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Author Topic: Patellar DeNovo NT - 2/10/2015  (Read 4194 times)

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Offline pplknee

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Patellar DeNovo NT - 2/10/2015
« on: March 30, 2015, 12:38:13 AM »
Sorry for the novel in advance….

I wasn’t planning on chronicling my experience with DeNovo but the recovery process has left me so bored that I have changed my mind.  So, here goes.

Background:  I’m a 30 year old very active male athlete (former military).  I was a swimmer most of my life and competed as a “pro” (as professional as you can be as a swimmer, I suppose – it was my job).  After I hung up the speedo and goggles I got into weightlifting and CrossFit.  In December of 2012 I was doing a strongman style workout using atlas stones.  While trying to lift a 200+ lb stone over my shoulder while fatigued my inexperience lifting the stones caused me to compromise my positioning, producing enough force on my left knee to cause a subluxation.  Subsequent MRI showed a full thickness tear of the patellar cartilage.  I have had tendonitis and jumpers knee on that knee before, but nothing serious enough that would lead me to believe it was an unhealthy joint before this injury.

My OS urged me to try PT and see if I could live the cartilage defect.  PT helped the knee recover all function, but over time pain caused me to stop doing more and more of the things I enjoy.  It got to the point where walking up stairs or prolonged sitting with my knee in flexion caused pain.  And that pain was minimal compared to what I experienced running, jumping, or weightlifting.  I tried synvisc shots twice.  The first time was shortly after the initial injury (early 2013).  It seemed to help, but I’m not sure how much improvement was attributable to synvisc vs natural healing after the injury.  The second synvisc shot was in Dec 2014 when I was looking for something to alleviate my pain.   This time, my knee swelled considerably several days after the shot and I reverted to using crutches.  At this point, my surgeon and I made the decision to schedule DeNovo for February 2015.

Surgery:  Went off without a hitch.  The lesion was larger than originally anticipated, 3cm at the widest measurement.  Two DeNovo patches were used.  Some people on this forum have mentioned the need for help from others… this is absolutely necessary.  In my state of fogginess after the surgery I didn’t remember any post surgery instructions, so my girlfriend was super helpful in that regard.  She also fed me, got water when I needed it, changed out my ice, and did all the things around the house that I was no longer able to do.  I definitely owe her one (or a few).

Weeks 0-2:  My surgeons definitely played it safe with me compared to some others on this forum.  I think they were worried that with my history of being very active I would try to overdo it.  So for the first two weeks post surgery, basically all I did was chill in bed.  That’s it.  No range of motion (ROM) work or anything.  I was shocked at how my once toned quad was now a sack of sad, soft tissue.  I iced on and off all day.  Finally took a shower at the 5 day point.  One of the best showers of my life.  Pain was pretty minimal and I was able to wean myself off the Percocet in just 4 or 5 days.  I ate very healthy in order to reduce systemic inflammation in order to give my body the best chance at recovery.  I did not attend any PT during this time.

Weeks 2-4:  At the two week point, I started working my way up to 30 degrees of flexion.  I had the brace on almost all of the time (even sleeping – not fun).  I continued icing.  My first follow up with the OS came at the 3 week point (first time I left the house!).  Getting in and out of the car was not easy, and I needed something of a booster seat in order to sit comfortably with my leg locked in extension in the brace.  Doc said all looked good and told to schedule an appointment with PT.  He also instructed me to start working towards 90 degrees of passive ROM.  While the joint was incredibly tight, it didn’t take me long to achieve this with diligent work.  However, each time I worked on ROM it would still start out very tight until I worked my way up to 90.  PT included Stim “quad sets” to bring my quad back to life, calf exercises, and hip exercises.  I was unable to initially do straight leg raises.  My PT is using some novel blood flow restriction techniques as well which I credit with bringing my quad strength back pretty quickly.

Weeks 4-6:  The incision healed up pretty nicely at this point.  I did need some aggressive scar massage because of the skin and scar tissue stickiness.  I was able to add in straight leg raises shortly after PT began.  I continued to do hip exercises, quad sets, and calf exercises.  I had a follow up with OS at 5 weeks.  It was short and sweet.  He told me to start weaning myself off crutches and that I could ditch them once I can walk without a limp.  He also had me unlock the brace. 

Week 6 – 7 (current day):  At the 6 week point, my PT changed up my program.  I’m now doing recumbent biking, mini squats (no weight), weighted straight leg raises, calf raises, heel slides (for ROM), single leg balancing, and the alter-g treadmill that allows me to walk on the treadmill at a preset percentage of my bodyweight.  On my own, I’m swimming and doing the occasional upper body weightlifting.  Despite having the strength, I’m unable to walk limp-free so far because I get some pain at the end of my stride, which causes me to shorten it.  Hopefully this goes away soon.  The other thing I was unable to do pain-free was a single leg extension.  This was probably the most frustrating moment I have had in PT so far. I hope to be able to do this in a few weeks.

Overall:  This process has had its ups and downs.  I knew it would be a grueling and long recovery process and I was prepared for that.  It takes its mental toll as well.  There have been plenty of times that I feel a pain in my knee and wonder if something has gone wrong with the allograft.  My PTs say its probably just scar tissue… but what are they supposed to say?  That maybe the graft has failed and I’m screwed?  I’ve accepted that all I can do is rehab my knee the best I can and hope for the best result. 

There’s plenty more I could write about my experience so far, but this at least tells the beginning of the story.  I’d be happy to answer questions about my experience.  I will do my best to come back and update everyone as I progress.

