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Author Topic: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary  (Read 8081 times)

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Offline gooner

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Just reached 6 weeks post surgery to repair three articular cartilage lesions on my left knee (Patellar - 3cm x 2cm, Grade 4a, Trochlea and MFC - both 2cm x 2cm, Grade 3).

Required an open procedure in the event to allow OS to get full access to my patellar and as a result had a 5" incision down the centre of my knee and 17 clips. I was in surgery for 2hrs and in hospital for two nights. This was because the nerve block didn't wear off for 36 hours. Used CPM while in hospital to max of 60deg. My operative leg gave way on me while in hospital (momentarily forgot about the op !) and I collapsed to the floor - real scary but fortunately appears to have been no damage.

For a few days after the operation the incision kept bleeding and some industrial bandages were needed to handle the leakage. I left hospital with Tramadol and took these for the first few days and then just a night time to ensure a good sleep. At four weeks the Tramadol were causing various side effects and I thought I was going crazy. Checked on web and stopped using them immediately - not recommended but .... ! Previous scope surgery was more painful though recovery is much longer this time. Clips were removed at 13 days and the incision was fully closed up by four weeks. Been doing daily PT prescribed exercises (SLRs, static quads, clams, glutes, tension bands and icing) and PWB on crutches for six weeks.

By five weeks the ROM had steadily improved and matched the non-operated leg. Have found the swelling to be variable based on level of activity, more recently knee has measured between 46 and 51cm, reckon on about 75cm immediately post op, it was enormous!!

Yesterday, I walked with one crutch around the garden, just twenty metres before remaining muscles raised strong objections and that was that. Still a milestone for me and I'm sure that the distance and muscle strength wil improve as muscle mass returns. PT session next week and further OS appointment week after. Haven't driven yet. Not restarted London commuting but that'll come all too soon!

So far so good ;D. Further update next week.

J.








 
« Last Edit: June 03, 2011, 11:08:27 PM by jdb_gooner »

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #1 on: June 06, 2011, 08:40:48 PM »
Have now been out driving a couple of times, yesterday and today. I checked that I could do an emergency stop on the driveway and please to report that the garage door is intact !

So just short trips but after nearly 7 weeks indoors, the sense of freedom again is fantastic.

Back at the physio tomorrow, so paralysed by Wednesday, lol




« Last Edit: June 07, 2011, 12:32:10 AM by gooner »

Offline Lottiefox

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #2 on: June 06, 2011, 09:36:25 PM »
Hi there

Good to see the diary!
Really good news on the ROM and I share your enthusiasm at the driving - I got back behind the wheel after 6 weeks last week and tested my emergency stop on the driveway next to the flower pots. I bottled slamming my beloved car into the garage but all was well. The enjoyment of being free again is awesome!


Good luck and keep us updated,

Lottie :)
« Last Edit: June 07, 2011, 08:23:03 AM by Lottiefox »
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: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #3 on: June 11, 2011, 11:05:17 AM »
Hi there,

Sounds like you are doing really well. It's great to have these small encouragements like getting behind the wheel and walking with one crutch.

I am 7 weeks post op cartilage repair but just on LFC so not so extensive as yours. Currently doing some unaided walking around the house but taking 2 crutches with me when I go out. I haven't yet tried driving but hoping to give it a go next week when I will be 8 weeks post op. Suffering today after agreeing to let my 7 year old daughter have a birthday party in our house yesterday. hmm ! I massively over did it so am resting up with loads of ice and letting the OH take the kids out.

Hope physio went well for you.

Catsmum

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #4 on: June 13, 2011, 05:13:00 PM »
Thanks Lottie (how are you doing now?) and Catsmum for your comments.

An update after my PT (at nearly seven weeks)

Been four weeks since I had seen PT and she was very pleased with progress and range of motion - 0 degree extension and 120-125deg flex - so approaching normal. However, there is significant muscle wastage and this is having a negative effect on ability to walk normally. Have some new and exciting (relative to what I had before!) exercises for calf, VMO, quad mainly and some general walking and balance routines for the pool to begin in around a week. PT advised me to return to using two crutches for now to improve walking "style" and avoid developing a limp.

Concern with just one crutch is that I'm compensating for not yet being ready to fully load the knee, I
tend to lean onto the single crutch (which is on the non-operative side) and may well undo the muscle work. I stood in front of the mirror and it is true!

I chatted about the amount of knee stiffness and swelling after walking too far or sitting for too long - typically its around 48-49cm, PT told me to continue regular icing, elevation and start with anti-inflammatories to control it as will now hinder progress in walking. My knee returns to about 45-46cm overnight.

