal splits don’t repair that well once you get past a certain age, and trimming it would just remove more cartilage and accelerate me down the path of the other knee.  The only good bit of news was, as tears to menisci go, he said it was the least serious kind, so not likely to spread rapidly or split the whole meniscus.  He just told me to ignore it for now and if it got painful in a few years, it could be looked at then.

I could have done without the distraction while I'm rebabbing my allografted knee.  Throughout all the problems over the years with my bad knee, I've always been able to count on my good one, without even thinking about it.  It was always there, like a dependable lift, a crutch, a lever. But now when I get up from sitting, or climb step or ladder, I'm going to have to think about it. Above all I have to avoid loading my grafted knee, to try and protect my 'good' one.  Oh well, s**t  happens.  Will post the next update in a month or two, unless I've anything to report before then. 
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline cliffoa

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Re: Archie's Meniscal Allograft
« Reply #13 on: January 10, 2013, 01:10:27 PM »
To those people who were following my Meniscal Allograft progress since my op in October 2010, I thought I'd post an update, as I've not been on here for over a year. 

The knee didn't settle down through 2011, or 2012, and the allograft didn't seem to have helped at all. I was still getting inflamation, instability, pain etc, and my range of movement since the allograft had been severly reduced to not much more than a 90 degree bend, so something was obviously not right. The surgeon who put it in in 2010 (Angus Strover) retired in early 2011, so my case was taken over by Ian McDermott at London Sports Orthopaedic, where Strover had worked.

Ian examined my knee in the summer of 2012, did MRI and Xray, and said he was fairly sure the allograft had failed. From the MRI he said it looked like it was detached at one end, therefore it was functionally useless. He wasn't sure whether this would be stopping me bending it, which could only be confirmed by him looking inside.

I was booked in for an arthroscopy in October 2012. The arthroscopy confirmed the allograft had indeed come away at one end (or even not been originally attached very well during the original allograft operation). It also had a large split down it.  So Ian removed the allograft.  He was still unable to bend the knee much past 90 degrees, because there was significant arthrofibrosis (scar tissue) which had formed during my immobilisation after the allograft operation.  He cleaned this out as best  he could and did a Manipulation while I was under general anaesthetic. It made my eyes water when he described it to me later, but he said he was able to get my calf back right to my thigh, which I hadn't been able to do for years!

Ian tidied the knee capsule up as good as he could, but the net result is I've got more or less no meniscus on the medial side. I also have significant areas of thinning and wear to the articular cartilage in the medial compartment, but as yet no bone on bone.  The lateral compartment was in pretty much pristine condition, with no damage to articular or meniscal, which was one bit of good news.

Following the operation I had a long chat with Ian about my options.

He said I could try another meniscal allograft, but he advised against it. From all he said about his own approach, I'm certain he would have made a much better job than Strover did, but he was honest enough to tell me there would still only be an 85% ish chance of success. I could be one of the unlucky ones, as I had last time. Also, my age might reduce those odds further, as I'm 57. It seems Meniscal Allografts (obviously) work better the younger and healthier the rest of your knee is, and when you get into your 50s they are at best a delaying tactic to gain a few more years before a knee transplant, which they prefer not to do until your 60s if they can avoid it. But having just been through two years of pretty much semi-invalidity since the allograft, did I want to put myself through another painful allograft op, with the long and painful rehab, and likely need for a follow-up operation a year later to clear away scar tissue, when there were no guarantees it would succeed any better than the previous one. His counsel was not to even go there, and it seemed like a no brainer to me too. The last two years hobbling around haven't been fun, and I'm in no hurry to repeat them.

So I'm pretty much back to square one where I was two years ago before the allograft.  Except I still  had a few remnants of medial meniscus then, but they were pretty much sacrified in the op.  On the upside, Ian has at least restored something like a normal range of movement to my knee. I've been working hard on the rehab since the op and can now get my heel almost back to my buttock, so that's progress.