Thanks to everyone on this site who wrote about their experience.  It helped me know what to expect. 

Offline LindsMarie

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Re: Patellar DeNovo NT - 2/10/2015
« Reply #1 on: April 03, 2015, 12:41:57 AM »
Thank you for posting this.

I am a 35 year old female who spent my teens and twenties playing volleyball, basketball, and softball. And for the past 2 and a half years I've been struggling with knee pain from a twisting injury.

On March 7, 2014 I had arthroscopic surgery to clean torn meniscus on my left knee but they found a flap of loose articular cartilage that was shaved. Since that surgery I've had cortisone, Synvisc, and PT to no avail.

On March 24, 2015 I had a DeNovo NT transplant as well. I'm still foggy on many of the details but I do know that I ended up needing 3 grafts on my left knee because the damage was worse than anticipated. I have been in bed since the surgery. It is quite challenging to get up with this large brace in the locked position. My doctor does not use the CPM machine. I have at least 30 staples in my left knee that I assume will be coming out next Wednesday (April 8). I still am having some pain but it is MUCH better than the first 4 days.

My main questions are around rehab and PT and the time frame. I understand that it will be different for everyone but if you can remember what did your first month of recovery entail?

Thank you. Anything that you can tell me is greatly appreciated. I've spent much of the last week searching the internet for anything I can find.

Offline surfnvb7

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Re: Patellar DeNovo NT - 2/10/2015
« Reply #2 on: April 17, 2015, 05:11:55 AM »
LindsMarie, my biggest advice is to buy your own E-stim unit from Amazon, use it daily during the first 2 months.

pplknee, Great job on your recovery!

My story is pretty similar to yours, aging ex-profesional athlete doing stupid over-aggressive weight lifting... Haha

My recovery sounds very identical to yours, same time line as well.   I had my trochlea repaired with DeNovo NT, and petalla chondroplasty.  So I had the same post-op restrictions and recovery time line.   

The popping sensations are pretty normal, with the quad muscles in atrophy, they can't control the patella sliding through the groove.   At a little over 4 months, mine still does this in any isolated movement, albeit much less often.   Leg extensions came VERY slowly, and still pretty much suck.   In fact, I still have trouble with them at about only 5# of force, mostly with the popping  /pain.  I should reiterate though that the popping only occurs at about 45deg, which according to my doc is where the graft is located and in contact with the knee cap.   I may try to incorporate the Estim with the weighted leg extensions and see if that helps. 

Swimming has been much harder than I anticipated.   During months 3-4 I went pretty hard; Rowing on the erg, Deadlifts & power cleans came very quickly, and I attended spin classes religiously which helped a ton. Jump rope,  jogging & small box jumps were a struggle at first, but I'm good with it now.   I've moved on to stair running which has been surprisingly easy, at least for the first few sets.   Jump rope on 1 leg & double-unders are very challenging, but pain free.

My biggest problems right now are with (1) agility, fast side movements mixed together with plyometrics, this is just plain weak & slow going.   (2) lunges...these are very frustrating & painful.  (3)  barbell squatting has been off & on, I'm strong but my core & back has weakened significantly and have caused a few set backs.  I'm backing away from the free barbell for a few weeks to work on this with the Smith machine for my weighted squats, which helps take the load off my core & back and focus on getting equal weight distribution on both legs.   

I would say I'm about 80% recovered, but I think that last 10-15% will be the toughest mountain to climb.  My doc & PT have pretty much turned me free, with stern advice not to push too hard and let the graph heal.   I'm part of the Zimmer clinical trial, so I have a follow up MRI at 6 months to see the progress of the growing cartilage, fingers crossed!

Good luck, keep the swole train moving!
« Last Edit: April 17, 2015, 05:27:57 AM by surfnvb7 »

Offline pplknee

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Re: Patellar DeNovo NT - 2/10/2015
« Reply #3 on: January 12, 2017, 03:18:47 AM »
I haven't really kept up with this forum, but figured I'd post an update in case any one is interested in my situation.  It's been almost 2 years since my surgery, so I don't remember all the details.  But I started walking without crutches around week 8 post-surgery and walking never really got comfortable for me.  I've developed some compensations that help me walk with less pain but if I walk with a normal stride (quad firing at initial contact of heel) I feel pain.

I had one other operation approximately a year ago.  It was a scope to accomplish 3 things:  1) look at DeNovo re-surfacing results; 2)  harvest cartilage for potential ACI; 3)  pull bone marrow from femur to refine and re-inject into patellofemoral joint.  Surgery went fine.  DeNovo fill actually looks good, but MRI shows abnormalities in the quality/fill of cartilage.  Un-related with this surgery I have also tried HA injections, PRP, and corticosteroid injections at different times.

Overall, I'm far worse than I was before the surgery.  I cannot run, jump, lunge, or even walk with a normal stride pain-free.  If I could go back in time I would not have chosen to do this surgery.  I'm very hesitant to do another surgery.  My OS would like to do the ACI with Fulkerson Osteotomy.  I consulted with another surgeon and he was hesitant to suggest I can expect any improvement with this surgery.  I'm leaning towards not pursuing any further operations until technology improves or I'm old enough for a knee replacement.

To anyone reading this considering this operation, keep in mind that my experience is just one data point.  It's possible that many others have had great results.  You should consider the full body of evidence (which, by the way, anecdotal accounts are very low-level evidence) before making a potentially life changing decision.