Also discussed the discomfort above the kneecap and PT thought that my quad tendon was probably cut temporarily to allow the kneecap to be flipped over for work on the back of it - seen the pictures of that and I'll get the video of the operation and photos to take away when I see the consultant again - I'll get the popcorn ready, lol.

We discussed my working day and 2.5 hrs journey each way to/from the office (was expecting to be back in this week) and was advised not to return for the time being as would be too much strain on the muscles at this stage and best to continue working from home (with regular movement / exercise breaks) until no longer dependant on crutches. It is difficult to determine the timeline but thought unlikely to be before next appointment in two weeks.

So a mixed bag, overall though progress continues each day just slower than I expected / hoped. Im continuing to enjoy my freedom from having restarted driving after so long.

As well the PT and surgeon, feels about time I mention especially my wife, children and parents who have been great in helping me post op - I don't know how I'd have managed without them.

Seeing the consultant this week, will ask about whether the quad was cut and will post afterwards.
Over the last three years that I've been having trouble, I have developed a nerdy interest in knees so can't wait to see the video and photos.

Thanks for reading.
« Last Edit: June 13, 2011, 06:15:52 PM by gooner »

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #5 on: June 14, 2011, 09:47:28 PM »
Seen the OS today, everything on track and he's pleased with progress, so thankfully no dramas.
The quad wasn't cut and the procedure was done subvastus instead which involves an incision under the VMO and allows the patellar to be tilted for work on the back of it - well pleased about that as obviously best to keep as much muscle and tendon intact as possible !

Photos and video of operation are amazing. Next appointment is in six weeks.





Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #6 on: July 09, 2011, 07:35:54 PM »
Hi,
Just over eleven weeks post-op. Hardly using the crutch indoors but still need them outside. Some good days and others not so good, enough to take a painkiller.

Have continued with physio every two weeks and now going to the pool every two/three days: nothing too demanding just walking, balancing on one leg, knee bends etc.  At first there was medial pain on reaching full extension during attempts at flutter kicks (breast stroke kicks are bad for kneecaps !!). Pain was enough to force taking it real easy. Improved over the last couple of weeks and now able to swim a couple of lengths, though hard work and so feeling it though next day. Have found it really difficult to balance doing too much against not enough.

Muscle bulk has improved and PT exercises are getting progressively more difficult. Been using an exercise ball for bridges and hip / pelvis strength and stability, again PT looks at all the muscles involved in knee function.

Driving is absolutely fine and no problems at all now. PT has measured flex at 125 degrees and extension -5 degrees, normal for me when lying down. But the knee is still reluctant to flex (small knee bend) on operative leg with full weight and currently PT still advises against commuting. OS warns of possible pain and swelling at around three months as new cartilage starts to grow, which may require an injection. For now swelling continues as was so typically around 49cm.

In summary, noticeable progress each week but it's a long road !

Has anyone else has their plaque psoriasis disappear on their operative knee - mine has and have no idea why ?

Post again soon.

Thanks for reading.

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #7 on: July 19, 2011, 10:38:04 PM »
Approaching thirteen weeks now post op. Another recovery milestone achieved in that I have made two train trips to work in London.

The first at twelve weeks. It is a long day with five hours commuting including around 1 mile walk from station to office, which I did in both directions. I needed to see what I could do and what I couldn't. I used one crutch,  and it took me 30 mins each way but hey no rush !

Some signs over the last few days of the predicted increase in pain as the new cartilage starts to grow. Planning to manage with oral meds rather than approach OS for an injection.

Keeping up my pool visits and have different exercises using two foam tubes "woggles" under my foot and lifting and lowering knee, each time under control against buoyant tubes - works really well and feels like a good but safe "workout", great for balance work also.

Also doing lunges to help improve gait and land heel and push off toes.

Looks like I'll not be clear of the crutches as soon as I'd wished or expected, still needing them to take some weight off my knee but really have come a long way since the op and very positive about progress.

Now working on small knee bends as per PT target, some signs of knee being ready to take body weight but further work needed to develop strength and stability in muscle groups.




 

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #8 on: August 21, 2011, 05:56:31 PM »
Now just over 17 weeks post op....

Into my second week without my new bestest friends - yes, OK they may be crutches - but they were true friends, there for me, always giving support when I needed it. I guess I should be ashamed of how I have used them and cast them aside when they were no longer of use;D

Now returned to normal working pattern and commuting to London a few days each week.

Knee is still stiff sometimes and a little uncomfortable after sitting in the same position for too long. Been able to do some DIY again though instructed not to kneel, run, cycle or play sports for a year. So weeding the garden without kneeling down was errr ... interesting !

