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Author Topic: Where to go from here??  (Read 2386 times)

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Offline irishgal

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Where to go from here??
« on: July 10, 2014, 11:44:56 AM »
Would love some input from people with real experience!  Here's my story:  53 year old female, avid tennis player and former college athlete.  NEVER had knee problems.  Slipped on wet tile.  No pain but noticed a piece of something floating just under the skin around  my knee.  Decided to see OS who said I needed surgery because that loose body would cause damage in the knee. Scans indicated loose body and lateral femoral condyle full thickness defect but otherwise knee in good shape.  Asked for pre-surgical consult to see what they do about the cartilage defect.  Was told the Dr. doesn't do p0re-surgical consults but I was welcome to come talk to his PA.  I did and I asked him to tell Dr. to please be conservative because I wasn't limited in my ability to be active and not in pain.  Sure enough, had surgery and OS removed loose body and trimmed up 5 separate meniscal tears!  Left me with hardly any medial meniscus.  Started having pain on lateral side directly after surgery with lots of popping, grinding, clicking on lateral side.  Unable to load on knee still 8 months after scope.  Decided I wasn't going to mess around and went to Hospital for Special Surgery.  MRI indicated there were now tears in the lateral meniscus.  And of course the defect was still there.  Dr. said he'd do a synthetic plug soaked in stem cells for the defect.  Said he'd deal with the meniscus when he got in there.  I couldn't find any good research on sythnthetic plugs so I was too scared to try it.  Mayo Clinic Dr. says my meniscus is too messed up now and it wouldn't make sense to go through the trouble of plugging the defect.  Says my pain is from the shredded meniscus and there's nothing that can be done for me.  Says he'll have to remove all remaining meniscus and then I'll be left in pain from that.  Says I'm too young for a knee replacement.  Says injections won't be helpful because I don't have athritis yet.  What do I do????

Offline MDAL

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Re: Where to go from here??
« Reply #1 on: July 10, 2014, 12:22:11 PM »
I would insist on the plug anyway... or look for someone willing to try something...

Without meniscus, the hole will tend to expand, until you need a replacement. But anything that will delay it, is a progress. So although the plug will not solve the issue, it will cause a delay to buy you time before a knee replacement.

Other options are Microfracture, ACI, Denovo, among others. There are some risks of failure, and any of these options will only buy you time.

Some other options could be meniscus transplant from donor or artificial one (high failure rate and not permanent either).

There are no easy solutions, but keep pressing. Not all doctors will attempt this...

Offline Vickster

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Re: Where to go from here??
« Reply #2 on: July 10, 2014, 01:10:23 PM »
Most cartilage repair surgeries where a foreign body is used to plug the hole (or indeed a bit of your own cartilage taken from elsewhere like OATS which could be an alternative to synthetic, although quite an old-fashioned procedure now) still require an arthrotomy (open surgery) rather than an arthroscopy (like a microfracture).  This may come with a long slow rehab, non weight bearing, bracing, and the risks associated with surgery.  So make sure your surgeon fully explains all the risks and post op protocol.  The best surgery depends on the size of the defect, how big is yours, also the integrity of the margins and subchondral bone

Also, unfortunately, success is lower as we get older, we just don't heal as well

If you've not done so, try hyaluronic acid, steroid or PRP - all can help with pain and healing of inflammation, you don't need to have arthritis to have success.  HA injections work for me, I have soft cartilage, a bit of lateral meniscus and a condyle defect (with fibrocartilage) and I get relief

Good luck with whatever you decide :)
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