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Author Topic: Lateral femoral condyle (LFC) Microfracture recovery  (Read 11777 times)

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Offline Maverick

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Lateral femoral condyle (LFC) Microfracture recovery
« on: May 15, 2012, 05:07:47 AM »
I am a 48 year old very active female, MMA black belt, rock climber, cyclist, etc.  I am accustomed to working out 8-10 hours a week.  Last September I had a Lateral femoral condyle (LFC) microfracture in my left knee along with a lateral meniscectomy.  Surgery included 7-8 microfractures.  I am in my 8th month of recovery and it is going very slow.  I spent 2.5 months non-weight bearing and did not get off crutched completely until 5 months.  Waiting this long ended up with significant atrophy in my leg.   I have an unloading brace that I just recently set to no-loading (0 setting) but still wear when my knee starts getting painful.  I work out at the gym 3-4 days a week with 30 minutes cycling (90 cadence) and using weight machines for leg press, leg extension, leg curls and abductor exercises using a cable and ankle cuff. I still have significant knee pain in the microfracture area 2-4 days a week, mostly at night.  My surgeon did a bone scan and MRI at 5 months to determine if there were any issues with the knee.  Nothing showed up other than thinning cartilage in the original injury area.  Although my recovery is slower than I would like, I am better than I was pre-surgery.

My questions are: 1) is this slow recovery and level of pain at 8 months reasonable?  2)  Has anyone else had a similar experience?  3)  How long should I wait before contacting my Dr. for further conversation? Also, my knee gets pink and warm at night sometimes.  Does anyone know what causes this?  This also happened with my lateral release of the patella in 2005.

Your feedback is appreciated.

1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline rob43

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #1 on: May 16, 2012, 12:03:38 PM »
good question
well ive also had a microfracture and a later release done and funny enough i'm at 8months too
i am jogging, walking up down the stairs pretty much pain free although doing lunges and one leg squads hurts and feel unstable still
if i push it i get swelling size of a golf ball around the lateral side, ive also got grinding now and then!
the surgeon who did the op said anything upto 12months before your active again!
yet another surgeon said 6months i guess everyone is different!

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #2 on: May 16, 2012, 02:31:06 PM »
My lateral release was in 2005 and my microfracture in 2011.  I am making progress although really really slow. 

I guess that I really don't understand why I still have pain at this point in my microfracture area?  The pain is not surgical or tissue pain.  I know that the fibro cartiledge is thinner and not as strong as normal cartiledge. I also know that the surrounding area has thinning cartiledge. Since cartiledge does not have nerve endings I don't understand the reason for the pain.  The only thing that makes sense to me is that the impact that I do have is enough to trigger pain sensors in the femur since the cartilage is so thin.

Anyone's thoughts are appreciated.  Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #3 on: May 16, 2012, 03:09:55 PM »
The only impact that I can do is stairs which my knee does not really like, walking and cycling.  All very low impact.
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Vickster

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #4 on: May 16, 2012, 09:32:44 PM »
My lateral release was in 2005 and my microfracture in 2011.  I am making progress although really really slow. 

I guess that I really don't understand why I still have pain at this point in my microfracture area?  The pain is not surgical or tissue pain.  I know that the fibro cartiledge is thinner and not as strong as normal cartiledge. I also know that the surrounding area has thinning cartiledge. Since cartiledge does not have nerve endings I don't understand the reason for the pain.  The only thing that makes sense to me is that the impact that I do have is enough to trigger pain sensors in the femur since the cartilage is so thin.

Anyone's thoughts are appreciated.  Thanks!

I haven't had mfx, but I do have an osteochondral defect (around 1.5cm2) on a weightbearing surface which was caused by trauma and in response, covered itself well with fibro.  This will be 3 years ago in September.  My knee was well settled last year following a second scope (first, bit of lateral meniscus taken, plus some tidying, second was to assess for cartilage transplant but ended up being another tidy up as the MACI would not have worked due to kissing lesions). 

My defect area has ALWAYS been tender, and can burn (whatever I do or don't do) and as best as I can understand it from the surgeons, is essentially fibro is rougher and harder and I also have damage to the subchondral bone as can be seen on the MRI below (although you said that your MRI showed nothing untoward).  The tenderness is due to these different factors.  Not only am I missing the bit of meniscus but I am also slightly knock kneed so presumably the surfaces don't move together as well as they might.



I am currently having a series of hyaluronic acid jabs in the hope of settling my currently very grumpy knee down again  >:(  Might be worth a try for you?
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 Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #5 on: May 17, 2012, 02:10:08 PM »
Vickster, thank you for your insight.  My knee alignment is good so I don't think that is the issue.  I think you are right though about the fibro cartilage.  I forgot that it is rougher than normal cartiledge.  Since day-to-day tasks such as walking and stairs are getting easier, although too much ends in swelling, I think that this is just how it is.  When I do work in the gym, do spinning with my bike, hiking, etc. it can set my knee off and cause real pain and keep me up all night.  Hopefully these will come with time too.  In the end, I think this is the way it is until someday I need a replacement.

My knee is not perfect and can only take so much abuse/use.  I just can't do MMA or running any more.  I am sure the rest of my body appreciates that too :)

Other feedback on fibrocartilage is appreciated.

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Vickster

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #6 on: May 17, 2012, 09:01:19 PM »
When I came round from my 1st scope and the surgeon told me that he hadn't needed to microfracture the defect as expected as fibro had formed, he said that there was no way of knowing how long it would last.  At the second scope (about 18 months ago), it was still fully intact, such that the different OS said the 'repair' had taken well.  I have had no further imaging but as far as I know it is still there - although my recently increased pain is of course a concern (I do wonder if this is down to less cycling and a crazy work schedule including travelling) 

I think there's plenty of info out there about mfx and success so do a search around here and also via Google (far less about we weirdos who form our own fibro in response to trauma)!
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 Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #7 on: May 17, 2012, 10:28:58 PM »
Trust me I have done a LOT of research and I don't find anything that really addresses my questions.  So, I believe you are right.  This is a stop gap and everyone is different.  I assume that I will always have some amount of pain and some days will be better than others.  I just wanted to see what others had experienced as well.