Seen the consultant again recently and he is very happy with progress, all normal and no injections needed. Next appointment with him will be in October after my MRI scan. Expecting to "see" some new cartilage then. Continuing with physios exercises and the pool sessions which have been really helpful in restoring movement and function. Enough muscle strength to climb stairs normally now, but going down is still difficult and uncomfortable. PT expects that to improve as muscle strength returns. No further appointments planned until October. Scare is healing nicely and has naturally smoothed out. As mentioned on previous posts the psoriasis has almost completely disappeared. This took the consultant by surprise and he has taken a picture to discuss with a dermo specialist. So there you have it, one cure* for psoriasis is to have an arthrotomy.
* it may not work for you  ;)

So overall continuing to improve every week and feeling confident that my left knee at least will be better than before I went in. However, it's a long road !

Take care and best wishes to you all for your own treatment and recovery.



Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #9 on: November 02, 2011, 08:16:38 PM »
Hi all,

I've now reached six months post-op and have had the results of my MRI scan.
The great news is that around 50% of the articular cartilage has regrown. It is visible on the MRI images (at least when the consultant points to it !! :) )

This level of regrowth is at the very upper end of the expectations so really good to hear that. I won't know the quality of the cartilage until the next scans in another six and twelve months but so far so good.

The knee has some stiffness on extension so I'm going to restart the exercises that the physio gave me to improve that early on. Going downstairs is still slow and a little uncomfortable. Some days I have more discomfort than others but not really worked out how this relates to activities the day before. Overall though, things are going quite well.

On advice from the consultant, I've avoided playing soccer, cycling or kneeling down. I'd love to be able to do those things again but all in good time.

Take care, all the best.



Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #10 on: February 09, 2012, 07:54:28 PM »
Approaching ten months post op now.......

I'd say that the recovery is going well. There is almost no pain from the cartilage now and it catches only rarely. The single stage articular repair is quite amazing, at least it seems to be working for me.

I often have some discomfort and stiffness in the knee itself, a factor of the open procedure and general disturbance in there - but that is improving also, with PT guided exercises and giving it time.

Not long now until the other activities are allowed. Looking forward to that and the next scan at 12 months. Hopefully, it will show that the volume of regrowth is on target and that it is good quality.

I'll post again then...

Thanks for reading and all the best.




Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #11 on: June 03, 2012, 04:37:20 PM »
So here we are, just over 13months since surgery - wow what a long road its been.

I've had my 12months scan which has revealed quite fantastic growth results. My patellar now has near 100% cartilage again rather than the 35 x 35mm hole and within the medial compartment growth is about 75%. As a result the joint space has widened and is now around 6mm.

The cartilage location itself feels absolutely fine, I can't remember the last occurrence of a lock/catch whereas before it was 2-3 times a day.
There is some numbness on the lateral part/outside of the knee joint which is down to the open procedure which cuts the nerves, these may regrow but a small price to pay. I also have a build up of fluid causing some other discomfort which can be treated.

I've been cleared for kneeling on it, cycling, straight line running and a little football - though after a good 18months away from these, I'll not be rushing. Did try to kneel down on both knees which wasn't exactly comfortable - I'll see over the weeks to come how that improves but I may be one who chooses to avoid it as the OS advises does happen from time to time.

So all things considered, very happy with the results - it has been a long journey but feels like I may be reaching the end. The other knee is OK just now but expect to need that attending to at some point.

I'm having a further T2 MRI scan soon to determine the quality of the cartilage that has grown and this helps the OS predict its lifetime. Will post again afterwards.

Meanwhile, all the best to you all.

J.


Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #12 on: September 03, 2012, 10:40:13 PM »
The results of the T2 mapping MRI are now in and they are very good.

Imagine a line - one end is Fibrocartilage and at the other Hyaline, as you've probably read by now - Hyaline is the natural more flexible type and it is the target. It's not [yet] achievable in the lab so the best we can hope for when having articular cartilage repair is "Hyaline like" !

My results show 90% Hyaline behind the kneecap (patellar) and higher still in the trochlea/mfc. My OS was delighted and its amongst the best he has seen, commonly it is 80-85%. Original predictions were for 6-8years lifetime whereas now the OS is speaking of around 10years for the cartilage, though the diseased joint / synovium fluid may break it down earlier. I was expecting to have another scan at 18 months to check the protein content in the grown cartilage but OS says it isn't necessary since you wouldn't achieve a high hyaline rating without good protein present.

My treatment is now finished, no more visits needed and I'm very happy with the results. I have tried a little cycling, some gentle jogging, badminton, beach volleyball and some soccer. Some way to go to recover agility and never to Olympic standard but I'm able to enjoy these simple pleasures again. It's been a long road - very nearly two years since the symptoms reached the point of needing sorting. I'll need to look after things and no doubt my right knee will need doing at some stage.