But in general, my knee still feels weak, not that stable, don't really feel I could run or jump or do anything vigorous with it.  So I mostly just walk around slow, picking my steps carefully. I have to ice it most days, when it gets a little hot and inflamed and starts to tighten up a bit.  Plus I eat ibuprofen like sweeties.  I guess it's all part of the fun of growing old.

Ian's counsel to me is to just get on with living with the knee as best I can, for the next few years or however long that is. There's currently no bone on bone but that's probably only a matter of time. He said when it got too painful or was stopping me doing too many things, that would be the time to consider having a partial knee replacement, by which time I'd hopefully be in my 60s. He said because my lateral compartment was in almost perfect nick, I'd probably get away with a uni-compartmental knee replacement just on the medial side, which would be a smaller op and leave me with more functionality, as I'd keep my own kneecap and ligaments, as opposed to a TKR.

So that's where I am folks. Not great, but hey, I did my knee 35 years ago in my early 20s playing football, (ruptured ACL and torn meniscus) and since then I've had around a dozen operations over the years, and gotten a fair amount of mileage out of the knee, so maybe I shouldn't complain too much. It sucks, of course, as I'd still rather be running up and down mountains, but I can still get out on my bike and do 20 miles of a weekend, I can swim and work out down the gym, so life could be worse.

So I'll be taking it one day, week, year at a time from now on, just getting on with life and listening to my knee, which tells me what I can and can't do.  I plan to get by for as long as I can before having the uni knee replacement, since who knows what medical breakthroughs are just around the corner.

But I gave the meniscal allograft my best shot. It just didn't work out for me.  Would I have it done the same, if I could go back 2 years? Hard to say. Probably yes, anything's worth a try. Everybody's knee is different, and I know from this forum and other places that other people's allografts have worked out just fine and restored them to pretty much full functionality. Techniques for allografts are improving all the time. All I'd say is, get yourself the best surgeon you can, who has a lot of experience of doing these ops.  (But not TOO MUCH, as I found out to my cost. I chose Angus Strover because he did the first allograft op in the UK and had most experience, but what I forgot to factor in was that the guy was probably in his 70s when he did my op, it was one of his last allografts, he retired soon after, and to be honest, I don't think he did a brilliant job. That may be unfair to him, but I can only say what I feel. It never felt right from the moment he put the darn thing in, that's all I know.)

So find the best surgeon you can. Ian McDermott at London Sports Ortho is a top guy whose done loads of these so I'd recommend him if you're in the UK. I'm sure there are other good UK surgeons, I just don't know them. As ever, research and read what other people say. If you're in the States, Stone seems to be the go to guy. Europe, I don't know about. 

Also, remember if you're in your 40s or 50s the chances of it working out so well are less than if you're younger. You'll have a lot more mileage in your knee then than youngsters, subtle arthritic changes over the years, cartilage thinning and losing some flexibility just from normal aging process, never mind any injuries. Not sure if scar tissue also becomes more of an issue as you get older, but it seemed to with me. I never really had trouble with scar tissue from previous ops, but after the allograft op, it felt like my knee had been sewn up to go no more than 90 degrees.  Just something else for you to factor in, if  you're getting on a bit and considering one of these allografts.  They're one of the longest and most painful rehabs of any knee op (you're looking a year at least), so not to be contemplated lightly, and remember to try and get an honest assessment from the surgeon of your likely chances of successful outcome, given YOUR knee, and YOUR age. 

If you're in your 50s or older and your knee is just too painful, you may be better off going straight for the partial or total replacement. These days they're much less hassle to fit, the rehab is a doddle compared to the allograft (they have you walking around next day), and replacements are being made with better materials and lasting longer than ever before. Pretty soon they'll hopefully crack the longevity issue with replacements altogether, so you wont have to worry about having a revision after 20 or so years.  But now I'm straying into medical areas where you'd be better off getting advice from a surgeon.

Good luck with your knees all. I'm off to hobble into the sunset. : 0 )





 
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.