Thanks!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #8 on: June 01, 2012, 03:27:25 PM »
I had a good visit with my PT yesterday and we went through all my questions and challenges.  He was great and very responsive.  Going through all the movements that cause pain, he believes that I have Patella Femoral syndrome.  We have been working on my patella for a while as it does not track straight.  When I tighten my quad, my knee cap tracks to the outside of my knee.  We are trying a bit different method of taping and he gave my one new exercise to strengthen my inside quad.

Based on my research on Patella Femoral syndrome, this is a catch 22.  What it really needs is rest to minimize the pain but to get it better through PT, I need to continue to strengthen my quads and hamstrings.  I will continue my workout as described earlier, continue to ice and see the PT again 2 days before my OS visit.  Hopefully with working hard on my new exercise I will see improvement and less pain.  As this makes so much sense to me, at least I have renewed hope that I have not turned into a wimp :)

Has only else had experience with Patella Femoral syndrome?  I am interested in your exercises and experiences.
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline PonyExpress

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #9 on: June 01, 2012, 04:27:32 PM »
I've just downloaded the e-book Patella Femoral Solutions as it was recommended in a separate thread. Although I don't have patella femoral syndrome, one of my work colleagues was desribing some of his exercises that were not focussed on straight leg lifts, quads and hamstrings.

I thought it might be worth trying some different exercises, I'll know the ones to avoid for my knee.

Might be worth you taking a look http://www.sports-injury-info.com/patella-femoral-solutions.html
19th Feb 2012 Damaged knee falling off horse, banged leg on jump
18th Apr 2012 MRI indicated significant bone bruising
30th Apr 2012 EUA arthroscopy, MUA, MFX medial femoral condyle
17th Jul 2012 Cortisone injection into Fat Pad

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #10 on: June 01, 2012, 04:45:01 PM »
Pony Express, thank you.  I ran across his site yesterday and it was a wealth of information.  The exercise that he shows on the front of his book, I already do but I will investigate this furhter.

Thanks again!
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #11 on: June 21, 2012, 04:07:01 PM »
Hi all, I said that I would update you after my latest PT and OS visit.  Well, my PT got upset with me for trying to wean myself out of my brace with the amount of pain that I am still having.  Needless to say, I am using my brace all day and now have the unloading setting set at 2.  The intensity of the pain is better but the pain is still always there.

When I met with my OS this morning, he was pleased with my progress since February but I still have atrophy in my leg.  He wants me to go a whole year (September 2012) and continue my strenghtening program and them come back and see him for next steps.  He / we are hopefull that my pain is still related to the atrophy and that another 3 months of work will help.  He has already scheduled x-rays for my September visit and we will see how things are then.

I do NOT want to rush anything and I will work hard over the next 3 months but it is hard to stay positive all the time especially when I don't think that I am making progress and the pain management takes so much of my time.  Oh well . . .

1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick

Offline minor_discrepancy

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #12 on: June 22, 2012, 06:27:55 PM »
Hi Maverick :)

Thought I'd join in on your thread!  My experience with microfracture was really different.  I had the surgery this past February for a full thickness lesion on the lateral femoral condyle, with bone underneath that has necrotized.  Basically, part of my femur is dead and the cartilage there just sort of sloughed off. 

The microfracture was what I started with as my first treatment option.  I have to say, about three weeks after my surgery, I felt better than I had in two years.  It was awesome.  I was able to go up and down the stairs without pain, I could kneel if the surface was soft like carpet, and I could jump!  It was great.  Unfortunately, my joy was rather short lived.  Since the surgery was so successful, my Doctor told me that I didn't need to go to a PT as long as I did exercises at home.  I was good at keeping up with the exercise, but eventually my lesion caught up with me.  Around April/May I started to have serious pain again.  A different kind than before, more like a crunching, and a deep bone ache.  Now I am mostly back to where I started and scheduled for an OATS procedure in the next week.

Anyways.. I feel like microfracture surgery can be quite fickle.  Either you feel super awesome, or it takes a long time.  I think it's smart for you to wait and see how the results progress.  Just don't try to ignore your symptoms if they seem to be getting worse.  Three years ago I ignored the ever worsening symptoms after my LR, assuming that my knee would just "always hurt" and ended up with a much more serious problem.  Not saying that this will be the case for you at all, but I'd definitely advise caution.  Hopefully this helps...
02/21 (scheduled) OATS
4/09 Dislocated patella
6/09 LR + Chondroplasty, LB removal
2/12 Microfracture + Chondroplasty
7/13 Chondroplasty + Cleanup

Offline Maverick

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Re: Lateral femoral condyle (LFC) Microfracture recovery
« Reply #13 on: June 24, 2012, 05:12:33 AM »
Minor discrepancy, thank you for your insight. Everyone's perspective and insight helps. I have not slept the past two nights due to pain but I have decided to stay the course. I hear from folks that have worked hard to build their muscles and over time (18 months), their knee has been great after the microfracture. I admit that it is hard sometimes but I will work hard until my next appointment in Septemnber and go from there.  I think that I can deal with 3 more months.
1976 Arthoscopy, damaged cartilage
2007 Lateral release of the patella
2011 Meniscectomy and microfracture (grade 4)
2012 Debridement / Chondroplasty
2013 CRPS left knee

Thank you, Maverick















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