I really don't know whether to leave this in PostOp Diary or add to Success Stories or Articular Cartilage Repair (though doesn't seem to be a natural section for my treatment - single stage using stem cells, grown in situ with a collagen gel implant - lost count whether that is 4th or 5th gen )

Special thanks to one member on here for their posts. They were a major influence on me following-up on this treatment option. You'll know who you are. Continuing the Olympic theme, Gold medals go to my OS and PT, simply thank you for everything.

Take care and all the best.

J.

Offline Joeybiscuits

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #13 on: September 03, 2012, 11:31:06 PM »
Gooner

Thank you much for your long-term updates. I am a veteran of seven knee surgeries, with six on my left knee including a DeNovo cartilage implant surgery 12 days ago. The defects were under the patella and on the shoulder of the patella. I previously had other defects worked on. Your diary is encouraging as I have heard anywhere from 1-3 years until folks who had this surgery are back to running, playing sports, etc.  It would be great if you could post in another few months. I am keeping a diary on here as well to try to assist others that may have a smiliar procedure.

joseph

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #14 on: April 26, 2013, 11:12:58 PM »
So here we are, just over two years since my surgery. Thought some might be interested to hear how things are now.

My operated knee is actually pretty good now, I've played some soccer, can run, cycle and do more or less as I please now. I do kneel on it from time to time but not for too long, it gets a little uncomfortable and not too sure if it is doing it any good - so I prefer to look after it.

The knee does ache for a day or two afterwards when if I have had a particularly busy day walking or standing on it for long periods but it soon passes and its not enough to disrupt my day.

It took around 18 months to settle after surgery including around a year for the new cartilage to grow but the difference between now and pre-op is quite amazing. But the continual feeling of joint slipping/reseating and associated pain I used to have just doesn't happen anymore.

I proudly show the photo of my operation in progress to anyone willing to see it - still find it incredible to look at and think what has been achieved.

The key question is then :  would I have the other knee done using this treatment - well, it is a long hard road through recovery. It was about three and half months on crutches and restricted activities for a year, lots of physio but it is worth it. So absolutely and without too much thought. I don't think it will be too long now before the other knee is done, of course I'll keep you all posted when the time comes.

Take care, all the best

J.
« Last Edit: April 26, 2013, 11:30:06 PM by gooner »

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #15 on: May 27, 2014, 11:58:21 PM »
Three years post-op using Cartifill. My knee is still great, it doesn't cause me too much problem at all and I can do more or less anything I choose, thought I still choose not to kneel too often. It does ache after a lot of walking or standing on it but I'm used to that now and it doesn't really affect me.

I would have my other knee done without a moments thought, despite the long recovery, because it is worth every minute to have a more or less fully functioning knee after several years of problems.

Hope you are all making good progress, stick with it !

J.

Offline IMF73

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #16 on: January 08, 2016, 06:48:12 PM »
Hi Gooner.....Its a long shot but are you still active on this forum? I have recently had very similar surgery to you & would be interested to compare notes. Really positive to read that yours was a success.

Offline PuneKnee

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #17 on: March 06, 2018, 08:25:46 PM »
Hi Gooner,

A 2018 update will be much appreciated :)

Offline Vickster

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #18 on: March 06, 2018, 08:58:10 PM »
Hes not visited the forum for 2 years. Once you have 20 posts yourself you could PM him and see if hes picking up messages via email

There are a couple of more recent Cartifill posters too
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 gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #19 on: April 15, 2018, 02:13:06 AM »
Hi all,
Approaching 7 years now since my cartifill treatment by Mr Shetty.
Apart from the odd ache or brief pain my knee has been and still is more or less "normal" - I'm not restricted in my activities at all !

I'd like to have my other knee done before Mr Shetty retires but I'm not sure its necessary just yet !

Hope you all good outcomes from your surgery.

Please feel free to message me if you have any questions at all.
Julian

Offline IMF73

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #20 on: April 15, 2018, 10:15:13 AM »
Hi Julian. Really good to hear.
My surgery by Shetty was now 2.5 years ago - we spoke just after my surgery if you remember.
Mine too is so far so good and I have also returned to most activities.
I remember you played football, is that right? Are you back playing?

Cheers

Offline gooner

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Re: Lesion repairs (MFC, Patellar and Trochlea) - post surgery diary
« Reply #21 on: April 21, 2018, 11:26:10 PM »
Hi Ian
Yes, I remember chatting to you just after your surgery. Glad to hear everything worked out for you too.

It's seven years today for me and it made such a difference to my life and what I could do - I'm eternally grateful to Mr Shetty.

My football was mostly coaching my son's youth team which I did go back to but that finished as he grew older.

I've since played badminton and cycled, both with no restrictions.
My knee is a little stiff for a short time now and then, it doesn't care for ages spent kneeling either, like laying laminate flooring but no major issue at 51 really.

Hope all continues to go well.
Keep in touch
Regards
Julian















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