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Author Topic: Possible graft failure and subchondral collapse - anyone good at reading x-rays?  (Read 3648 times)

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Offline redlotus

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Hi folks - haven't been on in a while, sorry!  Had my OC allograft back in October.  Recovery went alright - lots of blood rushes and some nerve issues, and still not where I want to be with extension, but I was on schedule for weight bearing and ahead of schedule for flextion.  I thought everything was healing up well, but the pain really lingered and started to go from expected post-op achyness to a more acute, arthritic feel.  I expressed concerns to my surgeon's PA who dismissed it was normal post-op pain.  Well a few weeks ago I had follow-up x-rays, and the radiologist's report arrived last week and scared the crap out of me.  I know that I shouldn't freak out over it because often radiologists misinterpret films and mistake grafts for problems, but I'm worried because one of the concerns listed was "subchondral collapse" under my graft site.  That means osteonecrosis, or bone death.  Also mentioned lesions on the "good" side of my knee, osteophytes, and possible osteochondral fragments/fractures.  Looking at my x-rays, I can see an area that concerns me under my graft.  I've seen a LOT of my own x-rays and I'm decent at reading them, and so I'm worried that this is graft failure.  I'm waiting on my surgeon to tell me for sure one way or the other, but it's taking a long time for him to get back to me and in the meantime I'm freaking out. 

So can anyone take a peek and let me know what they think?  I had a shell allograft on my anterior MFC, about the size of a quarter.  On the x-ray it's the chondyle on the right.  You can see the line where the graft meets my bone, and there is a dark smudge behind the graft on the left half of it that concerns me.  Problem is, I don't know what a healed graft looks like, because this is my first OC allograft.  So if you're not great at reading x-rays but you have your own images of a normally healed graft (OATs, allograft, anything) and you're willing to share, I'd love something to compare it to!  Or if you have an image of what subchondral collapse/osteonecrosis looks like, that's be great too.  I just really want to get SOME idea of rather or not I need to be freaking out and planning for surgery number 11 or not!

Thanks in advance!

Here's the x-ray:

file:///D:/IHE_PDI/AMPT0001/AMST0001/AMSE0001/IM000001.JPG

Offline Sam451

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I can't load the image. Sorry.
Nov 09 Torn MCL, Articular Cartilage & Lateral Meniscus
April 10 Microfracture Failed/menisectomy
Dec 10 Autograft
Sept 11 Chondroplasty
Nov 11 Allograft MCL Recon
Jan 13 Chondroplasty, Lat Release
May 13 TTO/Lat Release
Dec 14 lat retinaculum repair
Nov 15 screw removal tighten lat retinaculum

Offline Jaime0402

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How are you doing now?

Offline markld

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There is a new procedure out for bone marrow edema or so called collapse called Subchondralplasty in which they inject calcium phosphate I believe, under the bone. Jack Farr and others are performing it......
April 2008 microfracture left knee trochlea
Jan 2009 ACI harvest from right knee
Mar 2009 ACI right knee trochlea
July 2009 Aci left knee
Nov 2009 left knee scope to check graft